Chronic Anorexia Vs. Terminal Anorexia

The recent article about Anorexia Nervosa in the New York Times informed its readers about the severe medical consequences of this illness. In fact, the article made the case that some people with Anorexia might do best with palliative care, perhaps even assisted suicide.

For a clinician who treats people with eating disorders, the article did not talk about anything new in the field but focused largely on the most extreme cases.

The two doctors the article highlighted work on the medical floor which treats the most acutely sick patients in the country, aptly names ACUTE. Doctors know to send the patients in need of highly skilled medical care for eating disorders to this ward. I have worked with them many times, and they are uniquely able to shepherd these patients to a medically stable place for residential treatment.

Accordingly, these doctors also see a larger percentage of the sickest patients, including some who are so chronically ill that they may either need care to help manage severe intractable symptoms and may not survive their hospitalization.

Clinicians in private practice also see patients this sick who may refuse to go to ACUTE or be ineligible due to insurance issues. Some of these patients also won’t survive their eating disorder.

Calling the illness these most severe patients have terminal Anorexia as opposed to chronic Anorexia is dangerous. Since the ACUTE doctors don’t follow the most ill patients with Anorexia long term, only during their weeks long hospitalization, they may not have appropriate perspective to coin a new diagnosis.

Some patients with chronic Anorexia do need management of their medical symptoms, without hope of recovery, and some are not able to survive. However, a number of patients I have seen who would have qualified for this new term not only survived but fully recovered, and a few of them went to ACUTE as well.

I’ll link an old post from this blog about Chronic Anorexia as a counterpoint to the article.

An article read by many people about the severity of Anorexia is useful for general knowledge and understanding about this illness. However, using the platform to expound on a new diagnosis without consulting doctors in the field is risky.

Any new direction in diagnosis and treatment needs to rely on a consensus of clinicians, not the opinions of a couple of knowledgeable doctors with a narrow lens on the field.