Michael Strober1. 1. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, California 90024, USA. mstrober@mednet.ucla.edu
Abstract
OBJECTIVE: To describe the psychopathology of chronic, treatment-resistant anorexia nervosa, as well as a paradigm for its clinical management. METHOD: 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. DISCUSSION: 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.
OBJECTIVE: To describe the psychopathology of chronic, treatment-resistant anorexia nervosa, as well as a paradigm for its clinical management. METHOD: 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. DISCUSSION: 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.
Authors: Jennifer E Wildes; Kelsie T Forbush; Kelsey E Hagan; Marsha D Marcus; Evelyn Attia; Loren M Gianini; Wei Wu Journal: Int J Eat Disord Date: 2016-12-19 Impact factor: 4.861