The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.
Difficulties in Treating Patients with Eating Disorders: A Review of Patient and Clinician Variables
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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
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Self-citation
Research works printed but not linked: 6
- Kaplan AS, 1997, Balliere's clinical psychiatry, 3, 275
- Kaplan AS, 1997, Handbook of treatment of eating disorders
- Kennedy S, 1992, Feeding problems and eating disorders. Monographs in clinical pediatrics
- Goldbloom DS, 1993, Alcohol Alcohol, 28, 375
- Piran N, 1988, Int J Eat Disord, 8, 1
- Johnson C, 1987, The etiology and treatment of bulimia nervosa
Cited by
Sorted by citations
A systematic review of personality trait change through intervention.
Roberts, B. W., Luo, J., Briley, D. A., Chow, P. I., Su, R., & Hill, P. L. (2017) · Psychological Bulletin · doi:10.1037/bul0000088 · Cited by 1,047
Hambleton, A., Pepin, G., Le, A., Maloney, D., National Eating Disorder Research Consortium, Aouad, P., Barakat, S., Boakes, R., Brennan, L., Bryant, E., et al. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00654-2 · Cited by 377
Fassino, S., Pierò, A., Tomba, E., & Daga, G. A. (2009) · BMC Psychiatry · doi:10.1186/1471-244x-9-67 · Cited by 380
The Eating Attitudes Test: Twenty-five years later
Garfinkel, P. E., & Newman, A. C. (2001) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/bf03339747 · Cited by 188
Self-citationResistance to treatment and change in anorexia nervosa: a clinical overview
Daga, G. A., Amianto, F., Delsedime, N., Bacco, C. D., & Fassino, S. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-294 · Cited by 205
Metadata
- 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
- 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
- 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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