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A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

Published on: May 10, 2022

"Normal" vs. "difficult" cases with eating disorders: the therapists' perspective

Armin Hartmann¹, Inga Lau¹, Carolin Klose¹

¹Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Frontiers in Psychology

|March 6, 2026

Abstract

Introduction:

Patients with an eating disorder (ED) are considered difficult to treat. We aimed to identify the characteristics of patients with an ED, which are considered especially challenging to treat from the therapist's perspective.

Methods:

Psychotherapists with experience in ED treatment were asked to describe a "normal" as well as a "difficult" case they treated lately, using an online-survey. They described their patients by filling in a list of symptoms and their severity, on personality traits and functioning as well as a list of possible therapeutic challenges experienced over the course of treatment.

Results:

127 psychotherapists were recruited. "Difficult" cases were characterized by variables which could be related to three areas: patients´ motivation (higher level of ambivalence), interactional behavior/personality traits (more antagonism) and somatic complications, such as electrolyte imbalance. Ambivalence was the strongest predictor of case difficulty, followed by patient personality. Therapist or work place characteristics were not associated with experiencing treatments as "normal" or "difficult."

Discussion:

In particular, aspects related to the therapeutic process and relationship characterize the group of "difficult" cases from a therapist's view.

Keywords:

case difficulty eating disorder psychotherapy severity therapist perspective

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