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Cited by 137Eating Disorders and BehaviorsPsychological Treatments and DisordersNutrition, Health and Food Behavior

Managing the chronic, treatment-resistant patient with anorexia nervosa

Strober, Michael·2004·International Journal of Eating Disorders
DOI 10.1002/eat.20054
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Abstract

OBJECTIVE: To describe the psychopathology of chronic, treatment-resistant anorexia nervosa, as well as a paradigm for its clinical management. METHOD: The foundation of the approach integrates clinical experience, empirical psychological findings, and a conceptual understanding of developmental and phenomenologic aspects of the illness. RESULTS: Elements of the management paradigm take account of the compensatory nature of illness chronicity. The inherent risks of treating these patients in the customary way are described, along with therapist countertransference that must be anticipated and effectively considered. DISCUSSION: The chronically ill patient requires a unique approach to care, one that minimizes the risk of iatrogenic effects of rapid weight restoration or failure to appraise the deleterious influences of therapist countertransference.

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Crossref · 10.1002/eat.20054

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  • Terms such as 'treatment resistant', 'treatment refractory', 'recalcitrant', and 'severe and intractable' have appeared frequently in eating disorder research and commentaries, often within sweeping statements suggesting patients who have not recovered within a number of years are unlikely to improve with further treatment.

    “Terms such as “treatment resistant” (120 p. 247), “treatment refractory” (121 p. 372), “recalcitrant” (122), and “severe and intractable” (123) have appeared frequently in ED research and commentaries, often within sweeping statements suggesting patients who have not recovered within a number of years are unlikely to improve with further treatment.”

    From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [120]

  • Management of transference and countertransference are important features of how patients experience ED care and how clinicians respond, particularly in enduring EDs, and must be effectively managed to reduce iatrogenic harms in SE-AN treatment.

    “Management of transference and countertransference are important features of how we experience ED care and how clinicians respond to us, particularly in enduring EDs, and must be effectively managed to reduce iatrogenic harms in treatment of SE-AN [175].”

    From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [175]

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Authors
Strober, M.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Strober, Michael
ORCID
Strober, Michael
Venue
International Journal of Eating Disorders
Publisher
Wiley
Published
2004-10-11
Volume
36
Issue
3
Pages
245-255
ISSN
  • 0276-3478 (ISSN-L)
  • 1098-108X
DOI
10.1002/eat.20054
OpenAlex
W1969029698
Cited by
137
References
7
Citations by year
2026: 1 · 2025: 4 · 2024: 7 · 2023: 8 · 2022: 1 · 2021: 10 · 2020: 16 · 2019: 5 · 2018: 8 · 2017: 4 · 2016: 5 · 2015: 10 · 2014: 9 · 2013: 15 · 2012: 6
FWCI
1.60
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • International Journal of Eating Disorders (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
anorexia nervosa, chronic disease, psychopathology, clinical management, iatrogenic disease
MeSH terms
Adult, Anorexia Nervosa, Chronic Disease, Countertransference, Female, Hospitalization, Humans, Professional-Patient Relations, Treatment Failure

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