Background: Patients with severe and enduring anorexia nervosa (SE-AN) frequently challenge clinicians with difficult dilemmas: at times SE-AN patients may be literally starving, but they may resolutely refuse to gain weight or be admitted for medical assistance. This presentation will consider circumstances when it might make sense to relax the “aim for a cure”, and even say “enough is enough”, accepting the patient’s wishes if that means accepting that the patient will almost certainly die. When does it no longer makes sense to insist on hospitalization? At what point might SE-AN patients be considered for palliative care?
Objectives:
By the end of this presentation participants will be able to describe and discuss:
1. Definitions, clinical characteristics, psychological attitudes, and common comorbidities of patients with severe and enduring anorexia nervosa (SE-AN).
2. Internal and external factors beyond clinical characteristics entering clinicians’ “neuro-economic” assessments in determining recommended treatments for patients with SE-AN.
3. Perverse incentives to be recognized and avoided in the treatment of patients with SE-AN.
I. Introduction of Problem
II. Definition and Description of Severe and Enduring Anorexia Nerovs
III. Presentation of Illustrative Clinical Cases
IV. Management questions facing clinicians
V. Management principles underlying clinical decision-making
VI. Clinical, social, economic and other potentially competing interests affecting decision-making
VII. High vs low-intensity treatments
VIII. Interplay of clinician, patient, family, institutional and economic forces in course and outcome
Professor of Psychiatry, University of Colorado School of Medicine; Professor Emeritus, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA; Past Director, Adult Eating Disorders Program, UCLA Neuropsychiatric Institute Professor Emeritus, University of New Mexico School of Medicine; Past President, Academy for Eating Disorders; Past Chair, American Psychiatric Association Practice Guidelines for the Treatment of Eating Disorders (first three editions); Past Chair, Clinical and Scientific Council, National Eating Disorders Association (NEDA); Founding Editor-in-Chief Emeritus, Eating Disorders Review; Editorial Board – International Journal of Eating Disorders; Publications – More than 300 peer reviewed journal articles. book chapters; eight edited books.
