Dropout from brief psychotherapy within a combination treatment in bulimia nervosa: role of personality and anger

Background: To explore the personality, psychopathology, and clinical features of bulimic patients who do not complete psychotherapy, within a combined treatment.

Methods: 86 patients with bulimia nervosa (BN; DSM-IV) were evaluated before beginning treatment. The Eating Disorder Inventory II (EDI-II), State-Trait Anger Expression Inventory (STAXI), and the Temperament and Character Inventory (TCI) were administered to all patients.

Results: 3 subjects failed to engage in psychotherapy. Comparing patients who dropped out (n = 28) with those who did not drop out from psychotherapy (n = 55), significant differences were found in some psychopathologic (EDI-II, STAXI) and personality (TCI) variables. In particular, patients who dropped out from the treatment were more impulsive and more likely to feel anger; they were also less cooperative and less self-directive. No significant differences in sociodemographic, clinical variables and in response to fluoxetine were found between the two groups (dropout and completers).

Conclusions: We found a characteristic profile in the bulimic patients who dropped out from brief psychotherapy, i.e., they are less cooperative and more predisposed to anger. These data suggest that dropping out in a subgroup of BN patients could be related to borderline personality traits and to difficulties in making and maintaining a therapeutic relationship. Implications for treatment are discussed.