Severe and Enduring Eating Disorders: Concepts and Management

Abstract

The concept of severe and enduring mental illness was introduced in 1999 in order to direct resources to patients suffering from long-term serious disorders, and was suggested for eating disorders in 2009. However, the term is still restricted to patients with long-term psychosis. In this chapter, the concept of severe and enduring eating disorder (SEED) is described and its relevance to anorexia nervosa (AN) and bulimia nervosa (BN) is explored. The recovery curve for anorexia nervosa seems to follow an exponential pattern with an asymptote that approaches but does not meet the horizontal, suggesting that recovery is always possible. Symptoms of AN but not BN seem to worsen after 3 years of illness, perhaps a significant threshold. Symptoms of severe and enduring AN (SEED-AN) are debilitating and longstanding as well as potentially fatal. Symptoms of severe and enduring BN (SEED-BN) are also debilitating, especially in social adjustment. In both conditions, family difficulties are prominent. A clinical approach to SEED is described based on improving quality of life, the recovery approach, (rather than cure) for sufferers and their families is described, although full symptomatic recovery can occur at any stage and clinicians should be alert to the possibility in all patients.