This information reflects some key points about longstanding eating disorders. Longstanding eating disorders are sometimes also referred to as ‘chronic’ or ‘severe and enduring’. Most research has focused on longstanding anorexia nervosa.

Background

There is no agreed definition for longstanding eating disorders. Key considerations include a long duration of the illness such as 7 years, persistent and chronic symptoms and treatment resistance. “Treatment resistance”, however, is a problematic description because of how it may carry a sense of blame, as well as not being well understood. Some argue that current treatments for longstanding eating disorders are not meeting people’s needs rather than that they’re resistant.

Impact

There are physical, psychological, social, familial, financial and occupational consequences for those affected. For example:

• Depression and low self-esteem
• Social isolation
• Osteoporosis
• Not being taken seriously
• Difficult family relationships
• Difficulty spending money on oneself
• Being out of work.

Irish research with 6 women observed both potential contributory factors and the impact of longstanding anorexia nervosa and found  

• Feeling overwhelmed at the thought of life without the illness 
• Self-criticism due to not being successful in treatment
• Feeling “stuck”
• Experiencing emotional abuse from parents
• Sexual abuse
• Bullying from peers and teachers
• Intense experiences of abandonment, exclusion and isolation
• Difficulties with activities of daily living, showering, accepting warmth or comfort, spending money
• Wariness and distrust of others, being guarded
• Feeling like a burden to others
• Negative and judgemental experiences with acute frontline services, and a lack of tailored care. 

Treatment experiences

Hospital admissions for people with longstanding eating disorders can be very stressful, sometimes traumatising and felt as punitive. A review of 23 studies noted the following:

• Inpatient treatment programmes provided short-term effective symptom reduction but lacked consistency in long-term results
• Outpatient and day-hospital treatment programmes showed promise for symptom reduction
• Drug interventions had some benefits, for example as adjuvant therapies
• Brain stimulation brought about improvements in depressive symptoms. 
• Other treatments showed mixed results. 

Other research has described some potential improvements 

• Widening treatment goals, putting less emphasis on weight gain, and focusing on quality of life to achieve progress and meaningful positive change
• Addressing weight and eating pathology through minimum weight thresholds for treatment, rather than a focus on weight gain
• Re-establishing social and leisure activities with family and other supportive people
• Encouraging appropriate medical follow up. 

Podcasts