{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T07:27:40Z","timestamp":1771399660312,"version":"3.50.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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\u2019s perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Psychotherapists with experience in ED treatment were asked to describe a \u201cnormal\u201d as well as a \u201cdifficult\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>127 psychotherapists were recruited. \u201cDifficult\u201d cases were characterized by variables which could be related to three areas: patients\u00b4 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 \u201cnormal\u201d or \u201cdifficult.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In particular, aspects related to the therapeutic process and relationship characterize the group of \u201cdifficult\u201d cases from a therapist\u2019s view.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1761349","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T06:54:03Z","timestamp":1771397643000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cNormal\u201d vs. \u201cdifficult\u201d cases with eating disorders: the therapists\u2019 perspective"],"prefix":"10.3389","volume":"17","author":[{"given":"Armin","family":"Hartmann","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inga","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolin","family":"Klose","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Egenolf","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Almut","family":"Zeeck","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1186\/1471-244X-13-294","article-title":"Resistance to treatment and change in anorexia nervosa [corrected]: a clinical overview","volume":"13","author":"Abbate-Daga","year":"2013","journal-title":"BMC Psychiatry"},{"key":"ref2","volume-title":"Diagnostic and statistical manual of mental disorders. 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