Resistance to treatment and change in anorexia nervosa: a clinical overview

Giovanni Abbate-Daga,Federico Amianto,Secondo Fassino,Carlotta De-Bacco,Nadia Delsedime

doi:10.1186/1471-244x-13-294

Giovanni Abbate-Daga, Federico Amianto + Show 3 more

Open Access

https://doi.org/10.1186/1471-244x-13-294

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Journal: BMC Psychiatry	Publication Date: Nov 7, 2013
Citations: 269	License type: cc-by

Affiliation: University of Turin

Abstract

BackgroundCurrent literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN – with an in-depth investigation of resistance-related psychological factors.A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered.DiscussionThe selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists’ countertransference.SummaryRemarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.

Highlights

Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN)
The only exception is represented by adolescents affected by anorexia nervosa (AN) reporting a more favorable outcome when compared to adults [10]
We could not perform a meta-analysis because of the differences we found among studies regarding sample composition, methodology used in the assessment of patients, and different outcome criteria

Summary

Introduction

Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. Many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN – with an in-depth investigation of resistance-related psychological factors. There is a general consensus that the available treatments for major psychiatric disorders frequently result in either a lack of effect or a moderate response. One-third of adult AN patients show poor outcome because of an enduring and refractory illness [5,11]

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