Difficulties in Treating Patients with Eating Disorders: A Review of Patient and Clinician Variables

Kaplan, Allan S; Garfinkel, Paul E

doi:10.1177/070674379904400703

Cited by 126Eating Disorders and BehaviorsNutrition, Health and Food BehaviorChild Nutrition and Feeding Issues

Difficulties in Treating Patients with Eating Disorders: A Review of Patient and Clinician Variables

Kaplan, Allan S, Garfinkel, Paul E·1999·The Canadian Journal of Psychiatry

DOI 10.1177/070674379904400703

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Abstract

Objective: Patients with eating disorders (EDs) are often difficult to treat. Despite recent advances in treatment, a significant percentage of patients remain treatment refractory. This paper reviews variables that contribute to these difficulties and recent strategies that focus on increasing patient motivation for treatment. Method: The authors relate their clinical experience and synthesize the literature examining aspects of patients with EDs that may contribute to their treatment resistance and therapist variables that may contribute to negative nontherapeutic reactions. Results: Patient variables include the nature of the symptoms that patients experience, issues of trust, the not uncommon failure of ambulatory treatments, and issues related to comorbidity. Aspects of clinicians include lack of understanding of the biopsy chosocial pathophysiology of these conditions and lack of experience and appreciation for the countertransferential reactions that these patients evoke in caregivers. Conclusions: Improving understanding of the reasons for treatment refractoriness inpatients with EDs is critical to improving their care. New interventions aimed at enhancing motivation may facilitate this process.

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People with SE-AN may find it difficult to develop trust in clinicians, reject and defend against receiving compassion, and reaffirm their belief and investment in AN as a safe harbour.
“We may therefore find it difficult to develop trust in clinicians [181], reject and defend against receiving compassion [182–184], and reaffirm our belief and investment in AN as a safe harbour.”
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 [181]
Clinicians working with AN patients may experience feelings of frustration, anger, hostility, fear, tiredness, a sense of being manipulated, hopelessness, helplessness and failure.
“Clinicians working with those of us who experience EDs such as AN may experience feelings of frustration, anger, hostility and fear, tiredness and a sense of being manipulated, hopelessness, helplessness and failure [181, 185].”
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 [181]
Intense countertransferential feelings may be evoked when working with chronically ill, medically unstable AN patients at risk of death due to EDs, which clinicians may perceive as an unwillingness to recover.
“Intense countertransferential feelings may be evoked when working with chronically ill, medically unstable AN patients who are at risk of death due to the impact of our EDs, which clinicians may perceive as an unwillingness to recover [181, 186, 188].”
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 [181]
Strong negative feelings of revulsion and disgust for ED behaviours may also be experienced by clinicians.
“Strong negative feelings of revulsion and disgust for ED behaviours may also be experienced [181, 186, 188].”
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 [181]

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Authors: Kaplan, A. S., & Garfinkel, P. E.
Affiliations: University of Toronto (CA)
Centre for Addiction and Mental Health (CA)
Corresponding author: Kaplan, Allan S
ORCID: Kaplan, Allan S
Venue: The Canadian Journal of Psychiatry
Publisher: SAGE Publications
Published: 1999-09
Volume: 44
Issue: 7
Pages: 665-670
ISSN: 0706-7437 (ISSN-L)
1497-0015
DOI: 10.1177/070674379904400703
OpenAlex: W203645638
Cited by: 124
References: 40
Citations by year: 2025: 1 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 4 · 2014: 8 · 2013: 9 · 2012: 7
FWCI: 1.43
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: The Canadian Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
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: eating disorders, treatment resistance, treatment refractoriness, patient motivation, countertransference, therapeutic relationship, trust, comorbidities, biopsychosocial model, therapist experience
MeSH terms: Feeding and Eating Disorders, Attitude of Health Personnel, Mental Disorders, Humans, Motivation, Patient Compliance, Professional-Patient Relations, Psychotherapy, Comorbidity, Patient Selection

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Difficulties in Treating Patients with Eating Disorders: A Review of Patient and Clinician Variables

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