A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment
Abstract Objective The classification of severe and enduring eating disorders (SEED) was introduced to acknowledge the chronic nature of eating disorders (EDs) that persist beyond standard treatment. However, concerns exist regarding its role in reinforcing prognostic pessimism, shaping clinician at...
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BMC
2025-07-01
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| Series: | Journal of Eating Disorders |
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| Online Access: | https://doi.org/10.1186/s40337-025-01335-6 |
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| author | Gabriel Lubieniecki Isabella McGrath Gemma Sharp |
| author_facet | Gabriel Lubieniecki Isabella McGrath Gemma Sharp |
| author_sort | Gabriel Lubieniecki |
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| description | Abstract Objective The classification of severe and enduring eating disorders (SEED) was introduced to acknowledge the chronic nature of eating disorders (EDs) that persist beyond standard treatment. However, concerns exist regarding its role in reinforcing prognostic pessimism, shaping clinician attitudes, and influencing patient identity and treatment trajectories. This study explores lived experience perspectives on SEED classification, examining how diagnostic language affects treatment access, psychological outcomes, and engagement with care. Method An online survey was employed to collect demographic and clinical history data, followed by in-depth online semi-structured interviews with 41 individuals with longstanding eating disorders across a range of diagnoses. Reflexive thematic analysis examined participants’ experiences of SEED. Results Three key themes emerged: [1] SEED as a paradoxical classification, with participants describing the term as both validating and restrictive; [2] SEED as a justification for treatment withdrawal, with clinicians and services interpreting the classification as an indicator of treatment futility, contributing to reduced care opportunities and systemic exclusion; and [3] redefining SEED through recovery-oriented frameworks, with participants advocating for alternative terminology, such as “longstanding eating disorder,” and treatment models prioritising harm reduction, step-down care, and sustained engagement. Discussion These findings suggest that SEED classification is not merely a descriptor but actively shapes treatment options, patient agency, and long-term engagement with care. The inferred association between SEED and “treatment resistance” contributed to exclusion from services and reinforced therapeutic nihilism. Participants suggested the need for person-centred, recovery-oriented language and clinical frameworks that support continued access to care rather than rigid prognostic assumptions. Further research is needed to examine how chronicity-based classifications influence clinician decision-making, resource allocation, and stigma, informing more inclusive and responsive treatment models. |
| format | Article |
| id | doaj-art-233d4fa5079d44ca9006cd99a0c72364 |
| institution | Kabale University |
| issn | 2050-2974 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | Journal of Eating Disorders |
| spelling | doaj-art-233d4fa5079d44ca9006cd99a0c723642025-08-20T03:45:43ZengBMCJournal of Eating Disorders2050-29742025-07-0113111510.1186/s40337-025-01335-6A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatmentGabriel Lubieniecki0Isabella McGrath1Gemma Sharp2Department of Neuroscience, School of Translational Medicine, Body Image & Eating Disorders Research Program, Monash UniversitySchool of Psychology, University of QueenslandDepartment of Neuroscience, School of Translational Medicine, Body Image & Eating Disorders Research Program, Monash UniversityAbstract Objective The classification of severe and enduring eating disorders (SEED) was introduced to acknowledge the chronic nature of eating disorders (EDs) that persist beyond standard treatment. However, concerns exist regarding its role in reinforcing prognostic pessimism, shaping clinician attitudes, and influencing patient identity and treatment trajectories. This study explores lived experience perspectives on SEED classification, examining how diagnostic language affects treatment access, psychological outcomes, and engagement with care. Method An online survey was employed to collect demographic and clinical history data, followed by in-depth online semi-structured interviews with 41 individuals with longstanding eating disorders across a range of diagnoses. Reflexive thematic analysis examined participants’ experiences of SEED. Results Three key themes emerged: [1] SEED as a paradoxical classification, with participants describing the term as both validating and restrictive; [2] SEED as a justification for treatment withdrawal, with clinicians and services interpreting the classification as an indicator of treatment futility, contributing to reduced care opportunities and systemic exclusion; and [3] redefining SEED through recovery-oriented frameworks, with participants advocating for alternative terminology, such as “longstanding eating disorder,” and treatment models prioritising harm reduction, step-down care, and sustained engagement. Discussion These findings suggest that SEED classification is not merely a descriptor but actively shapes treatment options, patient agency, and long-term engagement with care. The inferred association between SEED and “treatment resistance” contributed to exclusion from services and reinforced therapeutic nihilism. Participants suggested the need for person-centred, recovery-oriented language and clinical frameworks that support continued access to care rather than rigid prognostic assumptions. Further research is needed to examine how chronicity-based classifications influence clinician decision-making, resource allocation, and stigma, informing more inclusive and responsive treatment models.https://doi.org/10.1186/s40337-025-01335-6Severe and enduring eating disorder (SEED)Longstanding eating disordersDiagnostic labellingPatient perspectivesLived experienceTreatment engagement |
| spellingShingle | Gabriel Lubieniecki Isabella McGrath Gemma Sharp A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment Journal of Eating Disorders Severe and enduring eating disorder (SEED) Longstanding eating disorders Diagnostic labelling Patient perspectives Lived experience Treatment engagement |
| title | A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment |
| title_full | A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment |
| title_fullStr | A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment |
| title_full_unstemmed | A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment |
| title_short | A lifeline or a label? lived experience perspectives on the severe and enduring eating disorder (SEED) classification in eating disorder treatment |
| title_sort | lifeline or a label lived experience perspectives on the severe and enduring eating disorder seed classification in eating disorder treatment |
| topic | Severe and enduring eating disorder (SEED) Longstanding eating disorders Diagnostic labelling Patient perspectives Lived experience Treatment engagement |
| url | https://doi.org/10.1186/s40337-025-01335-6 |
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