Severe and enduring anorexia nervosa: Can risk of persisting illness be identified, and prevented, in young patients?

Abstract

Long-term outcome studies of anorexia nervosa (AN) have demonstrated that up to 20% of cases will follow an unremitting course despite many attempts at symptom-based treatments. The objectives of this study are to identify in a younger age group with AN whether persistent illness can be identified early and prevented. An extensive literature review of such studies published in Pubmed was conducted. This review revealed that these studies have generally been conducted in adult patients who have been chronically ill over many years. Despite that fact that there is little published evidence on severe and persistent illness in a younger rage group, there are important clinical questions to consider in such a group of AN individuals. This commentary attempts to answer these questions, often in the absence of research evidence. These questions include whether it is possible to identify those who will go on to develop a severe, enduring course; whether early intervention can prevent the development of a such a course; and whether a focus on quality of life rather symptom alleviation is appropriate for a younger age group of unremitted sufferers. In the absence of research that that clearly informs these questions, the authors are left to recommend answers to these question based on a case by case interrogation of relevant factors, including the presence of the risk architecture to which AN has been strongly linked, the age of the patient, the wishes of the family and importantly, the opinions of expert bioethicists and clinicians sufficiently knowledgeable about the psychopathology, natural history, and treatment of AN to be able to render an informed decision.