title: Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence.
abstract: OBJECTIVE
  To examine the evidence to support using a staging heuristic for eating disorders, suggesting that the diagnosis of an eating disorder follows a trajectory across the life course. Specifically, to examine whether high-risk markers and prodromal features presenting in childhood and adolescence can later transition to the full manifestation of the illness in early adulthood, and whether over time, the illness can be described as becoming severe and enduring, often resistant to treatment.
  
  
  METHODS
  We conducted a comprehensive literature search on the MEDLINE, PubMed, PsycINFO, EMBASE and Cochrane databases from using the following terms: staging, duration of illness, early intervention, developmental epidemiology, neurobiological marker, phenotype, partial syndrome, severe enduring, chronic, prospective, longitudinal, cohort, epidemiology, adolescent, adult with anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder. The evidence was organized according to the staging heuristic defined by McGorry.
  
  
  RESULTS
  Evidence from epidemiological studies, neuropsychological findings, treatment responsivity and prognosis, support a specific staging trajectory for anorexia nervosa in that there is a longitudinal trajectory with evidence of neurobiological progression and evidence that interventions matched to stage of illness may optimize the benefit. There is less data at the moment to support such a model for bulimia nervosa and binge eating disorder.
  
  
  CONCLUSIONS
  The staging heuristic is a useful model for anorexia nervosa in terms of providing prognostic information and stage matched interventions. Although the evidence is encouraging, further research is needed before a similar model could be applied for bulimia nervosa and binge eating disorder.
authors.affiliation: PO59 Eating Disorder Unit, Kings College London, Institute of Psychiatry, London, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
authors.forename: Daniel
authors.initials: D
authors.lastname: Stein
authors.forename: Sarah
authors.initials: S
authors.lastname: Maguire
mesh_terms: D000856:Anorexia Nervosa / Q000175:diagnosis*; D056912:Binge-Eating Disorder / Q000175:diagnosis*; D052018:Bulimia Nervosa / Q000175:diagnosis*; D006801:Humans; D062706:Prodromal Symptoms; D011379:Prognosis
keywords: biological markers; early intervention; eating disorders; epidemiology; outcome