What constitutes severity?The use o

What constitutes severity?
The use of the concept of illness severity is common in
ED settings, and there are solid grounds for this. For example,
severity markers can help aid treatment decisions,
potentially aid prognosis, and promote more
uniform international understandings about clinical presentations
[63]. However, empirically supported definitions
of severity are largely lacking. Clinicians commonly
default to one or more symptom markers or treatment
intensity markers such as BMI [64] or multiple severity
indices based on different symptoms (not all of which
are AN symptoms [65]), hospitalisation [66] or length of
illness [67]. In an attempt to address problems with all
of the above strategies, a more recent approach has been
the development of empirically derived tools to stage
AN severity [36,68]. Early indicators suggest that such
measures involve multiple symptom dimensions, and
neatly capture both clinical reality and patient subjective
reality [36]. One of these instruments [67], the CASIAN,
largely assess the behavioural features of the ED so as to
minimise the factors of denial and the often perverse reduction
in psychological distress discussed above, as the
illness progresses (i.e. drive for thinness and body dissatisfaction
can decrease with severity). Longitudinal data is
still needed to determine how staging instruments could
usefully aid assessment, treatment pathway decisions and
the prediction of prognosis.