Severe and enduring Anorexia Nervosa: a brief narrative review about the concept and its therapeutic options

Anorexia Nervosa (AN) is a severe psychiatric disorder that can present in a chronic and durable form, often named severe and enduring AN (SE-AN), with little available literature considering therapeutic options in this subgroup of patients. We aimed to perform a bibliographic review considering articles about severe or chronic forms of AN published in the last ten years. According to the analyzed data, there are different definitions in the studies concerning SE-AN, however, many authors consider 7-years of disease as a threshold for diagnosing SE-AN. In the future, it will be important to have a standardized definition of SE-AN in order to characterize its preferential approach in large scale studies. Regarding therapeutic options, cognitive-behavior therapy remains a valuable option in these patients, despite the need of some adaptations considering the high probability of past failed psychotherapeutic approaches. Regarding biological therapies, there is now exploration of new possibilities such as the use of transcranial magnetic stimulation and deep brain stimulation in these patients. However, research towards these approaches is still in its beginnings, with need for further studies to characterize their possible role.