Severe and enduring anorexia nervosa: No easy solutions.

There is currently no evidence‐based definition of severe and enduring anorexia nervosa (SE‐AN) with which to reliably inform clinical practice and research. Indeed, data on the effect of AN severity and duration on treatment outcome are inconsistent. A large group of patients with SE‐AN are repeatedly unsuccessfully managed with the available eating disorders treatments and have no access to adequate treatment for their illness. Cognitive behavioral therapy (CBT) adapted for SE‐AN has been designed to enhance quality of life and reduce harm rather than promoting weight gain in such patients, and has had some success. However, a percentage of patients with SE‐AN achieves remission, or at least returns to a normal weight range, with available evidence‐based treatments for eating disorders, such as enhanced CBT (CBT‐E). It would therefore be worth conducting a large‐scale randomized controlled trial comparing CBT adapted for SE‐AN with CBT‐E to assess their relative acceptability; efficacy, including their effect on quality of life and medical stability; cost‐effectiveness; and the treatment response moderators that might allow better matching of patients with SE‐AN to a treatment oriented either to harm reduction or to change. [ABSTRACT FROM AUTHOR]