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We carried out a preliminary qualitative study (using Thematic Analysis) of patients with severe and enduring anorexia nervosa (SEED\u2010AN) in which we undertook recorded interviews in eight participants whose conditions had lasted 20\u201340\u2009years. We found 15 principle features in physical, psychological, social, family, occupational and treatment realms. Psychological and social realms were most affected. Severe physical problems were reported. They described feelings of unworthiness, frugality regarding money and obsessive time\u2010keeping. Persisting with negligible social networks, participants described depression and hopelessness, while somehow achieving a sense of pride at their endurance and survival in spite of the eating disorder. They emphasized the importance of professional help in managing their care. The severe and enduring description, often reserved for people with psychotic illness, is appropriately applied to SEED\u2010AN, which has major impacts in all realms. Copyright \u00a9 2015 John Wiley &amp; Sons, Ltd and Eating Disorders Association.<\/jats:p>","DOI":"10.1002\/erv.2367","type":"journal-article","created":{"date-parts":[[2015,6,10]],"date-time":"2015-06-10T16:55:19Z","timestamp":1433955319000},"page":"318-326","source":"Crossref","is-referenced-by-count":89,"title":["Severe and Enduring Anorexia Nervosa (SEED\u2010AN): A Qualitative Study of Patients with 20+ Years of Anorexia Nervosa"],"prefix":"10.1002","volume":"23","author":[{"given":"Paul H.","family":"Robinson","sequence":"first","affiliation":[{"name":"Barnet Enfield and Haringey Mental Health Trust  UK"},{"name":"University College London  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roza","family":"Kukucska","sequence":"additional","affiliation":[{"name":"Barnet Enfield and Haringey Mental Health Trust  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Guidetti","sequence":"additional","affiliation":[{"name":"Barnet Enfield and Haringey Mental Health Trust  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Leavey","sequence":"additional","affiliation":[{"name":"University College London  UK"},{"name":"Ulster University  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,9]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.74"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20546"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.975"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/erv.1080"},{"key":"e_1_2_5_7_1","unstructured":"British Psychological Society. 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