‘If someone has had an eating disorder for more than 5 years it is usually described as severe and enduring. Evidence shows it is much harder to recover from a long term eating disorder.  However it does happen and maintaining hope can be very important for everyone’ (source Edanz)

The general treatment for Severe and Enduring – Eating Disorders (SE-ED) is about improving the quality of life for the person with the eating disorder.  How they can live a more comfortable and fulfilled life and manage the eating disorder.  Therapy and treatment revolves more around keeping the person safe and addressing key areas in their life that they would like to improve.  The importance of a therapist that ‘walks beside’ the person with the eating disorder is emphaised.

See recent study

Professional Help: Specialist Supportive Clinical Management

A severe and enduring eating disorder can be fatal.  That is why it is absolutely vital for you – as a carer of someone with a severe and enduring eating disorder – to seek high quality professional support. It is recommended to consider SSCM (Specialist Supportive Clinical Management) for that support. SSCM is a combination of clinical management and supportive psychotherapy. SSCM includes paced and customised education, professional care and practical assistance. It focuses on coping strategies that address the beliefs about the disorder rather than focusing on symptoms.

Aims Of SSCM Treatment

Unless low weight is placing the person with the eating disorder at immediate risk to life, weight gain is not a priority. Focus on weight-grain can create psychological barriers. There can also be a tendency, when weight is regained, for the person to drop out of therapy before underlying causes are properly worked through. The person with the eating disorder is generally more motivated – and more positive change occurs – when focusing on building a meaningful and enjoyable life, rather than on changing their eating patterns or monitoring weight.

Why Weight Gain is Not a Priority

Through SSCM, the desired outcome is an improved quality of life and physical well being. More specifically, aims may include the following:

  • Keeping people in services
  • Self harm minimisation
  • Manage neuro-cognitive complications
  • Avoidance of further failure experience
  • Increasing motivation levels and sense of future direction
  • Managing co-morbidity
    (i.e. one or more additional disorders co-occurring withthe primary disorder)
  • Encourage engagement with life, relieve boredom and experience enjoyment

The Therapeutic Relationship

Through a positive therapeutic SSCM relationship with an ED professional or ‘coach’, the person with the eating disorder is more likely to stick a treatment plan. The relationship can be seen as a collaborative partnership between the therapist and the person with the eating disorder, who is considered an expert in their own care. Through this partnership, an exploration of practical steps is used to initiate change in daily life. This is done in an organised manner with manageable time-framed strategies towards agreed-to specific behavioural goals. With this said, flexibility must be applied when needed.
The therapist provides a sense of hope, along with consistency, reassurance, encouragement, and patience. Ultimately, sessions aim to help individuals reach their fullest potential in life.

Talk it through with…

Eating Disorders Association’s free counsellor:
07 3077 7320 Monday – Thursday 9-4pm (Queensland only)

Severe And Enduring Anorexia Nervosa (SE-AN): In Search Of A New Paradigm
Stephen Touyz & Phillipa Hay (School of Psychology, University of Sydney, AUST)
Published online 31 July 2015

Journal of Eating Disorders [UK]
Looks at result of study into CBT-AN and SSCM; a more technical read but helpful to gain an understanding.

Read Article Here

Taking New Approaches to Difficult-to-Treat Patients

Eating Disorders Review
July/August 2011 Volume 22, Number 4 ©2011 Gürze Books [UK]
Highlights from The 10th London International Eating Disorders Conference, held at the University of London late in March 2011, clinicians in concurrent sessions addressed three particularly challenging topics: managing compulsive exercise, treating patients with severe and enduring anorexia nervosa (AN), and treating eating disorders patients who have a history of childhood trauma.

Read Article Here

Predictors of therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa. Journal of Eating Disorders2016

Colleen Stiles-Shields, Bryony H. Bamford, Stephen Touyz, Daniel Le Grange, Phillipa Hay and Hubert Lacey

Read Article Here

Taking New Approaches to Difficult-to-Treat Patients

Eating Disorder Review, Current Clinical Information for Professional Treating Eating Disorder. Dr. Bryony Bamford, of St. George’s Hospital, University of London

Read Article Here

Talk it through with…

Eating Disorders Association’s free counsellor:
07 3077 7320 Monday – Thursday 9-4pm (Queensland only)
Butterfly Foundation Support Services Monday to Friday 8am – 9pm AEST

  1. ED HOPE 1800 33 4673
  2. Web counselling thebutterflyfoundation.org.au/web-counselling
Or encourage your loved one to call The Eating Issues Centre on 07 3844 6055 for information and support Tuesday – Friday 9-4pm (Queensland only).
If you would prefer to email we will respond to you during office hours mailto:admin@eda.org.au