<i>Slavery to Addiction</i> as Meaning of Dropout in Eating Disorders: Psychological Aspects among Women That Have Interrupted Treatment at a Specialized Service in Brazil

Abstract

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.

Patient perspectives on premature termination of eating disorder treatment: a systematic review and qualitative synthesis

“…Several studies identified the feeling of needing control as a major factor contributing to PTT – both apprehension around experiencing an absence of control and the inherent need to regain it [ 31 ]; one patient claimed: “ It was the only thing I felt I could control and still wasn’t ready to give it up ” [ 32 ]. Patients felt receiving treatment implied handing over control to clinicians, resulting in distress around ‘giving up’ their disorder, revealing the self-conflict experienced by some patients when deliberating whether to engage in potentially life changing treatment or to continue current behaviours [ 33 , 34 ]. One patient described stepping back from services in order to restore a sense of self-sovereignty and stated, “ I don’t want them to be able to know me inside out anymore ” [ 32 ].…”

“…One patient described stepping back from services in order to restore a sense of self-sovereignty and stated, “ I don’t want them to be able to know me inside out anymore ” [ 32 ]. Leaving treatment seemed to provide a sense of relief in these instances [ 34 ]. Patients described feeling like having an eating disorder was similar to the powerful, controlling hold of a substance addiction—the struggle of overcoming this ‘addiction’ led to the decision to terminate treatment [ 34 ].…”

“…Leaving treatment seemed to provide a sense of relief in these instances [ 34 ]. Patients described feeling like having an eating disorder was similar to the powerful, controlling hold of a substance addiction—the struggle of overcoming this ‘addiction’ led to the decision to terminate treatment [ 34 ].…”

Emotional Experiences of Obese Women with Adequate Gestational Weight Variation: A Qualitative Study

“…Firstly, the interviews and the researcher's observations were fully transcribed. Then, a reading of the material using suspended attention was performed, allowing the invasion of impressions and activities so as to suspend directed attention to the maximum [ 36 ], [ 43 ], [ 44 ], [ 45 ]. The next step was the selection of the units of meanings guided by the questions that the research would answer.…”

“…The next step was the selection of the units of meanings guided by the questions that the research would answer. The following phase corresponded to the categorization work [ 27 ], [ 43 ], [ 44 ], [ 45 ], in which the issues were pointed out according to their level of intimacy or proximity, organizing the themes that expressed important meanings and elaborations and that met the objectives of the study to produce new knowledge [ 37 ], [ 43 ], [ 44 ], [ 45 ]. The validation of the findings of the material was given by peers from the Clinical Qualitative Research Laboratory of the Medical Sciences Department of the State University of Campinas and through national and international scientific events.…”