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      ‘Terminal anorexia’: a lived experience perspective on the proposed criteria

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          Abstract

          In an article (Asaria in J Eat Disord 11:107, 2023) recently published by the Journal of Eating Disorders, I expressed my lived experience views on the concept of ‘terminal anorexia nervosa’ (AN), and why I believe that this is a harmful new term. The article was not a response to the original paper in which Gaudiani et al. (J Eat Disord 10:23, 2022) proposed criteria for the label. However, as a result of feedback that my article did not appreciate their criteria, I have written this follow-up paper to build on and reinforce what I previously wrote. This article outlines problems with each criterion in turn, again from my lived experience perspective. It then addresses dangerous ambiguities around how the criteria can be applied safely, and their confusing purpose in the real world. Finally, I discuss the impact of labelling AN sufferers with terms that may suggest their wholehearted allegiance to the illness, in both life and death (or ‘till death do us part’).

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          Most cited references22

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          Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up.

          The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa.
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            Medical Complications of Anorexia Nervosa and Bulimia.

            Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
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              Anorexia nervosa – medical complications

              In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications which are commonly present as part of their eating disorders. Almost every body system can be adversely, affected by this state of progressive malnutrition. Moreover, some of the complications can have permanent adverse effects even after there is a successful program of nutritional rehabilitation and weight restoration. Within this article we will review all body systems affected by AN. There is also salient information about both, how to diagnose these medical complications and which are the likely ones to result in permanent sequelae if not diagnosed and addressed early in the course of AN. In a subsequent article, the definitive medical treatment for these complications will be presented in a clinically practical manner.
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                Author and article information

                Contributors
                alyasaria@gmail.com
                Journal
                J Eat Disord
                J Eat Disord
                Journal of Eating Disorders
                BioMed Central (London )
                2050-2974
                11 December 2023
                11 December 2023
                2023
                : 11
                : 222
                Affiliations
                London, UK
                Author information
                http://orcid.org/0009-0005-8320-2955
                Article
                935
                10.1186/s40337-023-00935-4
                10714550
                38082348
                1d96cc9b-c2eb-4cf3-8c46-ec2130fe4e5c
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 27 July 2023
                : 19 November 2023
                Funding
                Funded by: Springer Nature
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                © BioMed Central Ltd., part of Springer Nature 2023

                anorexia nervosa,cognitive behavioural therapy,compassion,criteria,eating disorder,ego-syntonic,end-of-life,hope,identity,label,lived experience,palliative,terminal,therapeutic alliance,therapeutic relationship,treatment-resistant

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