Harm reduction in severe and long-standing Anorexia Nervosa: part of the journey but not the destination—a narrative review with lived experience

Abstract

Questions remain about the best approaches to treatment for the subset of patients with severe and long-standing Anorexia Nervosa, commonly described in the literature as “Severe and Enduring Anorexia Nervosa.” When discussing the optimal strategies and goals for treating this group, there is uncertainty over whether to focus on refining current treatment methods or exploring alternative approaches. One such alternative is “harm reduction,” which has generated a wave of positive interest from patients and clinicians alike because of its emphasis on individual autonomy, personal goals and quality of life. While harm reduction can provide an attractive alternative to seemingly endless cycles of ineffective treatment, this narrative review builds on previous work to highlight the inadequate terminology and possible dangers of considering harm reduction as the endpoint of treatment. In conjunction with perspectives from a lived experience author, we consider wider contextual and ethical issues in the field of eating disorders, which should inform the role of harm-reduction approaches in this patient group. One model of treatment for patients with severe and long-standing Anorexia Nervosa is termed “harm reduction”, which moves away from traditional treatment aimed at full recovery and weight gain. This approach instead prioritises quality of life, giving patients greater control over their care. Harm reduction remains ethically controversial due to concerns about unaddressed malnutrition and issues of consent for this subset of patients. This review examines the inadequacies in how severe and long-standing Anorexia is defined, alongside exploring the ethical concerns of harm reduction with lived experience from one author.