ORIGINAL RESEARCH article
Front. Psychol.
Sec. Psychology for Clinical Settings
"Normal" vs. "difficult" cases with eating disorders: The therapists' perspective
Provisionally accepted
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg; Germany, Freiburg, Germany
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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 characteristics 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
Received: 05 Dec 2025; Accepted: 29 Jan 2026.
Copyright: © 2026 Hartmann, Lau, Klose, Egenolf and Zeeck. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Almut Zeeck
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