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BMC Psychiatry

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Open Access 01-12-2013 | Research article

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

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

Published in: BMC Psychiatry | Issue 1/2013

Abstract

Background

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. 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.

Discussion

The 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.

Summary

Remarkably 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.

Posse PR, Nemeroff CB: The problem of treatment-resistant major psychiatric disorders. Management of treatment-resistant major psychiatric disorders. Edited by: Nemeroff CB. 2012, Oxford: Oxford University Press, 3-22.

Gabbard GO: Treatment resistance in Personality Disorders. Management of treatment-resistant major psychiatric disorders. Edited by: Nemeroff CB. 2012, Oxford: Oxford University Press, 265-284.

Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E: Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord. 2009, 42: 97-103. 10.1002/eat.20589.PubMed

Karwautz AF, Wagner G, Waldherr K, Nader IW, Fernandez-Aranda F, Estivill X, Holliday J, Collier DA, Treasure JL: Gene-environment interaction in anorexia nervosa: relevance of non-shared environment and the serotonin transporter gene. Mol Psychiatry. 2011, 16: 590-592. 10.1038/mp.2010.125.PubMed

Kaye W: Eating disorders: hope despite mortal risk. Am J Psychiatry. 2009, 166: 1309-1311. 10.1176/appi.ajp.2009.09101424.PubMed

Keel PK, Brown TA: Update on course and outcome in eating disorders. Int J Eat Disord. 2010, 43: 195-204.PubMed

Pohjolainen V, Rasanen P, Roine RP, Sintonen H, Wahlbeck K, Karlsson H: Cost-utility of treatment of bulimia nervosa. Int J Eat Disord. 2010, 43: 596-602. 10.1002/eat.20754.PubMed

Abbate Daga G, Facchini F, Delsedime N, De Bacco C, Leone V, Fassino S: Valutazione dei costi nel trattamento ospedaliero dei disturbi del comportamento alimentare. It J Psychopathol. 2011, 17: 225-245.

Haas L, Stargardt T, Schreyoegg J, Schlösser R, Hofmann T, Danzer G, Klapp BF: Introduction of DRG-based reimbursement in inpatient psychosomatics–an examination of cost homogeneity and cost predictors in the treatment of patients with eating disorders. J Psychosom Res. 2012, 73: 383-390. 10.1016/j.jpsychores.2012.09.001.PubMed

10.

Treasure J, Russell G: The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry. 2011, 199: 5-7. 10.1192/bjp.bp.110.087585.PubMed

11.

Fairburn CG: Evidence-based treatment of anorexia nervosa. Int J Eat Disord. 2005, 37 (26–30): 41-42.

12.

Rosenvinge JK, Kuhlefelt Klusmeier A: Treatment for eating disorders from a patient satisfaction perspective: a Norwegian replication of a British study. Eur Eat Disord Rev. 2000, 8 (4): 293-300. 10.1002/1099-0968(200008)8:4<293::AID-ERV346>3.0.CO;2-4.

13.

Kaplan AS, Garfinkel PE: Difficulties in treating patients with eating disorders: a review of patient and clinician variables. Can J Psychiatry. 1999, 44: 665-670.PubMed

14.

Fassino S, Pierò A, Tomba E, Abbate-Daga G: Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry. 2009, 9: 67-10.1186/1471-244X-9-67.PubMedPubMedCentral

15.

Fassino S, Daga GA, Piero A, Rovera GG: Dropout from brief psychotherapy in anorexia nervosa. Psychother Psychosom. 2002, 71: 200-206. 10.1159/000063645.PubMed

16.

Fassino S: Psychosomatic approach is the new medicine tailored for patient personality with a focus on ethics, economy, and quality. Panminerva Med. 2010, 52: 249-264.PubMed

17.

Nordbø RH, Espeset EM, Gulliksen KS, Skårderud F, Geller J, Holte A: Reluctance to recover in anorexia nervosa. Eur Eat Disord Rev. 2012, 20: 60-67.PubMed

18.

Fichter MM, Quadflieg N, Hedlund S: Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord. 2006, 39: 87-100. 10.1002/eat.20215.PubMed

19.

Van Son GE, Van Hoeken D, Van Furth EF, Donker GA, Hoek HW: Course and outcome of eating disorders in a primary care-based cohort. Int J Eat Disord. 2010, 43: 130-138.PubMed

20.

Nordbø RH, Espeset EM, Gulliksen KS, Skårderud F, Holte A: The meaning of self-starvation: qualitative study of patients’ perception of anorexia nervosa. Int J Eat Disord. 2006, 39: 556-564. 10.1002/eat.20276.PubMed

21.

Espíndola CR, Blay SL: Anorexia nervosa treatment from the patient perspective: a metasynthesis of qualitative studies. Ann Clin Psychiatry. 2009, 21: 38-48.PubMed

22.

Wildes JE, Ringham RM, Marcus MD: Emotion avoidance in patients with anorexia nervosa: initial test of a functional model. Int J Eat Disord. 2010, 43: 398-404.PubMedPubMedCentral

23.

Wildes JE, Marcus MD: Development of emotion acceptance behavior therapy for anorexia nervosa: a case series. Int J Eat Disord. 2011, 44: 421-427. 10.1002/eat.20826.PubMed

24.

Skårderud F: Bruch revisited and revised. Eur Eat Disord Rev. 2009, 17: 83-88. 10.1002/erv.923.PubMed

25.

Couturier JL, Lock J: Denial and minimization in adolescents with anorexia nervosa. Int J Eat Disord. 2006, 39: 212-216. 10.1002/eat.20241.PubMed

26.

Gothelf D, Apter A, Ratzoni G, Orbach I, Weizman R, Tyano S, Pfeffer C: Defense mechanisms in severe adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 1995, 34: 1648-1654. 10.1097/00004583-199512000-00015.PubMed

27.

Konstantakopoulos G, Tchanturia K, Surguladze SA, David AS: Insight in eating disorders: clinical and cognitive correlates. Psychol Med. 2011, 41: 1951-1961. 10.1017/S0033291710002539.PubMed

28.

Konstantakopoulos G, Varsou E, Dikeos D, Ioannidi N, Gonidakis F, Papadimitriou G, Oulis P: Delusionality of body image beliefs in eating disorders. Psychiatry Res. 2012, 200: 482-488. 10.1016/j.psychres.2012.03.023.PubMed

29.

Schoen EG, Lee S, Skow C, Greenberg ST, Bell AS, Wiese JE, Martens JK: A retrospective look at the internal help-seeking process in young women with eating disorders. Eat Disord. 2012, 20: 14-30. 10.1080/10640266.2012.635560.PubMed

30.

Steinglass JE, Eisen JL, Attia E, Mayer L, Walsh BT: Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa. J Psychiatr Pract. 2007, 13: 65-71. 10.1097/01.pra.0000265762.79753.88.PubMed

31.

Viglione V, Muratori F, Maestro S, Brunori E, Picchi L: Denial of symptoms and psychopathology in adolescent anorexia nervosa. Psychopathology. 2006, 39: 255-260. 10.1159/000094723.PubMed

32.

Ametller L, Castro J, Serrano E, Martínez E, Toro J: Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission. J Child Psychol Psychiatry. 2005, 46: 394-400. 10.1111/j.1469-7610.2004.00360.x.PubMed

33.

Ben-Tovim DI, Walker K, Gilchrist P, Freeman R, Kalucy R, Esterman A: Outcome in patients with eating disorders: a 5-year study. Lancet. 2001, 357: 1254-1257. 10.1016/S0140-6736(00)04406-8.PubMed

34.

Bewell CV, Carter JC: Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. Int J Eat Disord. 2008, 41: 368-371. 10.1002/eat.20513.PubMed

35.

Burket RC, Hodgin JD: Factors predicting reluctance to seek treatment in patients with eating disorders. South Med J. 1993, 86: 529-532. 10.1097/00007611-199305000-00008.PubMed

36.

Carter JC, Mercer-Lynn KB, Norwood SJ, Bewell-Weiss CV, Crosby RD, Woodside DB, Olmsted MP: A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychiatry Res. 2012, 200: 518-523. 10.1016/j.psychres.2012.04.037.PubMed

37.

Casasnovas C, Fernández-Aranda F, Granero R, Krug I, Jiménez-Murcia S, Bulik CM, Vallejo-Ruiloba J: Motivation to change in eating disorders: clinical and therapeutic implications. Eur Eat Disord Rev. 2007, 15: 449-456.PubMed

38.

Cavedini P, Zorzi C, Bassi T, Gorini A, Baraldi C, Ubbiali A, Bellodi L: Decision-making functioning as a predictor of treatment outcome in anorexia nervosa. Psychiatry Res. 2006, 145: 179-187. 10.1016/j.psychres.2004.12.014.PubMed

39.

Clausen L: Time to remission for eating disorder patients: a 2(1/2)-year follow-up study of outcome and predictors. Nord J Psychiatry. 2008, 62: 151-159. 10.1080/08039480801984875.PubMed

40.

Danner UN, Sanders N, Smeets PA, Van Meer F, Adan RA, Hoek HW, Van Elburg AA: Neuropsychological weaknesses in anorexia nervosa: set-shifting, central coherence, and decision making in currently ill and recovered women. Int J Eat Disord. 2012, 45: 685-694. 10.1002/eat.22007.PubMed

41.

Darcy AM, Katz S, Fitzpatrick KK, Forsberg S, Utzinger L, Lock J: All better? How former anorexia nervosa patients define recovery and engaged in treatment. Eur Eat Disord Rev. 2010, 18: 260-270. 10.1002/erv.1020.PubMedPubMedCentral

42.

Gale C, Holliday J, Troop NA, Serpell L, Treasure J: The pros and cons of change in individuals with eating disorders: a broader perspective. Int J Eat Disord. 2006, 39: 394-403. 10.1002/eat.20250.PubMed

43.

Geller J, Cockell SJ, Drab DL: Assessing readiness for change in the eating disorders: the psychometric properties of the readiness and motivation interview. Psychol Assess. 2001, 13: 189-198.PubMed

44.

Geller J, Drab-Hudson DL, Whisenhunt BL, Srikameswaran S: Readiness to change dietary restriction predicts outcomes in the eating disorders. Eat Disord. 2004, 12: 209-224. 10.1080/10640260490490438.PubMed

45.

Geller J, Cassin SE, Brown KE, Srikameswaran S: Factors associated with improvements in readiness for change: low vs. normal BMI eating disorders. Int J Eat Disord. 2009, 42: 40-46. 10.1002/eat.20574.PubMed

46.

Herzog DB, Dorer DJ, Keel PK, Selwyn SE, Ekeblad ER, Flores AT, Greenwood DN, Burwell RA, Keller MB: Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. J Am Acad Child Adolesc Psychiatry. 1999, 38: 829-837. 10.1097/00004583-199907000-00012.PubMed

47.

Karlsson GP, Clinton D, Nevonen L: Prediction of weight increase in anorexia nervosa. Nord J Psychiatry. 2013, Epub ahead of print

48.

Lund BC, Hernandez ER, Yates WR, Mitchell JR, McKee PA, Johnson CL: Rate of inpatient weight restoration predicts outcome in anorexia nervosa. Int J Eat Disord. 2009, 42: 301-305. 10.1002/eat.20634.PubMed

49.

McHugh MD: Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa. Int J Eat Disord. 2007, 40: 602-612. 10.1002/eat.20425.PubMed

50.

Mewes R, Tagay S, Senf W: Weight curves as predictors of short-term outcome in anorexia nervosa inpatients. Eur Eat Disord Rev. 2008, 16: 37-43. 10.1002/erv.807.PubMed

51.

Muñoz P, Quintana JM, Las Hayas C, Padierna A, Aguirre U, González-Torres MA: Quality of life and motivation to change in eating disorders. Perception patient-psychiatrist. Eat Behav. 2012, 13: 131-134. 10.1016/j.eatbeh.2011.11.008.PubMed

52.

Nordbø RH, Gulliksen KS, Espeset EM, Skårderud F, Geller J, Holte A: Expanding the concept of motivation to change: the content of patients’ wish to recover from anorexia nervosa. Int J Eat Disord. 2008, 41: 635-642. 10.1002/eat.20547.PubMed

53.

Gulliksen KS, Espeset EM, Nordbø RH, Skårderud F, Geller J, Holte A: Preferred therapist characteristics in treatment of anorexia nervosa: the patient’s perspective. Int J Eat Disord. 2012, 45: 932-941. 10.1002/eat.22033.PubMed

54.

Ricca V, Castellini G, Lo Sauro C, Mannucci E, Ravaldi C, Rotella F, Faravelli C: Cognitive-behavioral therapy for threshold and subthreshold anorexia nervosa: a three-year follow-up study. Psychother Psychosom. 2010, 79: 238-248. 10.1159/000315129.PubMed

55.

Rieger E, Touyz SW, Beumont PJ: The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ): information regarding its psychometric properties. Int J Eat Disord. 2002, 32: 24-38. 10.1002/eat.10056.PubMed

56.

Salbach-Andrae H, Schneider N, Seifert K, Pfeiffer E, Lenz K, Lehmkuhl U, Korte A: Short-term outcome of anorexia nervosa in adolescents after inpatient treatment: a prospective study. Eur Child Adolesc Psychiatry. 2009, 18: 701-704. 10.1007/s00787-009-0024-9.PubMed

57.

Schebendach JE, Mayer LE, Devlin MJ, Attia E, Contento IR, Wolf RL, Walsh BT: Dietary energy density and diet variety as predictors of outcome in anorexia nervosa. Am J Clin Nutr. 2008, 87: 810-816.PubMed

58.

Touyz S, Thornton C, Rieger E, George L, Beumont P: The incorporation of the stage of change model in the day hospital treatment of patients with anorexia nervosa. Eur Child Adolesc Psychiatry. 2003, 12 (Suppl 1): 65-71.

59.

Treasure J, Sepulveda AR, Whitaker W, Todd G, Lopez C, Whitney J: Collaborative care between professionals and non-professionals in the management of eating disorders: a description of workshops focussed on interpersonal maintaining factors. Eur Eat Disord Rev. 2007, 15: 24-34. 10.1002/erv.758.PubMed

60.

Wade TD, Frayne A, Edwards SA, Robertson T, Gilchrist P: Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry. 2009, 43: 235-243. 10.1080/00048670802653356.PubMed

61.

Ward A, Troop N, Todd G, Treasure J: To change or not to change–‘how’ is the question?. Br J Med Psychol. 1996, 69 (Pt 2): 139-146.PubMed

62.

Castro J, Toro J, Cruz M: Quality of rearing practices as predictor of short-term outcome in adolescent anorexia nervosa. Psychol Med. 2000, 30: 61-67. 10.1017/S0033291799001385.PubMed

63.

Danielsen M, Rø Ø: Changes in body image during inpatient treatment for eating disorders predict outcome. Eat Disord. 2012, 20: 261-275. 10.1080/10640266.2012.689205.PubMed

64.

Deter HC, Schellberg D, Köpp W, Friederich HC, Herzog W: Predictability of a favorable outcome in anorexia nervosa. Eur Psychiatry. 2005, 20: 165-172. 10.1016/j.eurpsy.2004.09.006.PubMed

65.

Fairburn CG, Cooper Z, Shafran R: Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther. 2003, 41: 509-528. 10.1016/S0005-7967(02)00088-8.PubMed

66.

Fassino S, Abbate Daga G, Amianto F, Leombruni P, Fornas B, Garzaro L, D’Ambrosio G, Rovera GG: Outcome predictors in anorectic patients after 6 months of multimodal treatment. Psychother Psychosom. 2001, 70: 201-208. 10.1159/000056254.PubMed

67.

Fassino S, Abbate Daga G, Amianto F, Leombruni P, Garzaro L, Rovera GG: Nonresponder anorectic patients after 6 months of multimodal treatment: predictors of outcome. Eur Psychiatry. 2001, 16: 466-473. 10.1016/S0924-9338(01)00608-3.PubMed

68.

Fassino S, Abbate Daga G, Delsedime N, Busso F, Piero A, Rovera GG: Baseline personality characteristics of responders to 6-month psychotherapy in eating disorders: preliminary data. Eat Weight Disord. 2005, 10: 40-50.PubMed

69.

Federici A, Kaplan AS: The patient’s account of relapse and recovery in anorexia nervosa: a qualitative study. Eur Eat Disord Rev. 2008, 16: 1-10. 10.1002/erv.813.PubMed

70.

Geller J: Mechanisms of action in the process of change: helping eating disorder clients make meaningful shifts in their lives. Clin Child Psychol Psychiatry. 2006, 11: 225-237. 10.1177/1359104506061413.PubMed

71.

Goddard E, Macdonald P, Sepulveda AR, Naumann U, Landau S, Schmidt U, Treasure J: Cognitive interpersonal maintenance model of eating disorders: intervention for carers. Br J Psychiatry. 2011, 199: 225-231. 10.1192/bjp.bp.110.088401.PubMed

72.

Helverskov JL, Clausen L, Mors O, Frydenberg M, Thomsen PH, Rokkedal K: Trans-diagnostic outcome of eating disorders: A 30-month follow-up study of 629 patients. Eur Eat Disord Rev. 2010, 18: 453-463. 10.1002/erv.1025.PubMed

73.

Hjern A, Lindberg L, Lindblad F: Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9- to 14-year follow-up. Br J Psychiatry. 2006, 189: 428-432. 10.1192/bjp.bp.105.018820.PubMed

74.

Löwe B, Zipfel S, Buchholz C, Dupont Y, Reas DL, Herzog W: Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol Med. 2001, 31: 881-890.PubMed

75.

Schmidt U, Treasure J: Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol. 2006, 45 (Pt 3): 343-366.PubMed

76.

Signorini A, Bellini O, Pasanisi F, Contaldo F, De Filippo E: Outcome predictors in the short-term treatment of anorexia nervosa: an integrated medical-psychiatric approach. Eat Weight Disord. 2003, 8: 168-172. 10.1007/BF03325008.PubMed

77.

Steinhausen HC, Seidel R, Winkler Metzke C: Evaluation of treatment and intermediate and long-term outcome of adolescent eating disorders. Psychol Med. 2000, 30: 1089-1098. 10.1017/S0033291799002354.PubMed

78.

Sutandar-Pinnock K, Blake Woodside D, Carter JC, Olmsted MP, Kaplan AS: Perfectionism in anorexia nervosa: a 6-24-month follow-up study. Int J Eat Disord. 2003, 33: 225-229. 10.1002/eat.10127.PubMed

79.

Vrabel KR, Rø O, Martinsen EW, Hoffart A, Rosenvinge JH: Five-year prospective study of personality disorders in adults with longstanding eating disorders. Int J Eat Disord. 2010, 43: 22-28.PubMed

80.

Feld R, Woodside DB, Kaplan AS, Olmsted MP, Carter JC: Pretreatment motivational enhancement therapy for eating disorders: a pilot study. Int J Eat Disord. 2001, 29: 393-400. 10.1002/eat.1035.PubMed

81.

Forget K, Marussi DR, Le Corff Y: Counter-transference in eating disorder treatment:a systematic review. Can J Psychiatry. 2011, 56: 303-310.PubMed

82.

Geller J, Brown KE, Srikameswaran S: The efficacy of a brief motivational intervention for individuals with eating disorders: a randomized control trial. Int J Eat Disord. 2011, 44: 497-505. 10.1002/eat.20847.PubMed

83.

Masson PC, Sheeshka JD: Clinicians’ perspectives on the premature termination of treatment in patients with eating disorders. Eat Disord. 2009, 17: 109-125.PubMed

84.

Moyers TB, Rollnick S: A motivational interviewing perspective on resistance in psychotherapy. J Clin Psychol. 2002, 58: 185-193. 10.1002/jclp.1142.PubMed

85.

Satir DA, Thompson-Brenner H, Boisseau CL, Crisafulli MA: Countertransference reactions to adolescents with eating disorders: relationships to clinician and patient factors. Int J Eat Disord. 2009, 42: 511-521. 10.1002/eat.20650.PubMedPubMedCentral

86.

Strober M: Managing the chronic, treatment-resistant patient with anorexia nervosa. Int J Eat Disord. 2004, 36: 245-255. 10.1002/eat.20054.PubMed

87.

Tierney S, Fox JR: Chronic anorexia nervosa: a Delphi study to explore practitioners’ views. Int J Eat Disord. 2009, 42: 62-67. 10.1002/eat.20557.PubMed

88.

Tozzi F, Sullivan PF, Fear JL, McKenzie J, Bulik CM: Causes and recovery in anorexia nervosa: the patient’s perspective. Int J Eat Disord. 2003, 33: 143-154. 10.1002/eat.10120.PubMed

89.

Vitousek K, Watson S, Wilson GT: Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev. 1998, 18: 391-420. 10.1016/S0272-7358(98)00012-9.PubMed

90.

Warren CS, Crowley ME, Olivardia R, Schoen A: Treating patients with eating disorders: an examination of treatment providers’ experiences. Eat Disord. 2009, 17: 27-45.PubMed

91.

American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 2000, Washington DC: Masson, 4

92.

Prochaska JO, Redding CA, Evers KE: The transtheoretical model and stages of change. Health behavior and health education: Theory, research, and practice. Edited by: Glanz K, Rimer BK, Viswanath K. 2002, San Francisco: Jossey-Bass, 60-84.

93.

Treasure J, Schmidt U: MI in the management of eating disorders. Motivational Interviewing in the Treatment of Psychological Problems. Edited by: Arkowitz H, Westra HA, Miller WR, Rollnick S. 2010, New York: The Guilford Press

94.

Treasure J, Crane A, McKnight R, Buchanan E, Wolfe M: First do no harm: iatrogenic maintaining factors in anorexia nervosa. Eur Eat Disord Rev. 2011, 19: 296-302. 10.1002/erv.1056.PubMed

95.

Thompson-Brenner H, Eddy KT, Franko DL, Dorer DJ, Vashchenko M, Kass AE, Herzog DB: A personality classification system for eating disorders: a longitudinal study. Compr Psychiatry. 2008, 49: 551-560. 10.1016/j.comppsych.2008.04.002.PubMed

96.

Russell GF: Metabolic, endocrine and psychiatric aspects of anorexia nervosa. Sci Basis Med Annu Rev. 1969, 236-255.

97.

Bruch H: Anorexia Nervosa: therapy and theory. Am J Psychiatry. 1982, 139: 1531-1538.PubMed

98.

Thompson-Brenner H, Satir DA, Franko DL, Herzog DB: Clinician reactions to patients with eating disorders: a review of the literature. Psychiatr Serv. 2012, 63: 73-78.PubMed

99.

Marzola E, Trunko ME, Grenesko-Stevens E, Kaye WH: Anorexia and Bulimia Nervosa. Management of treatment-resistant major psychiatric disorders. Edited by: Nemeroff CB. 2012, Oxford: Oxford University Press, 197-224.

100.

Waller G: The myths of motivation: time for a fresh look at some received wisdom in the eating disorders?. Int J Eat Disord. 2012, 45: 1-16. 10.1002/eat.20900.PubMed

101.

Fassino S, Daga GA, Pierò A, Delsedime N: Psychological factors affecting eating disorders. Adv Psychosom Med. 2007, 28: 141-168.PubMed

102.

Kaye WH, Fudge JL, Paulus M: New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci. 2009, 10: 573-584. 10.1038/nrn2682.PubMed

103.

Wamberg E, Marcus ER: Processo, resistenza, interpretazione. Psicoanalisi. Teoria, clinica, ricerca. Edited by: Person ES, Cooper AM, Gabbard GO. 2004, Milano: Raffaello Cortina Editore, 373-393.

104.

Nemeroff CB: Management of treatment-resistant major psychiatric disorders. 2012, Oxford: Oxford University Press

105.

Fabbri S, Fava GA, Sirri L, Wise TN: Development of a new assessment strategy in psychosomatic medicine: the diagnostic criteria for psychosomatic research. Adv Psychosom Med. 2007, 28: 1-20.PubMed

106.

Guarda AS: Treatment of anorexia nervosa: insights and obstacles. Physiol Behav. 2008, 94: 113-120. 10.1016/j.physbeh.2007.11.020.PubMed

107.

Abbate-Daga G, Delsedime N, Nicotra B, Giovannone C, Marzola E, Amianto F, Fassino S: Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry. 2013, 13: 14-10.1186/1471-244X-13-14.PubMedPubMedCentral

108.

Abbate-Daga G, Gramaglia C, Amianto F, Marzola E, Fassino S: Attachment insecurity, personality, and body dissatisfaction in eating disorders. J Nerv Ment Dis. 2010, 198: 520-524. 10.1097/NMD.0b013e3181e4c6f7.PubMed

109.

Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Palmer RL, Dalle Grave R: Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK-Italy study. Behav Res Ther. 2013, 51: R2-R8. 10.1016/j.brat.2012.09.010.PubMedPubMedCentral

110.

Wiffen BD, O’Connor JA, Gayer-Anderson C, Reis Marques T, McQueen G, Happé F, Murray RM, David AS: “I am sane but he is mad”: Insight and illness attributions to self and others in psychosis. Psychiatry Res. 2013, Epub ahead of print

111.

Malson H, Bailey L, Clarke S, Treasure J, Anderson G, Kohn M: Un/imaginable future selves: a discourse analysis of in-patients’ talk about recovery from an “eating disorder”. Eur Eat Disord Rev. 2011, 19: 25-36. 10.1002/erv.1011.PubMed

112.

Adenzato M, Todisco P, Ardito RB: Social cognition in anorexia nervosa: evidence of preserved theory of mind and impaired emotional functioning. PLoS One. 2012, 7: e44414-10.1371/journal.pone.0044414.PubMedPubMedCentral

113.

Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S: Effectiveness of cognitive remediation therapy (CRT) in anorexia nervosa: a case series. J Clin Exp Neuropsychol. 2012, 34: 1009-1015. 10.1080/13803395.2012.704900.PubMed

114.

Serpell L, Treasure J: Bulimia nervosa: friend or foe? The pros and cons of bulimia nervosa. Int J Eat Disord. 2002, 32: 164-170. 10.1002/eat.10076.PubMed

115.

Serpell L, Teasdale JD, Troop NA, Treasure J: The development of the P-CAN, a measure to operationalize the pros and cons of anorexia nervosa. Int J Eat Disord. 2004, 36: 416-433. 10.1002/eat.20040.PubMed

116.

Treasure J, Schmidt U: Anorexia Nerv. Clin Evid. 2004, 11: 1192-1203.PubMed

117.

Tierney S, Fox JR: Living with the anorexic voice: a thematic analysis. Psychol Psychother. 2010, 83: 243-254. 10.1348/147608309X480172.PubMed

118.

Williams S, Reid M: “It”s like there are two people in my head’: a phenomenological exploration of anorexia nervosa and its relationship to the self. Psychol Health. 2012, 27: 798-815. 10.1080/08870446.2011.595488.PubMed

119.

Barron JW: Making diagnosis meaningful: Enhancing evaluation and treatment of psychological disorders. 1998, Washington DC: American Psychological Association

120.

Skårderud F: Eating one’s words, part I: “Concretised metaphors” and reflective function in anorexia nervosa–an interview study. Eur Eat Disord Rev. 2007, 15: 163-174. 10.1002/erv.777.PubMed

121.

Fassino S, Amianto F, Rocca G, Daga GA: Original articles parental bonding and eating psychopathology in bulimia nervosa: personality traits as possible mediators. Epidemiol Psichiatr Soc. 2010, 19 (3): 214-222.PubMed

122.

Mahon J, Winston AP, Palmer RL, Harvey PK: Do broken relationships in childhood relate to bulimic women breaking off psychotherapy in adulthood?. Int J Eat Disord. 2001, 29: 139-149. 10.1002/1098-108X(200103)29:2<139::AID-EAT1003>3.0.CO;2-I.PubMed

123.

Money C, Genders R, Treasure J, Schmidt U, Tchanturia K: A brief emotion focused intervention for inpatients with anorexia nervosa: a qualitative study. J Health Psychol. 2011, 16: 947-958. 10.1177/1359105310396395.PubMed

124.

Jenkins J, Ogden J: Becoming “whole” again: a qualitative study of women’s views of recovering from anorexia nervosa. Eur Eat Disord Rev. 2012, 20: e23-e31. 10.1002/erv.1085.PubMed

125.

Stanghellini G, Castellini G, Brogna P, Faravelli C, Ricca V: Identity and eating disorders (IDEA): a questionnaire evaluating identity and embodiment in eating disorder patients. Psychopathology. 2012, 45: 147-158. 10.1159/000330258.PubMed

126.

Hasan TF, Hasan H: Anorexia nervosa: a unified neurological perspective. Int J Med Sci. 2011, 8: 679-703.PubMedPubMedCentral

127.

Wilson GT, Fairburn CG, Agras WS: Cognitive behavioral therapy for bulimia nervosa. Handbook of Treatment for Eating Disorders. Edited by: Garner DM, Garfinkel PE. 1997, New York: The Guilford Press, 67-93.

128.

Bruschweiler-Stern N, Lyons-Ruth K, Morgan AC, Nahum JP, Sander LW, Stern DN: The foundational level of psychodynamic meaning: implicit process in relation to conflict, defense and the dynamic unconscious. Int J Psychoanal. 2007, 88 (Pt 4): 843-860.PubMed

129.

Winnicott DW: The development of the capacity for concern. Bull Menninger Clin. 1963, 27: 167-176.PubMed

130.

Freeman MP: Nutrition and psychiatry. Am J Psychiatry. 2010, 167: 244-247. 10.1176/appi.ajp.2009.09121746.PubMed

131.

Oldershaw A, Hambrook D, Stahl D, Tchanturia K, Treasure J, Schmidt U: The socio-emotional processing stream in Anorexia Nervosa. Neurosci Biobehav Rev. 2011, 35: 970-988. 10.1016/j.neubiorev.2010.11.001.PubMed

132.

Abbate-Daga G, Buzzichelli S, Amianto F, Rocca G, Marzola E, McClintock SM, Fassino S: Cognitive flexibility in verbal and nonverbal domains and decision making in anorexia nervosa patients: a pilot study. BMC Psychiatry. 2011, 11: 162-10.1186/1471-244X-11-162.PubMedPubMedCentral

133.

Krug I, Penelo E, Fernandez-Aranda F, Anderluh M, Bellodi L, Cellini E, Di Bernardo M, Granero R, Karwautz A, Nacmias B, Ricca V, Sorbi S, Tchanturia K, Wagner G, Collier D, Treasure J: Low social interactions in eating disorder patients in childhood and adulthood: a multi-centre European case control study. J Health Psychol. 2013, 18: 26-37. 10.1177/1359105311435946.PubMed

134.

Hay PJ, Touyz S, Sud R: Treatment for severe and enduring anorexia nervosa: a review. Aust N Z J Psychiatry. 2012, 46: 1136-1144. 10.1177/0004867412450469.PubMed

135.

Fassino S, Abbate-Daga G, Amianto F, Facchini F, Rovera GG: Eating psychopathology and personality in eating disorders. Epidemiol Psichiatr Soc. 2003, 12: 293-300. 10.1017/S1121189X00003109.PubMed

136.

Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Bohn K, Hawker DM, Wales JA, Palmer RL: Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. Am J Psychiatry. 2009, 166: 311-319. 10.1176/appi.ajp.2008.08040608.PubMed

137.

Schmidt U, Oldershaw A, Jichi F, Sternheim L, Startup H, McIntosh V, Jordan J, Tchanturia K, Wolff G, Rooney M, Landau S, Treasure J: Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. Br J Psychiatry. 2012, 201: 392-399. 10.1192/bjp.bp.112.112078.PubMed

138.

McIntosh VV, Jordan J, Luty SE, Carter FA, McKenzie JM, Bulik CM, Joyce PR: Specialist supportive clinical management for anorexia nervosa. Int J Eat Disord. 2006, 39: 625-632. 10.1002/eat.20297.PubMed

139.

Strober M: The Chronically Ill Patient with Anorexia Nervosa. Development, Phenomenology, and Therapeutic Considerations. The treatment of eating disorders: a clinical handbook. Edited by: Grilo C, Mitchell JE. 2010, New York: Guilford Press, 225-233.

140.

Garner DM, Garfinkel PE: Perceptive and cognitive disturbances. Anorexia nervosa: a multidimensional perspective. Edited by: Garfinkel PE, Garner DM. 1982, New York: Brunner & Mazel, 123-163.

141.

Abbate Daga G, Gramaglia C, Bailer U, Bergese S, Marzola E, Fassino S: Major depression and avoidant personality traits in eating disorders. Psychother Psychosom. 2011, 80: 319-320. 10.1159/000324761.

142.

Fassino S, Daga GA, Pierò A, Leombruni P, Rovera GG: Anger and personality in eating disorders. J Psychosom Res. 2001, 51: 757-764. 10.1016/S0022-3999(01)00280-X.PubMed

143.

Abbate-Daga G, Marzola E, Gramaglia C, Brustolin A, Campisi S, De-Bacco C, Amianto F, Fassino S: Emotions in eating disorders: changes of anger control after an emotion-focused day hospital treatment. Eur Eat Disord Rev. 2012, 20: 496-501. 10.1002/erv.2199.PubMed

144.

Zachrisson HD, Skårderud F: Feelings of insecurity: review of attachment and eating disorders. Eur Eat Disord Rev. 2010, 18: 97-106. 10.1002/erv.999.PubMed

145.

Rothschild-Yakar L, Levy-Shiff R, Fridman-Balaban R, Gur E, Stein D: Mentalization and relationships with parents as predictors of eating disordered behavior. J Nerv Ment Dis. 2010, 198: 501-507. 10.1097/NMD.0b013e3181e526c8.PubMed

146.

Truglia E, Mannucci E, Lassi S, Rotella CM, Faravelli C, Ricca V: Aggressiveness, anger and eating disorders: a review. Psychopathology. 2006, 39: 55-68. 10.1159/000090594.PubMed

147.

Wildes JE, Marcus MD, Bright AC, Dapelo MM, Psychol MC: Emotion and eating disorder symptoms in patients with anorexia nervosa: An experimental study. Int J Eat Disord. 2012, 45: 876-882. 10.1002/eat.22020.PubMedPubMedCentral

148.

Dare C, Eisler I, Russell G, Treasure J, Dodge L: Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments. Br J Psychiatry. 2001, 178: 216-221. 10.1192/bjp.178.3.216.PubMed

149.

Holmes J: Psychodynamic psychiatry’s green shoots. Br J Psychiatry. 2012, 200: 439-441. 10.1192/bjp.bp.112.110742.PubMed

150.

Siegel DJ: The Developing Mind. 1999, New York: The Guilford Press Inc. and Mark Paterson

151.

Castiello U, Becchio C, Zoia S, Nelini C, Sartori L, Blason L, D’Ottavio G, Bulgheroni M, Gallese V: Wired to be social: the ontogeny of human interaction. PLoS One. 2010, 5: e13199-10.1371/journal.pone.0013199.PubMedPubMedCentral

152.

Nummenmaa L, Glerean E, Viinikainen M, Jääskeläinen IP, Hari R, Sams M: Emotions promote social interaction by synchronizing brain activity across individuals. Proc Natl Acad Sci U S A. 2012, 109: 9599-9604. 10.1073/pnas.1206095109.PubMedPubMedCentral

153.

Leichsenring F, Rabung S: Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA. 2008, 300: 1551-1565. 10.1001/jama.300.13.1551.PubMed

154.

Diener MJ, Hilsenroth MJ, Weinberger J: Therapist affect focus and patient outcomes in psychodynamic psychotherapy: a meta-analysis. Am J Psychiatry. 2007, 164: 936-941. 10.1176/appi.ajp.164.6.936.PubMed

155.

Shedler J: The efficacy of psychodynamic psychotherapy. Am Psychol. 2010, 65: 98-109.PubMed

156.

Person ES, Cooper AM, Gabbard GO: Psicoanalisi. Teoria, clinica, ricerca. 2005, Raffaello Cortina Editore: Milano

157.

Freud S: The Dynamics of Transference. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XII (1911–1913): The Case of Schreber, Papers on Technique and Other Works. 1912, London: Hogarth Press, 97-108.

158.

Fosshage JL: The explicit and implicit dance in psychoanalytic change. J Anal Psychol. 2004, 49: 49-65. 10.1111/j.0021-8774.2004.0440.x.PubMed

159.

Stern DN, Sander LW, Nahum JP, Harrison AM, Lyons-Ruth K, Morgan AC, Bruschweiler-Stern N, Tronick EZ: Non-interpretive mechanisms in psychoanalytic therapy. The “something more” than interpretation. The process of change study group. Int J Psychoanal. 1998, 79 (5): 903-921.PubMed

160.

Gallese V: Before and below “theory of mind”: embodied simulation and the neural correlates of social cognition. Philos Trans R Soc Lond B Biol Sci. 2007, 362: 659-669. 10.1098/rstb.2006.2002.PubMedPubMedCentral

161.

Fan Y, Duncan NW, De Greck M, Northoff G: Is there a core neural network in empathy? An fMRI based quantitative meta-analysis. Neurosci Biobehav Rev. 2011, 35: 903-911. 10.1016/j.neubiorev.2010.10.009.PubMed

162.

Fassino S, Amianto F, Gramaglia C, Facchini F, Abbate Daga G: Temperament and character in eating disorders: ten years of studies. Eat Weight Disord. 2004, 9: 81-90. 10.1007/BF03325050.PubMed

163.

Tchanturia K, Anderluh MB, Morris RG, Rabe-Hesketh S, Collier DA, Sanchez P, Treasure JL: Cognitive flexibility in anorexia nervosa and bulimia nervosa. J Int Neuropsychol Soc. 2004, 10: 513-520. 10.1017/S1355617704104086.PubMed

164.

Ward A, Ramsay R, Turnbull S, Steele M, Steele H, Treasure J: Attachment in anorexia nervosa: a transgenerational perspective. Br J Med Psychol. 2001, 74: 497-505. 10.1348/000711201161145.PubMed

165.

Gramaglia C, Abbate Daga G, Amianto F, Brustolin A, Campisi S, De Bacco C, Fassino S: Cinematherapy in the day hospital treatment of patients with eating disorders. Case study and clinical considerations. Arts Psychother. 2011, 38: 261-266. 10.1016/j.aip.2011.08.004.

166.

Wild B, Friederich HC, Gross G, Teufel M, Herzog W, Giel KE, De Zwaan M, Schauenburg H, Schade-Brittinger C, Schäfer H, Zipfel S: The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa–a randomized controlled trial. Trials. 2009, 10: 23-10.1186/1745-6215-10-23.PubMedPubMedCentral

167.

Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002, 159: 1284-1293. 10.1176/appi.ajp.159.8.1284.PubMed

168.

Fassino S, Abbate-Daga G, Amianto F, Leombruni P, Boggio S, Rovera GG: Temperament and character profile of eating disorders: a controlled study with the temperament and character inventory. Int J Eat Disord. 2002, 32: 412-425. 10.1002/eat.10099.PubMed

169.

Amianto F, Abbate-Daga G, Morando S, Sobrero C, Fassino S: Personality development characteristics of women with anorexia nervosa, their healthy siblings and healthy controls: What prevents and what relates to psychopathology?. Psychiatry Res. 2011, 187: 401-408. 10.1016/j.psychres.2010.10.028.PubMed

170.

Shapiro J: Perspective: does medical education promote professional alexithymia? a call for attending to the emotions of patients and self in medical training. Acad Med. 2011, 86: 326-332. 10.1097/ACM.0b013e3182088833.PubMed

171.

Barthes R: Leçon. 1979, Paris: Éd. du Seuil

172.

Kohut H: The Restoration of the Self. 1977, New York: International Universities Press

173.

Watts RE, Pietrzak D: Adlerian “encouragement” and the therapeutic process of solution- focused brief therapy. J Couns Dev. 2000, 78 (4): 442-447. 10.1002/j.1556-6676.2000.tb01927.x.

174.

Rovera GG: Le strategie dell’incoraggiamento. Riv Psicol Indiv. 2009, 66: 139-169.

175.

Fassino S, Amianto F, Ferrero A: Brief Adlerian psychodynamic psychotherapy: theoretical issues and process indicators. Panminerva Med. 2008, 50: 165-175.PubMed

176.

Stuhldreher N, Konnopka A, Wild B, Herzog W, Zipfel S, Löwe B, König H-H: Cost-of-illness studies and cost-effectiveness analyses in eating disorders: a systematic review. Int J Eat Disord. 2012, 45: 476-491. 10.1002/eat.20977.PubMed

177.

Vandereycken W: The place of inpatient care in the treatment of anorexia nervosa: questions to be answered. Int J Eat Disord. 2003, 34: 409-422. 10.1002/eat.10223.PubMed

178.

Bateman AW, Fonagy P: Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry. 2001, 158: 36-42. 10.1176/appi.ajp.158.1.36.PubMed

179.

Bateman AW, Fonagy P: The development of an attachment-based treatment program for borderline personality disorder. Bull Menninger Clin. 2003, 67: 187-211. 10.1521/bumc.67.3.187.23439.PubMed

180.

Lazar SG: Psychotherapy Is Worth It. A Comprehensive Review of Its Cost-effectiveness. 2010, Washington DC: American Psychiatric Publishing

181.

Fassino S, Amianto F, Sobrero C, Abbate Daga G: Does it exist a personality core of mental illness?A systematic review on core psychobiological personality traits in mental disorders. Panminerva Med. in press

182.

McIntosh VV, Jordan J, Carter FA, Luty SE, McKenzie JM, Bulik CM, Frampton CM, Joyce PR: Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry. 2005, 162: 741-747. 10.1176/appi.ajp.162.4.741.PubMed

183.

Carter FA, Jordan J, McIntosh VV, Luty SE, McKenzie JM, Frampton CM, Bulik CM, Joyce PR: The long-term efficacy of three psychotherapies for anorexia nervosa: a randomized, controlled trial. Int J Eat Disord. 2011, 44: 647-654. 10.1002/eat.20879.PubMed

184.

Halmi KA, Agras WS, Crow S, Mitchell J, Wilson GT, Bryson SW, Kraemer HC: Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Arch Gen Psychiatry. 2005, 62: 776-781. 10.1001/archpsyc.62.7.776.PubMed

185.

Zipfel S, Wild B, Groß G, Friederich HC, Teufel M, Schellberg D, Giel KE, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, von Wietersheim J, Zeeck A, Schade-Brittinger C, Schauenburg H, Herzog W, on behalf of the ANTOP study group: Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet. 2013, [Epub ahead of print]

186.

McKay KM, Imel ZE, Wampold BE: Psychiatrist effects in the psychopharmacological treatment of depression. J Affect Disord. 2006, 92: 287-290. 10.1016/j.jad.2006.01.020.PubMed

187.

Heinonen E, Lindfors O, Laaksonen MA, Knekt P: Therapists’ professional and personal characteristics as predictors of outcome in short- and long-term psychotherapy. J Affect Disord. 2012, 138: 301-312. 10.1016/j.jad.2012.01.023.PubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/13/294/prepub

Title: Resistance to treatment and change in anorexia nervosa: a clinical overview
Authors: Giovanni Abbate-Daga
Federico Amianto
Nadia Delsedime
Carlotta De-Bacco
Secondo Fassino
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2013
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/1471-244X-13-294

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Discussion

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Discussion

Summary

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