When is enough enough: the administrative discharge

Clinicians' perspectives on the premature termination of treatment in patients with eating disorders

In-depth interviews concerning the premature termination of treatment (PTT) were conducted with seven clinicians in an inpatient eating disorders program. Motivation to be in the program and work on recovery, and the ability to establish a trusting relationship with staff were thought to be important factors in completing treatment. Patients who are asked to leave the treatment program, termed "administrative discharge" (AD), were believed by clinicians to differ from patients who dropped out of treatment in terms of having more reasons to stay in the program. While AD was described as a stressful process, particularly when there was disagreement among team members, it was considered necessary in order to maintain a recovery-centered community milieu. These findings, their implications and suggestions for future research are discussed.

Premature termination of treatment in an inpatient eating disorder programme

This retrospective study was conducted to explore rates, timing and predictors of two forms of premature termination of treatment (PTT) in an inpatient eating disorders programme: patient dropout (DO) and administrative discharge (AD). A chart review was conducted to obtain demographic, Eating Disorder Inventory-2 (EDI-2), and Resident Assessment Instrument-Mental Health (RAI-MH) data for 186 patients being treated for bulimia nervosa (BN), anorexia nervosa (AN), or eating disorder not otherwise specified (EDNOS). Overall, of the 37.6% of patients who terminated treatment prematurely, 22.1% of patients dropped out, and 15.5% of patients were administratively discharged. Time at which discharge occurred was found to be associated with the type of premature termination. The presence of DSM-IV Axis-I comorbidity was found to be the only factor associated with an increased risk of being administratively discharged. No factors were predictive of patients dropping out of treatment. The findings support the notion that AD and patient DO are different events that may have different factors influencing their rates and timing. Implications for future research and programme planning are discussed.