Managing the chronic, treatment-resistant patient with anorexia nervosa.
OBJECTIVE
To describe the psychopathology of chronic, treatment-resistant anorexia nervosa, as well as a paradigm for its clinical management.


METHODS
The foundation of the approach integrates clinical experience, empirical psychological findings, and a conceptual understanding of developmental and phenomenologic aspects of the illness.


RESULTS
Elements of the management paradigm take account of the compensatory nature of illness chronicity. The inherent risks of treating these patients in the customary way are described, along with therapist countertransference that must be anticipated and effectively considered.


CONCLUSIONS
The chronically ill patient requires a unique approach to care, one that minimizes the risk of iatrogenic effects of rapid weight restoration or failure to appraise the deleterious influences of therapist countertransference.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, California 90024, USA. mstrober@mednet.ucla.edu
Michael
M
Strober
D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D002908:Chronic Disease; D003379:Countertransference; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D011369:Professional-Patient Relations; D017211:Treatment Failure