"Just So Horrible For Everyone Involved": 21 Times Mental Health Professionals Explained What Disorders Are The Hardest To Treat, And Why

Note: The following content has mentions of mental health illnesses, drug use, and other sensitive matters. Reader discretion is advised. 

Here are 21 mental health disorders that professionals find challenging to treat:

1. "Based on my professional experience, treating eating disorders can be very tricky. The disorder is very competitive by nature and can be worsened by people expressing concern for them. The disease tells the brain that getting sicker means they’re succeeding. It has incredibly high mortality rates, and insurance (U.S.A.) is often reluctant to treat it. It requires a lot of specialized training for good reason."

— literal9

2. "As an infectious disease doctor, delusional parasitosis is such a challenging disorder. Quite difficult to get anywhere with a patient when they are convinced there is some external reason for their internal sensations. I have very rarely felt truly threatened or in physical danger in my 10+ years as a doctor—but almost every time has been in an encounter with a delusional parasitosis patient."

— _m0ridin_

"As a dermatologist, I was going to say the same. These patients often specifically refuse to see mental health professionals. It has to be a carefully nuanced discussion, and even then, only after building major rapport. We’re on the same side—I want you to get better too." 

— Creative-Train-2886

3. "Putting organic brain issues like dementia and TBI aside, hoarding, somatization, and stalking are always very difficult. In my 10 years of experience, I would say those are the clients I saw make the least progress. Even my clients with intractable delusional disorder will be able to make positive adjustments in their lives while still living within their delusional system. I have never been able to make progress with clients with hoarding, somatization (hypochondria), and stalking disorders. I think it’s just the nature of how the illness presents itself. Not only is the client lacking insight, but the more skills and reality checks you try to do, the more they grasp onto the problem. But then also every therapist has their strengths and weaknesses, so it could just be me."

— SweetPickleRelish

4. "Personality disorders (particularly BPD, NPD, and ASPD) because they can significantly complicate the therapeutic relationship, which is often one of the most important components of successful treatment."

— Greasy007

5. "Anorexia is really difficult on many levels and dangerously lethal. You can't help patients who don’t want the help and want to continue losing weight. Even when we get court-ordered tube feeds, they achieve a BMI of 18, get discharged, and immediately start restricting again. Also really difficult because they typically decompensate on an inpatient psych unit, but medical floors don’t want a psych patient and try like hell to get them off their service and onto psych. Too medically sick for the psych floor, too psychiatrically sick for the medicine floor."

— blu9bird

6. "Alzheimer’s with behaviors is extremely difficult. When they reach advanced dementia, they have terrible memory, especially of recent events. They can forget their own name and no longer recognize their own living space or anyone around them. “With behaviors” means they tend to be defiant and contrary rather than cooperative, so it is extremely difficult to get them to do anything even for their own well-being. Simple tasks like getting them to eat, bathe, and go to the toilet are challenging sometimes. You cannot reason with them."

— Wonderful_Low_89

7. "I'm not a clinician, and I don't 'treat' people, but I work in mental health as a peer worker. I do outreach, which means I'm sometimes in people's homes and more involved in their day-to-day life. So I tend to see the struggle they live with more up close than my colleagues who are mental health clinicians. The most difficult disorder someone had that I supported was animal hoarding. Just so horrible for everyone involved, especially the animals. It broke my heart and was honestly the first time I felt there wasn't hope for someone. The look in the animals' eyes still haunts me."

— Sheilahasaname

8. "Anything where self-awareness is distorted or not really present. Really smart, talented folks who can talk about the same life-wrecking beliefs, behaviors, or distorted perspectives for years without being able to understand their own role in their suffering."

— Dandelion-Fluff-

9. "I would say any disorder that they are not willing to admit the problem. That would be substance use, restrictive eating disorders, personality disorders, or folks that engage in emotional avoidance. That limits so much of the work that we can do if they are willing to feel their feelings.

10. "I’m a therapist, and honestly for me it’s chronic depression. All of the things that would help with being depressed are too difficult for people with chronic depression to find the motivation for, and upkeeping positive habits is constant. Medication is a band-aid and honestly just numbs some people even more. It's really hard to treat people who believe to their core there is no point and can’t find joy in life, and I really wish there was more I could do for them."

— Gullible-Spare-749

11. "I’m not a mental health professional, but I work in an adjacent field (I’m a neurologist, mostly research-oriented), but my research has lots to do with the mechanics of the brain and mood disorders. I followed someone for a year (car accident victim with severe concussion and borderline personality disorder). My close friend was her attending physician, so we often shared notes. This cocktail of TBI plus BPD was incredibly difficult to treat, extremely difficult to make progress on… I’ve treated a number of people with acute TBI and depression; it makes me wonder about “chicken and egg."

— Content-Car8811

12. "The disorders that patients are in denial about. It could be any disorder. Examples include a bipolar patient insisting they have ADHD, someone who has a personality disorder they refuse to go to therapy for, people not taking their medications because they feel better (spoiler alert, they feel better because of the medications), patients who think that meds do all the heavy lifting and they don’t have to change anything else, and patients who cannot or will not change their environment/situations contributing to the symptoms so they’re stuck in a loop. A lot of patient success isn’t just their medications; it’s their readiness to change and apply that change. If that is lacking, there’s only so much a pill will fix. Then I’m the bad guy when the meds aren’t fixing their broken marriage, trauma history, bad work environment, etc."

— _pickledpickles

13. "There’s a lot of good insight in this thread, all of which I agree with, so I’m going to throw in something I haven’t seen yet. Dependent personality disorder. A pillar for mental health/helping professionals is empowering clients to make decisions for themselves, often centering clients as the “experts of their situation.” Oftentimes we see clients who, for whatever reason only they truly understand, are not in a place where they can engage with your help (or help in general). In those instances, you/your organization might have a policy in place that helps them transition out or at least gives them space. These policies help prevent burnout, as it can get pretty exhausting pouring yourself into someone who’s not ready to receive that energy."

14. "Personality disorders can be incredibly challenging to work with, but antisocial PD combined with a victim complex in particular is quite tough. Many clients have a trail of people they’ve hurt behind them with no acknowledgement that they did anything wrong. Rather, they believe they were the ones who were wronged, and when confronted with reality, they can cycle through every possible excuse, explanation, etc. to attempt to flip the script back in their favor. You can “get to know” a client who realistically does not exist; you simply know their “therapy persona." If you discover this and attempt to deconstruct it, severe anger emerges. Incongruence is constant for these clients. How can you treat someone who is completely unwilling to entertain the idea that they may not be the victim but rather the abuser?"

— ifearbears

15. "Borderline personality disorder. The deeply held core beliefs and complex trauma make it very difficult to address and heal. It is not a defect in the individual but childhood programming and trauma that create an identity that is difficult to break away from."

— seeshellovesthesea

16. "Part of addiction is relapse—it’s not addiction if it’s easy to quit. This means that it can feel really hard to work with because progress can be so up and down; sometimes you’re not really sure if the work is making a difference and the stakes feel really high since addiction is so damaging to people’s lives and wellbeing."

— jemjerrica

17. "I'm just a clinical admin on a psych ward, but I find the Histronic PDs really difficult. The only patient who has assaulted me had HPD, and I find her difficult. I'm still polite to her, but yeah. We had another patient with HPD, and he always asked me sex questions, and I had to get visitors to wait at the desk with me instead of in the chairs if he was around because he'd ask them sexually invasive questions. In my personal life, bipolar has been the hardest, but I think that was just because of the specific person."

— Few_Cup3452

18. "The saddest I've ever been for a client was meeting a 19-year-old who has 'reality monitoring' issues. Basically, she can’t tell the difference between her dreams/imagination/memories and the real world. For instance, yesterday she was upset because she remembered her senior year of high school; she didn’t see her friend. To her, that was real life, happening right now. Imagine having to relive the bad moments of your life in 4K, to the point it takes over what's actually happening in front of you."

— CommunistBarabbas

19. "Clients who have spontaneous confabulations (false memories that they believe to be true) are very difficult to work with. They will often become paranoid of those around them and lack insight into their condition. These are usually people who have Korsakoff's syndrome or an ABI."

— lacifx

20. "I have a difficult time with patients with chronic pain or chronic body dysfunction. They will come to therapy and try to work with me, but they will also stick to medicine, hoping for the one saving procedure/medication/surgery. That and obsessive thinking."

— AlexanderPerchov

21. "Severe OCD. It starts off with rational fears at the very beginning until it balloons to be larger than anything you could imagine. And it's incredibly challenging to break through the psychological spirals folks can have. It can be absolutely debilitating for many. It's one of the few diagnoses that being admitted into inpatient treatment has the potential to do more harm than good, so there's a lot of risk analysis that has to be done to ensure they're getting the right level of care. But what's extra challenging is if the OCD is debilitating enough, it leads them to having ideation of harming themselves or others. That can happen too."

— PoeticSplat

After reading these stories, I sincerely hope that people who are suffering with such illnesses are able to get the treatment they require. If you are a doctor or mental health professional with similar stories, please let us know in the comments.

The National Alliance on Mental Illness helpline is 1-800-950-6264 (NAMI) and provides information and referral services; GoodTherapy.org is an association of mental health professionals from more than 25 countries who support efforts to reduce harm in therapy.