Treatment dropout represents one of the most significant barriers to eating disorder recovery, yet receives surprisingly little systematic attention despite affecting 20-40% of patients seeking care. This therapeutic gap perpetuates cycles of relapse and extends suffering for individuals with conditions that already carry substantial mortality risk.
Clinical researchers have identified seven underutilized retention strategies that could dramatically improve outcomes: providing low-resource interventions during waiting periods, implementing integrated multidisciplinary care teams, incorporating recovery-oriented treatment augmentation, offering patients meaningful treatment choices, utilizing real-time session feedback measures, personalizing treatment approaches, and prioritizing therapeutic relationship quality. These interventions target the most common discontinuation triggers including treatment mismatch, lack of early engagement, and poor therapeutic alliance.
This systematic approach to retention represents a significant departure from traditional eating disorder treatment models that often rely on standardized protocols with limited flexibility. The evidence base supporting these strategies comes primarily from other mental health domains, highlighting how eating disorder treatment has lagged behind broader psychotherapy innovation. Most compelling is the focus on patient agency and collaborative decision-making, which directly counters the control dynamics that often characterize eating disorders themselves. However, rigorous testing of these approaches specifically within eating disorder populations remains limited, and the authors acknowledge significant gaps in understanding which combinations of strategies prove most effective for different patient profiles. The proposed research agenda could fundamentally shift how clinicians approach treatment engagement, potentially transforming dropout rates from an accepted limitation into a modifiable treatment target.