Managing Patients With Severe and Enduring Anorexia Nervosa

Joel Yager

63 citations0/0 files storedThe Journal of Nervous and Mental Disease

No readable copy stored yet — this record is metadata only.

No open-access location is known for this record yet.

Literature note Cite in a project Citation map

Eating Disorders and Behaviors Nutrition, Health and Food Behavior Child Nutrition and Feeding Issues

Abstract

OBJECTIVE: Approximately 20% of patients with anorexia nervosa develop severe and enduring anorexia nervosa (SE-AN), manifest by decades-long illnesses. At certain points, demoralized and/or based on judicious appraisals of the seeming futility of further professional treatment to radically alter their course, some SE-AN patients decide that "enough is enough" and opt out of intensive treatment. This article considers courses and treatment options available at these stages for patients, families, and clinicians. METHODS: The author uses clinical illustrations, Socratic questioning, and available literature to explore questions of treatment strategies with patients struggling with SE-AN. RESULTS: SE-AN patients have frequently received care in varieties of medical, psychiatric, and specialized eating disorders inpatient, residential, partial hospital, and outpatient treatment settings. Patients may reject further high-intensity treatment for judicious or capricious reasons, but may still accept lower intensity treatments. Some may reject any and all offers of treatment. Clinicians' treatment recommendations, not always coinciding with patients' wishes, are influenced by numbers of clinical, social, and professional pressures, including those from families, treatment settings, regulatory bodies, and payors. CONCLUSIONS: When managing patients with decades-long disease and multiple comorbidities, clinicians must be realistic about the low odds of effecting cure and adjust treatment expectations accordingly. For patients with SE-AN, a variety of low-intensity treatment approaches, at times extending to palliative and hospice care, may be useful. Clinicians should always strive to provide humane comfort and support, as closely aligned to patients' judicious wishes as realistically possible.

Paper brief

Loading…

Cite this work

Citation unavailable for this work.

BibTeX RIS CSL-JSON

No public copy is stored for this record, so only the metadata is cited.

Citations in this library

Citation map →

Stored only when both papers are in the corpus — 63 citations exist upstream.

References

2002The Outcome of Anorexia Nervosa in the 20th Century 2007The Lucifer effect: understanding how good people turn evil 1964Games People Play 2016Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up 2000Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study 2013Epidemiology, course, and outcome of eating disorders 2015Medical Complications of Anorexia Nervosa and Bulimia 2019Psychiatric and medical correlates of DSM‐5 eating disorders in a nationally representative sample of adults in the United States

Cited by

2023A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope 2021Addressing Suffering in Patients With Psychiatric Disorders

Explore the map →

Papers that cite the same references — the relational fallback while embeddings are still backfilling.

Imported from OpenAlex (CC0) — nothing here is generated.