A clinical overview of anorexia nervosa and overcoming treatment resistance
Open accessAbstract
Anorexia nervosa (AN) is a type of eating disorder that has been increasing in incidence and has been encountered more commonly by physicians in their daily practice. Both environmental and genetic risk factors paired along with a more susceptible neurobiology are at play in the emerging resistance to treatment in AN. Preoccupations with intense fear of weight gain, dietary restrictions, excessive exercise, and how the individual is perceived by society mixed with underlying psychopathology all further add to the issue. Many patients who fall into this cycle of obsessive and restrictive patterns refuse to get treatment. As clinicians, it is essential we recognize the early signs of both eating disorders during the initial primary care appointments. To review the literature on the etiology of AN, possible misdiagnosis leading to inappropriate management of this condition, and understand the treatment-resistant AN and its management. Additionally, it will explore possible reasons that contribute to the resistance to treatment, the underlying psychopathology of anorexics, its genetic predisposition, psychiatric comorbidities, identification of the early signs and symptoms, and timely prevention. Early recognition by a physician includes a thorough history and physical examination, pertinent laboratory, and electrolyte studies, and identifying comorbid psychiatric conditions. The treatment of AN is intricate and requires a holistic approach. Treatment includes multiple modalities such as nutritional rehabilitation and psychosocial and pharmacological therapies. An interdisciplinary team of medical professionals for managing chronic AN is recommended.
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Conceptions of treatment resistance vary widely between studies.
“Conceptions of treatment resistance vary widely between studies (124).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [124]
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Reed, K. K., Bulik‐Sullivan, E. C., Qian, Y., Javorsky, E., Tarantino, L. M., Fodor, A. A., Steffen, K. J., Wonderlich, S. A., Mehler, P. S., Bulik, C. M., et al. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24331 · Cited by 3 · see citing works
Early intervention in eating disorders: introducing the chronopathogram
Preti, A., Bevione, F., Lacidogna, M. C., Raballo, A., Poletti, M., & Daga, G. A. (2025) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-025-01715-6 · Cited by 3 · see citing works
Psychopharmacological considerations for comorbid anorexia nervosa and bipolar disorder
Zhang, C., Carter, L. R., & McAdams, C. J. (2023) · Psychiatry Research Case Reports · doi:10.1016/j.psycr.2023.100192 · Cited by 1 · see citing works
Pitfalls in the diagnosis of eating disorders: a case series from infancy to adolescence
Fiordelisi, A., Stivala, M., Pellegrino, R., Innocenti, E., & Trapani, S. (2025) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-025-01781-w · Cited by 1 · see citing works
Kleszczewska-Albińska, A. (2023) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2023.135530 · Cited by 1 · see citing works
Valenta, S. T., Rapezzi, M., Marcolini, F., Speciani, M., Giordani, G., Panfilis, C. D., Ronchi, D. D., & Atti, A. R. (2024) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-024-01653-9 · Cited by 1 · see citing works
Spanos, K. E., Wright, T. S., DeAngelis, C., & Essayli, J. H. (2024) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2024.12.017 · Cited by 1 · see citing works
Troscianko, E. T., & Leon, M. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01537-6
Gilardini, F., Sabatucci, A., Cifani, C., Segura‐Garcìa, C., Pucci, M., Rania, M., & D’Addario, C. (2026) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2026.1761785
- Authors
- Nagy, H., Paul, T., Jain, E., Loh, H., Kazmi, S. H., Dua, R., Rodriguez, R., Naqvi, S. A. A., U., M. C., & Bidika, E.
- Affiliations
- Larkin University (US)
- Corresponding author
- Nagy, Hassan
- ORCID
- Venue
- Avicenna Journal of Medicine
- Publisher
- Georg Thieme Verlag KG
- Published
- 2022-12-21
- Volume
- 13
- Issue
- 01
- Pages
- 003-014
- ISSN
- 2231-0770 (ISSN-L)
- 2249-4464
- PMC
- PMC10038755
- OpenAlex
- W4313499838
- Cited by
- 21
- References
- 81
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 6
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- creativecommons.org/licenses/by/4.0/ (vor)
- Locations
- Avicenna Journal of Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- anorexia nervosa, treatment resistance, eating disorders, etiology, genetic susceptibility, psychopathology, psychiatric comorbidity, misdiagnosis, early recognition, prevention, nutritional rehabilitation, psychosocial interventions, pharmacotherapy, multidisciplinary care, electrolyte imbalance
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