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Those with longstanding eating disorders are commonly labelled \u2018severe and enduring\u2019 (SEED), which has been challenged for its conceptual vagueness and potential to discourage patients. Attempts to define individuals from this cohort as having \u2018terminal\u2019 illness have also gained traction in recent years. This paper is grounded in lived\/living experience and relevant research. It challenges the logical coherence and utility of SEED, arguing that the word \u2018enduring\u2019 unhelpfully situates intractability of longstanding illness within patients themselves and the nature of their illness. This risks a sense of inevitability and overlooks the important role of contextual factors such as lacking resources and insufficient evidence for withholding active treatment. Recommendations suggest approaches to dismantling unhelpful binaries between early intervention and intensive support, recovery and decline.<\/jats:p>","DOI":"10.1192\/bjb.2023.38","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T04:07:04Z","timestamp":1686197224000},"page":"177-181","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":29,"title":["Care pathways for longstanding eating disorders must offer paths to recovery, not managed decline"],"prefix":"10.1192","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4321-8574","authenticated-orcid":false,"given":"James","family":"Downs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2023,6,8]]},"reference":[{"key":"S2056469423000384_ref33","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2787"},{"key":"S2056469423000384_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2018-135658"},{"key":"S2056469423000384_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30423-5"},{"key":"S2056469423000384_ref16","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201100050"},{"key":"S2056469423000384_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(21)00094-8"},{"key":"S2056469423000384_ref14","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23495"},{"key":"S2056469423000384_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23486"},{"key":"S2056469423000384_ref27","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000319"},{"key":"S2056469423000384_ref19","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20369"},{"key":"S2056469423000384_ref31","doi-asserted-by":"publisher","DOI":"10.1002\/erv.425"},{"key":"S2056469423000384_ref18","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22715"},{"key":"S2056469423000384_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/B978-012654050-5\/50016-6"},{"key":"S2056469423000384_ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-022-00620-y"},{"key":"S2056469423000384_ref9","unstructured":"9 NHS Digital. Hospital Admissions with a Primary or Secondary Diagnosis of Eating Disorders. NHS Digital, 2022 (https:\/\/digital.nhs.uk\/supplementary-information\/2022\/hospital-admissions-with-a-primary-or-secondary-diagnosis-of-eating-disorders)."},{"key":"S2056469423000384_ref17","doi-asserted-by":"publisher","DOI":"10.1002\/erv.2367"},{"key":"S2056469423000384_ref25","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-022-00729-0"},{"key":"S2056469423000384_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.mce.2018.12.014"},{"key":"S2056469423000384_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2021.07.014"},{"key":"S2056469423000384_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00040-7"},{"key":"S2056469423000384_ref37","unstructured":"37 Parliamentary and Health Service Ombudsman. Ignoring the Alarms: How NHS Eating Disorder Services Are Failing Patients. The Stationery Office, 2017 (www.ombudsman.org.uk\/sites\/default\/files\/page\/FINAL%20FOR%20WEB%20Anorexia%20Report.pdf)."},{"key":"S2056469423000384_ref34","article-title":"Please see the whole picture of my eating disorder","volume":"372","author":"Downs","year":"2021","journal-title":"BMJ"},{"key":"S2056469423000384_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2018.10.001"},{"key":"S2056469423000384_ref12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.2458"},{"key":"S2056469423000384_ref5","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0000000000000641"},{"key":"S2056469423000384_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-022-00648-0"},{"key":"S2056469423000384_ref11","doi-asserted-by":"publisher","DOI":"10.31234\/osf.io\/6eszj"},{"key":"S2056469423000384_ref30","doi-asserted-by":"publisher","DOI":"10.3390\/nu13114158"},{"key":"S2056469423000384_ref24","doi-asserted-by":"publisher","DOI":"10.1186\/s40337-022-00548-3"},{"key":"S2056469423000384_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2009.10.003"},{"key":"S2056469423000384_ref15","unstructured":"15 Kelly, J. , Whitfield, J . 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