‘It’s about reclaiming who you really are’: a qualitative study of patients’ perspectives on dropping out of an eating disorders treatment programme

Treatment dropout is common in patients with eating disorders and is usually considered a negative outcome. This study aimed to explore patients' subjective experiences of dropping out from specialised treatment and examine the meaning they attributed to their decision. Eighteen adult patients diagnosed with anorexia nervosa or bulimia nervosa, with a history of at least one unilateral treatment dropout, were recruited from a specialised centre in Switzerland. Semi-structured in-depth interviews were conducted and analysed using thematic analysis. Participants reported experiencing dissatisfaction with treatment due to rigid protocol-driven care, insufficient individualisation, and difficulties in the therapeutic relationship. Second, dropping out was linked to manifestations of the eating disorder itself (notably, ambivalence, denial, and exhaustion). Third, dropout was described as a positive step towards 'getting back to normal', which involved the pursuit of work, studies, and other interests, and the experience was described as a reclaiming of autonomy, often in opposition to clinicians and family members. While dropouts may reflect treatment failure, they can, in part, represent a meaningful step in patients' recovery trajectories. Such episodes should be explored carefully with these patients to gain a deeper understanding of the various facets and implications of the individual's decision.