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Keywords:

  • treatment-resistant patient;
  • anorexia nervosa;
  • weight restoration

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. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 36: 245–255, 2004.