From Across the Desk: Working toward Better Guidelines for Severe and Extreme Eating Disorders

Vol. 30 / No. 1 — Eating Disorders Review

It is well known that the mortality rate from anorexia nervosa makes it the most deadly of psychiatric illnesses.  Two articles this month turn to the challenging task of matching the level of care to severe eating disorders. Jeana Cost and Philip Mehler, of the Eating Recovery Center in Denver (“Level of Care Considerations for Severe and Extreme Eating Disorders”) note that historically clinicians have followed the guidelines from the American Psychiatric Association but, as the authors note, the guidelines fail to outline medical treatment for these patients. The authors offer helpful guidelines, including considerations for patients with normal to higher body mass indices, and stress the importance of medical stabilization.

In the article, “Finding a Better Definition for Severe and Enduring Anorexia Nervosa,”Phillipa Hay and Stephen Touyz lament the lack of consensus for clear-cut definitions of severe AN and for recovery. They offer three components of severe and enduring anorexia nervosa. They would also like to delete the term “treatment resistant,” which they feel blames the physician and patient for the disorder.  The first-look release of the ICD-11 at the World Health Assembly in May might offer some solutions, according to Drs. Hay and Touyz.