Characterizing severe and enduring anorexia nervosa: An empirical approach
Open accessAbstract
Targeted approaches for the treatment of severe and enduring anorexia nervosa (SE-AN) have been recommended, but there is no consensus definition of SE-AN to inform research and clinical practice. This study aimed to take initial steps toward developing an empirically based definition of SE-AN by characterizing associations among putative indicators of severity and chronicity in eating disorders. Patients with AN (N = 355) completed interviews and questionnaires at treatment admission and discharge; height and weight were assessed to calculate body mass index (BMI). Structural equation mixture modeling was used to test whether associations among potential indicators of SE-AN (illness duration, treatment history, BMI, binge eating, purging, quality-of-life) formed distinct subgroups, a single group with one or more dimensions, or a combination of subgroups and dimensions. A three-factor (dimensional), two-profile (categorical) mixture model provided the best fit to the data. Factor 1 included eating disorder behaviors; Factor 2 comprised quality-of-life domains; Factor 3 was characterized by illness duration, number of hospitalizations, and admission BMI. Profiles differed on eating disorder behaviors and quality-of-life, but not on indicators of chronicity or BMI. Factor scores, but not profile membership, predicted outcome at discharge from treatment. Data suggest that patients with AN can be classified on the basis of eating disorder behaviors and quality-of-life, but there was no evidence for a chronic subgroup of AN. Rather, indices of chronicity varied dimensionally within each class. Given that current definitions of SE-AN rely on illness duration, these findings have implications for research and clinical practice.
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Attempts to empirically validate distinct clinical stages based on severity, chronicity, and response to treatment have been unsuccessful.
“Despite a growing and laudable body of work in this area, attempts to empirically validate distinct clinical stages based on severity, chronicity, and response to treatment have been unsuccessful (108).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [108]
The Discussion reports no evidence for a distinct chronic subgroup, and severity-profile membership was not associated with outcomes at treatment discharge. But it also identifies distinct higher- and lower-severity profiles, so saying empirical attempts to distinguish clinical stages have been unsuccessful without qualification overstates the findings. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSEED and SE-AN have not been validated for clinical use or formally recognized as psychiatric diagnoses by ICD-11 or DSM-5-TR.
“They have not been validated for clinical use or formally recognized as a psychiatric diagnosis by the International Classification of Diseases, 11th Edition (ICD-11) or Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) (105, 108–112).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [108]
The Discussion says there is no consensus definition of severe and enduring eating disorder psychopathology to inform clinical practice, and the paper describes its work as initial steps toward an empirically based definition of SE-AN. That supports the concern about clinical validation, but the copy does not establish that SEED and SE-AN lack validation for clinical use, nor does it address their recognition in ICD-11 or DSM-5-TR. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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- Authors
- Wildes, J. E., Forbush, K. T., Hagan, K. E., Marcus, M. D., Attia, E., Gianini, L. M., & Wu, W.
- Affiliations
- University of Chicago (US)
- University of Kansas (US)
- University of Pittsburgh (US)
- Columbia University (US)
- Corresponding author
- Wildes, Jennifer E.
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2016-12-19
- Volume
- 50
- Issue
- 4
- Pages
- 389-397
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC5386793
- OpenAlex
- W2562571193
- Cited by
- 70
- References
- 40
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 10 · 2023: 2 · 2022: 5 · 2021: 12 · 2020: 12 · 2019: 6 · 2018: 4 · 2017: 5
- FWCI
- 6.69
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K01MH080020 and T32MH096679)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- severe and enduring anorexia nervosa, anorexia nervosa, eating disorder severity, disease duration, binge eating, purging, quality of life, body mass index, treatment outcomes, patient subgroups
- MeSH terms
- Adolescent, Adult, Anorexia Nervosa, Body Weight, Bulimia, Eating, Feeding Behavior, Female, Humans, Male, Prognosis, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Body Mass Index, Bulimia Nervosa, Young Adult, Binge-Eating Disorder
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