Difficulties in treating patients with eating disorders: a review of patient and clinician variables.
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.


METHODS
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 biopsychosocial 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 in patients with EDs is critical to improving their care. New interventions aimed at enhancing motivation may facilitate this process.
Kaplan
A S
AS
Program for Eating Disorders, Toronto Hospital, ON. akaplan@torhosp.toronto.on.ca
Garfinkel
P E
PE
D001291:Attitude of Health Personnel; D015897:Comorbidity; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology; D009042:Motivation; D010349:Patient Compliance; D018579:Patient Selection; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods / Q000592:standards