Perplexities of treatment resistence in eating disorders
Open accessAbstract
BACKGROUND: Treatment resistance is an omnipresent frustration in eating disorders. Attempts to identify the features of this resistance and subsequently develop novel treatments have had modest effects. This selective review examines treatment resistant features expressed in core eating disorder psychopathology, comorbidities and biological features. Novel treatments addressing resistance are discussed. DESCRIPTION: The core eating disorder psychopathology of anorexia nervosa becomes a coping mechanism likely via vulnerable neurobiological features and conditioned learning to deal with life events. Thus it is reinforcing and ego syntonic resulting in resistance to treatment. The severity of core features such as preoccupations with body image, weight, eating and exercising predicts greater resistance to treatment. Bulimia nervosa patients are less resistant to treatment with treatment failure related to greater body image concerns, impulsivity, depression, severe diet restriction and poor social adjustment. For those with binge eating disorder overweight in childhood and high emotional eating predicts treatment resistance. There is suggestive data that a diagnosis of an anxiety disorder and severe perfectionism may confer treatment resistance in anorexia nervosa and substance use disorders or personality disorders with impulse control problems may produce resistance to treatment in bulimia nervosa. Traits such as perfectionism, cognitive inflexibility and negative affect with likely genetic influences may also affect treatment resistance. Pharmacotherapy and novel therapies have been developed to address treatment resistance. Atypical antipsychotic drugs have shown some effect in treatment resistant anorexia nervosa and topiramate and high doses of SSRIs are helpful for treatment of resistant binge eating disorder patients. There are insufficient randomized controlled trials to evaluate the novel psychotherapies which are primarily based on the core psychopathological features of the eating disorders. CONCLUSION: Treatment resistance in eating disorders is usually predicted by the severity of the core eating disorder psychopathology which develops from an interaction between environmental risk factors with genetic traits and a vulnerable neurobiology. Future investigations of the biological features and neurocircuitry of the core eating disorders psychopathology and behaviors may provide information for more successful treatment interventions.
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Many authors use the term treatment resistance interchangeably with chronicity of illness or difficulty to treat, muddying the clinical validity of the term and complicating efforts to generalize findings between studies.
“Inaccurately, many authors use the term treatment resistance interchangeably with chronicity of illness or difficulty to treat, muddying the clinical validity of the term and complicating efforts to generalize findings between studies (128).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [128]
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“Inaccurately, many authors use the term treatment resistance interchangeably with chronicity of illness or dif fi culty to treat, muddying the clinical validity of the term and complicating efforts to generalize fi ndings between studies (128).”
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- Authors
- Halmi, K. A.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Corresponding author
- Halmi, Katherine A
- ORCID
- Halmi, Katherine A
- Venue
- BMC Psychiatry
- Published
- 2013-11-07
- Volume
- 13
- Issue
- 1
- Pages
- 292-292
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3829659
- OpenAlex
- W2036076263
- Cited by
- 132
- References
- 45
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 19 · 2023: 17 · 2022: 7 · 2021: 10 · 2020: 13 · 2019: 14 · 2018: 7 · 2017: 11 · 2016: 11 · 2015: 4 · 2014: 2 · 2013: 1
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- 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
- treatment resistance, eating disorders, anorexia nervosa, bulimia nervosa, binge eating disorder, body image concern, perfectionism, impulsivity, comorbidities, neurobiology, pharmacotherapy, topiramate, atypical antipsychotics, selective serotonin reuptake inhibitors, emotional eating, genetic susceptibility
- MeSH terms
- Adaptation, Psychological, Feeding and Eating Disorders, Emotions, Humans, Patient Compliance, Psychotherapy
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