Patients with anorexia nervosa who are difficult to treat

Abstract

Among the patients with anorexia nervosa, some can have insight into their illness and accept treatment without much conflict; others have little insight into their illness and strongly resist treatment with severe behavioral problems. The severity of the pathology of the patients varies. Difficult-to-treat cases are assumed as follows; ① treatment does not progress due to strong treatment resistance, ② response to treatment is good, but relapse and hospitalization are repeated, ③ patients with physical complications, ④ patients with comorbidity of other mental disorders. The therapeutic options for the difficult-to-treat cases are as follows. First, it is important to establish the treatment structure. The severer the pathology of the patient is, the stronger the treatment structure is required to be. Second, it is important to improve the patient's motivation. It is necessary to help the patient to be able to realize a conflict in his/her recovery. Third, it is important to maintain the function of the therapist. It is necessary for the patient and the therapist to avoid falling into a conflictive relationship, and it is necessary to promote treatment in cooperation with multidisciplinary action. It is also necessary to prevent burnout of the therapists and to deal with the countertransference of the therapists.