"Terminal anorexia nervosa" may not be terminal: An empirical evaluation
Gaudiani et al. (2022) presented terminal anorexia nervosa (T-AN) as a potential new specifier to the anorexia nervosa (AN) diagnosis, with criteria including (a) AN diagnosis, (b) age > 30 years, (c) previously participated in high-quality care, and (d) the clear, consistent determination by a patient with decision-making capacity that additional treatment would be futile, knowing death will result. This study’s purpose was to empirically examine a subgroup of participants with AN who met the first three criteria of T-AN—and a smaller subset who also met a proxy index of the fourth criterion involving death (TD-AN)—and compare them to an adult “not terminal” anorexia nervosa (NT-AN) group and to a “not terminal” subset 30 years of age or older (NTO-AN). Patients at U.S. eating disorder treatment facilities (N = 782; T-AN: n = 51, TD-AN: n = 16, NT-AN: n = 731, NTO-AN: n = 133), all of whom met criteria for a current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of AN, were compared regarding admission, discharge, and changes from admission to discharge on physiological indices (i.e., white blood cell counts, albumin levels, aspartate aminotransferase levels, and body mass index), as well as self-report measures (i.e., eating disorder, depression, anxiety, and obsessive-compulsive symptoms). In contrast to the tight syndromal symptom interconnections of, and inevitable spiral toward death expected for, a terminal diagnosis, results suggest substantial variability within the T-AN group and TD-AN subset, and an overall trend of improvement across physiological and self-report measures. This study thus provides some empirical evidence against the specification of the T-AN diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Impact Statement
General Scientific Summary—“Terminal” is a proposed new specifier for an anorexia nervosa (AN) diagnosis with the following criteria: (a) diagnosis of AN, (b) over 30 years old, (c) previously repeatedly sought high-quality treatment, and (d) desire to fatally discontinue treatment. This study empirically scrutinizes the “terminal” label for AN by comparing those with AN who meet the “terminal” criteria to those who do not. Findings here suggest that the groups meeting three-criteria T-AN (as well as those meeting a proxy of the fourth criterion) show substantial variability in admission, discharge, and treatment response on physiological and self-report measures, overall indicating improvement that is inconsistent with a terminal pattern for this group. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
