This study investigated the narratives of women who dropped out of treatment from a specialized outpatient unit for eating disorders (ED). Psychodynamics aspects involved were discussed regarding the issue of adherence and dropout, since it was found to be directly affected by addictive aspects. A qualitative approach was used to identify interpretative matrices that led to a broad understanding of the clinical phenomena observed. Our aim was to identify contributions to the clinical management of barriers to treatment regarding the challenge of adherence to addiction and eating disorders treatments. The sample consisted of eight in-depth interviews fully recorded and transcribed. The emergent categories indicated elements from the experience of the disorders in psychological meanings assigned to dropout by patients. Findings are discussed under a theoretical framework focused on anorexia and bulimia as addictions. The discussion aims to make a contribution to the ED treatment approach and also understand them in their addictive dimension in order to enhance compliance and retention in treatment. The psychodynamic elements from addictive experiences described by patients may contribute to supporting the discussion about 1 The study was developed at LPCQ; the subjects interviewed used to be patients of Interdisciplinary Group of Assistance and Studies in Eating Disorders (GETA). Resulting from a Master's Degree, research funded by scholarship to the first author from the Coordination of Improvement of the Personnel of Higher Education (CAPES-Ministry of Education, Brazil). The first and last author also received auxiliary research Grant Research from São Paulo Research Foundation (FAPESP; No.2011/20469-8) providing subsidies for the field phase of the original study following. F. M. Seidinger-Leibovitz et al. 789 eating disorders as "addictive behaviors" beyond the "addiction model of eating disorders" as a physiological model of "addictive" or "toxic" food dependence. Eating disorders experienced as addiction were found affecting the response to treatment.

The article presents a critical review regarding the premature termination of eating disorder's treatment among inpatients and outpatients, with the aim of identifying-emotional, psychodynamic and family-related aspects involved. The search strategy used the following MeSH terms combined by Boolean operators: "eating disorders" AND "treatment" OR "patient dropouts" OR "drop-out/dropouts" OR "attrition" OR "premature termination" AND "empirical study" OR "qualitative research", for on Medline/PUBMED, PsycINFO and EMBASE databases. This article follows the PRISMA Guidelines. A total of 26 studies composed this review, of which 24 were original research articles, 1 was a review and 1 a theoretical article. Only two articles applied qualitative methods analyzing categories of content obtained by in-depth interviews, three combine quantitative and qualitative methods and other three present qualitative analyses while discussing quantitative studies. Further qualitative studies should be carried out to clarify meanings of dropout, premature termination of treatment, and attrition. Different expectations held by patients and by therapeutic teams, and the interpersonal difficulties of these types of patients, stand out as difficulties in constructing "therapeutic alliances", with impacts on dropout, premature termination and attrition rates.

RESUMO Objetivo Compreender o transtorno afetivo bipolar (TAB) e suas implicações pela perspectiva dos filhos adultos de mães que receberam o diagnóstico quando eles eram crianças. Métodos Pesquisa qualitativa, por meio de entrevistas semiestruturadas de questões abertas em profundidade com 21 filhos de pacientes do Ambulatório de Psiquiatria Geral de Adultos do HC/Unicamp. A técnica de tratamento de dados foi feita por meio da análise de conteúdo das entrevistas transcritas na íntegra e categorização. Resultados Os significados psicológicos atribuídos pelos filhos à experiência de ter uma mãe com TAB possibilitaram a elaboração de um esquema da infância, adolescência à vida adulta. Os achados revelam que na infância a instabilidade da mãe, característica do TAB, gera sentimentos de culpa e desamparo nos filhos, pela percepção da introspecção materna nos períodos dos episódios em contraste com os momentos de remissão, nos quais percebem envolvimento emocional e disponibilidade para a maternidade. Na adolescência, os filhos contestam as demandas de suas mães. Demonstram identificação com os sintomas maternos. Na vida adulta, há percepção de melhora na relação mãe-filho diante da abdicação das escolhas pessoais para a dedicação aos cuidados à mãe. Os achados revelam que a compreensão do TAB feita por meio da experiência dos filhos com suas mães fica apenas na racionabilidade, pois eles não conseguem manejá-la de forma efetiva e sentem-se aprisionados. Conclusões A equipe de saúde pode auxiliar os filhos desde o manejo de questões cotidianas até o diagnóstico precoce de psicopatologias ao se dedicar ao acolhimento deles quando da vinda de suas mães ao tratamento.