Wikipedia says: “In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between. As an adjective, chronic can refer to a persistent and lasting medical condition. Chronicity is usually applied to a condition that lasts more than three months. The opposite of chronic is acute.”

Hmmm. This looks clear but is actually confusing. Is anorexia chronic or recurrent eating disorder, according to this definition? Certainly anorexia lasts more than three months, in most cases; it can be “persistent and lasting” and therefore meet that criterion for chronic. But like cancer it can relapse—even repeatedly—with periods of remission in between, meeting the definition for recurrent. Is anorexia, therefore, chronic or recurrent illness? It is certainly not acute, like strep throat or pneumonia.

Wikipedia goes on to say that one in two Americans has a chronic disease or illness that does not necessarily disable them since they are frequently able to carry on with most of their normal activities. This can certainly be true for those with anorexia, even for those who seek and obtain expert eating disorder help.

So what do I mean when I say anorexia nervosa is a chronic illness?

I mean that anorexia is usually an illness of long standing (a typical adult presentation) or of sudden onset (a typical pediatric presentation) that, even when treated successfully, can go on for months and years and, once in remission, can relapse and return. Although anorexia behaves like a chronic or recurrent illness in most cases, there are exceptions. Occasionally there are people with AN who seem to have “one bout” only. Rarely, in my experience, does anorexia “go away on its own”. This is decidedly not the norm.

At Kartini Clinic we have seen several patients relapse in adolescence or early adulthood whom we successfully treated as young children, and we definitely read of older adults with anorexia who were symptom-free for years, having had an earlier “bout” as a younger person. One of my cherished colleagues has cancer. She says the cancer doctors never write “cured” in a patient’s chart, they write “NED” or “no evidence of disease”.

Knowing an illness such as anorexia can recur allows us to focus on early recognition and prompt treatment. Thinking that something has been “cured” sets us up for anger, disappointment and feelings of failure if it does recur.

“No evidence of disease”. I’ll take it.