title: New treatment approaches for severe and enduring eating disorders.
abstract: OBJECTIVE
  The aim of this paper is to map the possibility of new treatment approaches for eating disorders.
  
  
  BACKGROUND
  Eating disorders have a protracted trajectory with over 50% of cases developing a severe and enduring stage of illness. Although a good response to family-based interventions occurs in the early phase, once the illness has become severe and enduring there is less of a response to any form of treatment. Neuroprogressive changes brought about by poor nutrition and abnormal eating patterns contribute to this loss of treatment responsivity.
  
  
  METHODS
  We have summarised the profile of symptoms at the various stages of illness and considered new treatments that might be applied.
  
  
  RESULTS
  In the enduring stage of illness in addition to problems with body image, food and eating, there are additional problems of low mood, high anxiety and compulsivity and problems in social functioning. This suggests that there are dysfunctions in circuits subsuming reward, punishment, decision-making and social processes. New approaches have been developed targeting these areas.
  
  
  CONCLUSIONS
  New interventions targeting both the primary and secondary symptoms seen in the enduring stage of eating disorders may improve the response to treatment.
authors.affiliation: Section of Eating Disorders, Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom. Electronic address: janet.treasure@kcl.ac.uk.
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
authors.affiliation: Section of Eating Disorders, Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom. Electronic address: valentina.cardi@kcl.ac.uk.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cardi
authors.affiliation: Section of Eating Disorders, Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom. Electronic address: jenni.leppanen@kcl.ac.uk.
authors.forename: Jenni
authors.initials: J
authors.lastname: Leppanen
authors.affiliation: Section of Eating Disorders, Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom. Electronic address: robert.turton@kcl.ac.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: Turton
mesh_terms: D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans
keywords: Eating disorders; Neuroprogressive changes; Novel interventions; Staging model; Treatment targets