Severe and enduring eating disorders (SEED)

Background: Severe enduring eating disorders (SEED) encompass longstanding presentations of anorexia nervosa and bulimia nervosa and is among the most impairing (physical, emotional, fiscal, and social) of all mental illnesses. SEED was first described in the 1980s, however inadequate research persists to support labeling, nosology, and define treatment. Body: This chapter provides an overview of SEED and explores current issues, limitations, and directions for future research, while offering a position on nosology, assessment, medical, and psychological management. Given limitations in defining optimal treatments, a recovery approach and person-centered care are described for SEED, together with ethical considerations. Conclusion: Much remains unknown about SEED, including defining features and mechanisms of illness persistence such that conceptualizations and treatments can be meaningfully progressed. In recent years, there has been increased funding for eating disorders in some countries, including for research, together with publication of clinical practice guidelines to include SEED and the first quality standards for eating disorders. These invite hope for the future development and improved delivery of care and services for all concerned, extending to SEED.