Learning the Lessons of Premature Discontinuation of Eating Disorder Therapy: Informing Guidelines to Improve Retention

OBJECTIVE: Around one to two in five patients prematurely disengage from eating disorder therapy. This Forum paper suggests innovative strategies to increase retention and strategies for evaluating these with patients who have eating disorders. METHOD: We start by clarifying the definition of premature discontinuation and note one obstacle in the field is a lack of routine and uniform reporting across treatment studies and clinical practice. We then examine common reasons for discontinuation, suggest evidence-informed strategies to improve retention, and ways to evaluate the success of these strategies. RESULTS: We outline seven underutilized solutions for decreasing risk of premature discontinuation, including: offering low resource interventions while patients are on the waitlist; integrated multidisciplinary care; recovery-oriented treatment augmentation; treatment choice; session measures accompanied by feedback; personalized treatment; paying attention to the relational aspects of treatment. DISCUSSION: While each of these solutions is evidence-informed, they are rarely the focus of research in eating disorders, and we outline a research agenda for examining which of these approaches have the most promise in improving retention of patients in therapy.