Mahon J, Winston A P, Palmer R L, Harvey P K
Department of Psychiatry, University of Leicester, Leicester, United Kingdom.
Int J Eat Disord. 2001 Mar;29(2):139-49. doi: 10.1002/1098-108x(200103)29:2<139::aid-eat1003>3.0.co;2-i.
OBJECTIVE/METHOD: The case notes of 111 women presenting consecutively to an outpatient eating disorders clinic with bulimia nervosa or atypical bulimia nervosa were reviewed for pretreatment factors that predicted dropout in a retrospective study. Dropping out was conceptualized as not just a patient characteristic but as a transaction between patient and therapist. Factors believed to influence this transaction included experiences of childhood trauma, severity of eating disorder characteristics and comorbid psychiatric symptoms, demographic characteristics, waiting times for assessment and therapy, distance traveled to the clinic, previous experience of psychiatric treatment, and Eating Disorder Inventory (EDI) and Rosenberg Self-Esteem questionnaire results.
Witnessing parental breakup, being younger, being employed outside the home, and having previous experience of psychiatric treatment predicted dropping out in logistic regression models. Experiences of childhood trauma had a dose-effect relationship with dropping out. Having lower overall severity of eating disorder characteristics may also relate to dropping out.
An impaired ability to trust resulting from disturbed attachments may link childhood trauma and dropping out.
目的/方法：在一项回顾性研究中，对111名连续到门诊饮食失调诊所就诊的神经性贪食症或非典型神经性贪食症女性患者的病历进行审查，以寻找预测其退出治疗的预处理因素。退出治疗不仅仅被视为患者的一种特征，而是被看作是患者与治疗师之间的一种相互作用。据信影响这种相互作用的因素包括童年创伤经历、饮食失调特征的严重程度和共病的精神症状、人口统计学特征、评估和治疗的等待时间、到诊所的路程、先前的精神治疗经历，以及饮食失调量表（EDI）和罗森伯格自尊问卷的结果。
在逻辑回归模型中，目睹父母离异、年龄较小、在外工作以及有过精神治疗经历可预测退出治疗。童年创伤经历与退出治疗存在剂量效应关系。饮食失调特征的总体严重程度较低也可能与退出治疗有关。
依恋关系紊乱导致的信任能力受损可能将童年创伤与退出治疗联系起来。
