Outcomes of Severe and Enduring Anorexia Nervosa

Abstract

A significant minority of individuals with eating disorders suffers with symptoms for more than 5 years (American Psychiatric Association, Diagnostic and statistical manual of mental disorders (DSM-5), American Psychiatric Pub, 2013). While most of those diagnosed with anorexia nervosa (AN) recover within 5 years of onset, others are more long-standing and have difficulty responding to established interventions (Wonderlich et al., Int J Eat Disord 45(4):467–475, 2012). Severe and enduring AN (SE-AN) is a term that refers to chronic AN, typically 7 years or longer in duration. Outcome data have shown that 7 years marks a plateau in course of illness trajectories, where recovering becomes less likely (Robinson, Severe and enduring eating disorders: a need for some new ideas, paper presented at the eating disorders international conference, London, 2010). SE-AN is by definition severe in nature, and treatment is imperative. However, research guiding the selection of targeted intervention for this population is scant. Consequently, clinicians often view individuals with SE-AN with little optimism and few positive expectations. This chapter will review the available literature to date about SE-AN. The aims of the current chapter are to: (1) empirically define SE-AN, (2) discuss the functional outcomes of those with a chronic history of AN, (3) describe various intervention strategies that show promise, and (4) summarize a randomized controlled trial (RCT) comparing two types of treatment for SE-AN (Touyz et al., Psychol Med 43(12):2501–2511, 2013). Our review and conclusions highlight the challenges with the current literature, the importance of continuing research on this topic, and the need to set more realistic treatment goals with this population.