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

Objective: Patients with eating disorders (EDs) are often difficult to trea t. Despite recent advances in treatment, a significant percentage of patien ts remain treatment refractory. This paper reviews variables that contribut e to these difficulties and recent strategies that focus on increasing pati ent motivation for treatment. Method: The authors relate their clinical experience and synthesize the lit erature examining aspects of patients with EDs that may contribute to their treatment resistance anal therapist variables that may contribute to negat ive nontherapeutic reactions. Results: Patient variables include the nature of the symptoms that patients experience, issues of trust, the not uncommon failure of ambulatory treatm ents, anal issues related to comorbidity. Aspects of clinicians include lac k of understanding of the biopsychosocial pathophysiology of these conditio ns and lack of experience and appreciation for the countertransferential re actions that these patients evoke in caregivers. Conclusions: Improving understanding of the reasons for treatment refractor iness in patients with EDs is critical to improving their care. New interve ntions aimed at enhancing motivation may facilitate this process.