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Long illness duration does not mean an eating disorder is irreversible.

Intensive, integrated care may improve outcomes in longstanding eating disorder.

Healthy weight restoration and continuity of care appear especially important.

For many years, some people with anorexia nervosa and other eating disorders who remained ill despite repeated treatments were described as having a “severe and enduring eating disorder.” The term was intended to identify people with complex and persistent illness. But it also carried a risk: The word enduring can easily be interpreted as permanent.

That matters. If clinicians, patients, or families begin to believe that an eating disorder is unlikely to improve simply because it has lasted many years, therapeutic expectations may gradually shift from recovery toward resignation.

A recent systematic review published in the Journal of Eating Disorders challenges this assumption. The review examined recent studies of adults with severe and longstanding eating disorders and found an important message: The duration of an eating disorder, by itself, does not reliably predict poor treatment outcome.

From “enduring” to “longstanding”

One of the first issues raised by the review is terminology. There is no universally accepted definition of “severe and enduring anorexia nervosa.” Different studies have used arbitrary illness-duration thresholds of three, five, or seven years. Some definitions have also included previous unsuccessful treatments, low weight, or persistent psychopathology. More importantly, people with lived experience have questioned whether the term enduring unintentionally suggests irreversibility.

For this reason, the authors suggest using the........

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