{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T07:09:11Z","timestamp":1790752151956,"version":"4.1.0"},"reference-count":59,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T00:00:00Z","timestamp":1581897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["PB\u2010PG\u20100712\u201028041"],"award-info":[{"award-number":["PB\u2010PG\u20100712\u201028041"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Eating Disorders"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We explored the utility of \u201cstaging\u201d anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12\u2010month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We conducted secondary analyses on data from a multisite clinical trial of adults with AN (<jats:italic>n<\/jats:italic> = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: \u201cearly stage\u201d (illness duration &lt;3\u2009years; <jats:italic>n<\/jats:italic> = 60) and \u201csevere and enduring\u201d stage (SE\u2010AN; <jats:italic>n<\/jats:italic> = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS \u226560) and illness duration (\u22657\u2009years).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work\/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE\u2010AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work\/social adjustment at baseline, and lower rates of improvement in work\/social adjustment at 12 months compared to \u201cearly stage\u201d respondents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision\u2010making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.23246","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T08:03:41Z","timestamp":1581926621000},"page":"1337-1348","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":97,"title":["A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of \u201cearly stage\u201d versus \u201csevere and enduring\u201d classification"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7975-1971","authenticated-orcid":false,"given":"Suman","family":"Ambwani","sequence":"first","affiliation":[{"name":"Department of Psychology Dickinson College  Carlisle Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7763-7099","authenticated-orcid":false,"given":"Valentina","family":"Cardi","sequence":"additional","affiliation":[{"name":"Section of Eating Disorders, Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6981-6273","authenticated-orcid":false,"given":"Gaia","family":"Albano","sequence":"additional","affiliation":[{"name":"Section of Eating Disorders, Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"},{"name":"Department of Psychology Educational Sciences and Human Movement, University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Cao","sequence":"additional","affiliation":[{"name":"Sanford Center for Biobehavioral Research  Fargo North Dakota USA"},{"name":"Department of Psychiatry and Behavioral Sciences University of North Dakota School of Medicine and Health Sciences  Fargo North Dakota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9131-1629","authenticated-orcid":false,"given":"Ross D.","family":"Crosby","sequence":"additional","affiliation":[{"name":"Sanford Center for Biobehavioral Research  Fargo North Dakota USA"},{"name":"Department of Psychiatry and Behavioral Sciences University of North Dakota School of Medicine and Health Sciences  Fargo North Dakota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Section of Eating Disorders, Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1335-1937","authenticated-orcid":false,"given":"Ulrike","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Section of Eating Disorders, Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0871-4596","authenticated-orcid":false,"given":"Janet","family":"Treasure","sequence":"additional","affiliation":[{"name":"Section of Eating Disorders, Department of Psychological Medicine Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eatbeh.2012.09.002"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22173"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.74"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20546"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.18101125"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000485182"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22715"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12382"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2016.11.006"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-0701-6"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291719002824"},{"key":"e_1_2_9_13_1","first-page":"3","article-title":"Severe and enduring Anorexia Nervosa: A brief narrative review about the concept and its therapeutic options LETTER TO THE EDITOR Citation: Coutinho et al. Severe and enduring Anorexia Nervosa: A brief narrative review about the concept and its therapeutic options INTERN ATIONAL JOURNAL OF AND CLINICAL NEUROSCIENCES MENTAL HEALTH Severe and enduring Anorexia Nervosa: Concepts and therapeutic options","volume":"6","author":"Coutinho F.","year":"2019","journal-title":"International Journal of Clinical Neurosciences and Mental Health"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20309"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-021531"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20956"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.15m10393"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20215"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2017.10.008"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12881"},{"key":"e_1_2_9_22_1","unstructured":"Geller J. Goodrich S. Chan K. Cockell S. &Srikameswaran S.(n.d.).Clinical practice guidelines for the BC eating disorders continuum of services. Retrieved fromhttp:\/\/mh.providencehealthcare.org\/sites\/default\/files\/BCEating Disorders Clinical Practice Guidelines.pdf"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004867414555814"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1092852917000529"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/10640266.2012.668480"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(17)30076-7"},{"key":"e_1_2_9_27_1","volume-title":"Manual for the depression anxiety and stress scales","author":"Lovibond S.","year":"1995"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2508"},{"key":"e_1_2_9_29_1","volume-title":"Behavioral psychotherapy","author":"Marks I.","year":"1986"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2579"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2414"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(03)00161-X"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23137"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23187"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-018-0195-1"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291718002088"},{"key":"e_1_2_9_37_1","unstructured":"NHS England. (2019).Adult eating disorders: Community inpatient and intensive day patient care \u2013 Guidance for commissioners and providers. Retrieved fromhttps:\/\/www.england.nhs.uk\/publication\/adult-eating-disorders-community-inpatient-and-intensive-day-patient-care-guidance-for-commissioners-and-providers\/"},{"key":"e_1_2_9_38_1","unstructured":"NICE. (2004).Eating disorders \u2013 Core interventions in the treatment and management of anorexia nervosa bulimia nervosa and related eating disorders. NICE Clinical Guideline No 9. London UK. Retrieved fromhttp:\/\/www.nice.org.uk"},{"key":"e_1_2_9_39_1","unstructured":"NICE. (2017).Eating disorders: Recognition and treatment. (NC69). London UK. Retrieved fromhttps:\/\/www.nice.org.uk\/guidance\/ng69"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.425"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000319"},{"key":"e_1_2_9_42_1","volume-title":"Severe and Enduring Eating Disorder (SEED): Management of complex presentations of anorexia and bulimia nervosa","author":"Robinson P.","year":"2009"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1192\/bja.2017.2"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-014-0030-2"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1987.01800240021004"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000019"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1348\/014466505X53902"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22739"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2633"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2010.08.005"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23095"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291713000949"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/2050-2974-1-13"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12170"},{"key":"e_1_2_9_55_1","unstructured":"Treasure J. Willmott D. Ambwani S. Cardi V. Clark Bryan D. Rowlands K. &Schmidt U.(under review).Cognitive interpersonal model for anorexia nervosa revisited: The perpetuating factors that contribute to the development of the severe and enduring illness."},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(16)30147-X"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22651"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20978"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2018.00158"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61746-8"}],"container-title":["International Journal of Eating Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Feat.23246","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/eat.23246","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/eat.23246","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/eat.23246","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T07:35:52Z","timestamp":1693899352000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/eat.23246"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,17]]},"references-count":59,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1002\/eat.23246"],"URL":"https:\/\/doi.org\/10.1002\/eat.23246","archive":["Portico"],"relation":{},"ISSN":["0276-3478","1098-108X"],"issn-type":[{"value":"0276-3478","type":"print"},{"value":"1098-108X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,17]]},"assertion":[{"value":"2019-11-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}