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Severe and Enduring ED — MRCPsych Paper B MCQ

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ModerateEating DisordersSevere and Enduring EDMRCPsych Paper B

A 30-year-old woman has had anorexia nervosa for 10 years. She remains markedly underweight, with a BMI of 14.5 kg/m², and has substantial psychosocial impairment despite several adequate specialist psychological and nutritional treatments, including inpatient care. In specialist practice and the clinical literature, which descriptive, non-diagnostic term is commonly used for this pattern of prolonged severe illness with repeated treatment non-response?

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Correct answer: A — Severe and enduring eating disorder (SEED)

The best answer is **B, severe and enduring eating disorder (SEED)**. It is a descriptive rather than formally codified diagnosis, used for a prolonged eating disorder with continuing severity, major functional impact and repeated non-response to appropriate treatment. There is no universally accepted duration threshold, so SEED should not be defined rigidly as illness lasting more than 7 years. Treatment-resistant anorexia nervosa describes non-response but does not necessarily incorporate chronicity and broader enduring impairment. Atypical anorexia nervosa involves the characteristic psychopathology of anorexia without significantly low weight, which is incompatible with a BMI of 14.5 kg/m². NICE has not formally adopted SEED as a distinct category or recommended abandoning recovery-oriented treatment; care should remain individualised, multidisciplinary and attentive to physical safety, psychological recovery and quality of life.

Reference: Royal College of Psychiatrists, Quickbite: Severe and enduring eating disorders, 2017. https://elearninghub.rcpsych.ac.uk/products/Quickbite_Severe_enduring_eating_disorders