Moving from “I know it when I see it” to an empirical classification of severe and enduring anorexia nervosa: Commentary on Wonderlich et al. (2020)
Abstract
Severe and enduring anorexia nervosa (SE‐AN) is well known to clinicians who treat eating disorders, especially in adults, yet an empirically validated definition of SE‐AN is lacking. Current approaches to delineating SE‐AN rely on expert opinion, and there is little consensus regarding the criteria that distinguish SE‐AN from other clinical presentations or the thresholds that define the boundaries of severity and enduringness. Empirical classification techniques and clinical staging frameworks that incorporate biomarkers offer intriguing alternatives to expert consensus in refining the definition of SE‐AN. Empirical approaches, such as latent class analysis and taxometric analysis, have contributed to advances in eating disorders classification, including support for distinctions between eating disorder classes. Likewise, clinical staging models are being applied to other psychiatric disorders and offer a framework for incorporating biological indices of illness progression, such as neurocognitive changes, into a definition of SE‐AN. Though some of these methods (e.g., biomarkers) are a long way from being realized, the need for an evidence‐based approach to classifying SE‐AN is clear. Without it, the challenges outlined by Wonderlich et al. (International Journal of Eating Disorders, 2020) will be difficult to resolve, and the burden of SE‐AN on patients, their loved ones, and the healthcare system will continue.
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SEED 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 [110]
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- Authors
- Wildes, J. E.
- Affiliations
- University of Chicago (US)
- Corresponding author
- Wildes, Jennifer E.
- ORCID
- Wildes, Jennifer E.
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2020-06-04
- Volume
- 53
- Issue
- 8
- Pages
- 1315-1317
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W3032309292
- Cited by
- 7
- References
- 14
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2020: 1
- FWCI
- 0.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- severe and enduring anorexia nervosa, anorexia nervosa, eating disorder classification, empirical classification, latent class analysis, taxometric analysis, clinical staging, biomarkers, disease severity, disease duration, adult anorexia nervosa
- MeSH terms
- Adult, Anorexia Nervosa, Feeding and Eating Disorders, Humans
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