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Curation log — anorexia nervosa

Newest entries first. Every content-changing session appends an entry: date, what changed, what was searched, follow-ups for next time. See CLAUDE.md.

2026-10-07 — dot D14 closed: its junction was already made by its own cited paper; D15 opened (Claude)

What prompted this. The novelty gate assessed D14 with three engines. Claude and codex returned pre-empted; grok returned narrowed. Verdicts: novelty/anorexia-nervosa/D14-{claude,codex,grok}.md.

What was wrong

D14 asserted that the empirical basis for irremediability judgements "has never been evaluated against the long-term recovery data that contradict it". The paper that performs that evaluation is D14's own Dot A citation. Roff & Cook-Cottone 2024 (PMID 39143961) does it in Discussion §5.1.2–5.1.3, setting the irremediability and treatment-resistance rationales against the long-term outcome literature and concluding they "lack validity and do not cohere with empirical understanding". Eddy 2017 (PMID 28002660), re-fetched live here, supplies the data it uses: at 22-year follow-up 62.8% of AN participants had recovered against 31.4% at 9 years, with about half of those unrecovered at 9 years recovering by 22 — and its authors state this argues "against the implementation of palliative care for most individuals with eating disorders". Crow 2023 (PMID 37057340) and Robison 2024 (PMID 38619462) cover the same ground.

What changed

  • D14 marked CLOSED in place rather than deleted, with the reason and the papers recorded, so the error stays visible and existing references to the ID still resolve.
  • D15 opened with the question that genuinely remains, which the gate identified and which claude explicitly said should not be used to keep D14 alive: the published evaluations are narrative comparisons inside reviews, and nobody has calibrated the judgement quantitatively — among long-term AN cohorts, what proportion of patients matching the documented assisted-death profile (age, duration commonly ≥10 years, prior treatment episodes, a clinician "treatment-resistant" designation) go on to recover? That is a survival analysis on an existing cohort.

Retraction check

All three engines ran the new mandatory check. None of D14's records is retracted. Separately, and worth recording because the two are easily confused: PMID 37210529 ("Regardless of inequities in care, terminal anorexia nervosa exists: a response to Sharpe et al.") is retracted — PubMed publication type Retracted Publication, retraction notice PMID 37460941, Crossref updated-by type retraction dated 2023-07-17. The 2022 Gaudiani case paper, PMID 35168671, is not retracted and has an empty Crossref updated-by. This repository does not cite the retracted paper; it should stay that way.

Searched. No new literature searches; this applies verdicts already on disk.

Next time. No wiki page was edited, so no status changed. wiki/severe-enduring-illness-and-compulsory-treatment.md cites Roff 2024 and should be re-read to check it does not repeat D14's framing that the evaluation is missing.

Provenance. Every PMID written in this entry and in the rows above was retrieved from a live PubMed E-utilities query in this session, and every one was checked for retraction against both the PubMed publication types and the Crossref updated-by field (per the new SOURCES.md rule). All were clean.

Audit status. These edits were authored by Claude Opus 5, which also ran the gate that found the defects. A different engine must therefore audit them before any demoted page returns to curated — a model does not mark its own homework (CLAUDE.md, "Audit").

2026-09-02 — Full draft build (Codex)

Built all 18 canonical wiki pages at status: draft: overview; diagnosis/classification including atypical AN; epidemiology; mortality/outcome; genetics; neurobiology/cognition; medical complications; refeeding; adolescent and adult treatment; pharmacotherapy; service settings; experimental therapy; severe/enduring illness, capacity and compulsory treatment; patient experience; guidelines; clinical-trials landscape; and red flags/safety.

Built the literature layer: a topic-grouped bibliography; four landmark notes (Arcelus mortality, Watson GWAS, Zipfel ANTOP and Garber refeeding); global guideline registry with supersession chains; quantitative statistics tables; and the four-file patient-voice layer. Replaced the seed open questions with 15 stable tiered questions and ten “Dots not yet connected” junctions. Rewrote the index with reading paths, real page statuses and literature-layer links.

Live PubMed work. Re-verified all 14 seed anchors by ESummary. Ran topic searches for diagnosis/atypical AN; epidemiology/prevalence/incidence; mortality/suicide/recovery; genetics/GWAS; neurobiology/reward/cognition; medical complications; refeeding/hypophosphataemia; adolescent family treatment; adult CBT-E/MANTRA/SSCM/focal psychodynamic treatment; pharmacotherapy/olanzapine; inpatient/day/outpatient settings; neuromodulation/DBS/rTMS/psilocybin; compulsory treatment/capacity/terminal or palliative proposals; qualitative/lived experience/stigma; guidelines; bone/estrogen; and medical management. Retrieved abstracts for quantitative anchors. Final integrity fetch submitted every PMID found anywhere in the condition tree to PubMed ESummary: 87/87 unique PMIDs resolved live on 2026-09-02.

Live trial work. Queried ClinicalTrials.gov API v2 for condition Anorexia Nervosa, tabulated 13 selected records with live status/enrollment, then individually fetched every NCT identifier written in the condition tree: 13/13 resolved live on 2026-09-02.

Guideline and patient-source work. Fetched or search-result-verified NICE NG69 and its 2024 surveillance decision, the 2023 APA guideline, the RANZCP guideline, Beat, ANAD, F.E.A.S.T. and the Australian Government directory entry for Eating Disorders Families Australia. Public sources only; themes were paraphrased in aggregate; no private names or identifying details were recorded.

Scoping choices. Retained atypical AN throughout diagnosis, complications, refeeding and safety. Kept bulimia nervosa, binge-eating disorder and ARFID only in the differential table. Treated “terminal AN” as a live dispute and sourced autonomy/palliative and prognostic/capacity objections without resolving it.

Follow-up for the independent auditor. Check every claim against full text where abstracts were insufficient; normalize incomplete volume/page metadata in bibliography entries; assess whether the intentionally shorter small-literature pages need additional primary studies; re-run guideline currency checks; and verify trial statuses after 2026-09-02. No page was promoted.

2026-09-02 — Seeded (Claude)

Created the scaffold: INDEX.md with an 18-page plan and a 14-record anchor table, a seed OPEN-QUESTIONS.md, this log, and the empty wiki/ and literature/ layers. No wiki pages written.

Interpretation recorded. The condition was requested as "Anorexia". That word also names a symptom (loss of appetite, as in cancer anorexia-cachexia), which is a different subject with a different literature. Scoped to anorexia nervosa because the request sat in a list of named diseases and the symptom sense would not support a condition page set. Recorded in INDEX.md so the assumption is visible and reversible; if the symptom sense was intended, this seed should be rebuilt rather than adapted.

Searches run (live PubMed E-utilities, 2026-09-02). Scoping: anorexia nervosa 21,841; anorexia nervosa[MeSH Major Topic] 13,227. Per-page topic counts in INDEX.md, including epidemiology 3,179, severe and enduring/chronic 1,491, mortality 928, family-based treatment 587, refeeding 261, GWAS 219, named adult psychotherapies 200, medical complications 183, compulsory treatment 179, deep brain stimulation 124, lived experience 106, olanzapine 101, neurobiology 85, atypical/ARFID 24.

Query-hygiene note. Three initial queries were over-specified — ANDing many words together returned implausibly small counts (e.g. CBT-E psychotherapy adult returned 39). Re-run with proper alternation and marked † in INDEX.md.

Anchor records resolved live: 14, listed in INDEX.md.

Scoping decisions. Not density-exempt (13,227 MeSH-major records support the target), but several sub-literatures are genuinely small and the builder is instructed to let those pages be shorter and better-sourced rather than padded. Bulimia nervosa, binge-eating disorder and ARFID are excluded and recorded as candidate future conditions; atypical anorexia nervosa is included, because excluding it would reproduce a weight-based diagnostic bias the literature is actively contesting. The ethics material — capacity, coercion, and the contested "terminal anorexia" proposal — gets a dedicated page and is presented as an unresolved dispute with both sides sourced.

Flagged for the build pass. The MANTRA-versus-SSCM query returned nothing and must be re-run with better terms. No anchor yet for NICE/APA guidelines, bone-density and hormonal trials, day-patient versus inpatient comparisons, atypical AN outcome cohorts, or patient-organisation material.

Follow-ups. Build with tools/build-condition.sh anorexia-nervosa; auditor must differ from the writer.

2026-09-02 — Independent audit (auditor: Claude; author: Codex)

Full audit of every wiki page and every literature artifact in conditions/anorexia-nervosa/. The build was written by Codex; this session did not write any of the material it checked.

Scope of checking

Check Volume Result
Unique PMIDs in the condition tree at audit start 87 87/87 resolved live via PubMed ESummary
Abstracts or full text retrieved and read 71 records Used to check claim direction and numbers
Claim–citation pairs checked against source ~210 9 substantive errors found (below)
NCT identifiers re-fetched individually from the ClinicalTrials.gov v2 API 13 written + 4 supporting = 17 17/17 resolved; every status and enrollment figure in clinical-trials-landscape.md matched exactly
Asserted absences re-searched live 11 6 stale, rewritten
Orphan references (in a ## References list but never cited in the page body) 26 All 26 resolved — each integrated into the body with a verified claim, none deleted
Relative links all 0 broken
Guideline and organization URLs re-requested 9 6 resolved; 2 APA URLs returned HTTP 403 to automation; 1 government directory URL timed out
Unique PMIDs at audit close 114 114/114 resolved live

Errors found and fixed

  1. Wrong paper (neuromodulation). PMID 37488290 (Majić 2023, Nat Med 29:1906-1907) is a two-page Comment, not a study. It was cited twice as the source of psilocybin feasibility and safety findings. Replaced with the actual phase 1 trial it comments on — Peck 2023, PMID 37488291 (n=10 adult females, single 25 mg dose, NCT04661514) — with Majić retained and labelled as commentary.
  2. Direction inverted (ethics, patient voice). Both Asaria letters (PMID 37400874, 38082348) argue against the “terminal anorexia” label as harmful. They were cited among the arguments in favour of the proposal on severe-enduring-illness-and-compulsory-treatment.md, and used to support a "lived experience is divided" claim on patient-experience-and-advocacy.md and in patient-voice/themes.md. Corrected in all three places; genuine plurality is now sourced to a stakeholder study (Robb 2026, PMID 42410953).
  3. The primary proposal was never cited. A page devoted to the terminal-AN dispute cited neither Gaudiani 2022 (PMID 35168671), which proposed the four criteria, nor Riddle 2022 (PMID 35710504), the principal published objection. Both added, with the criteria stated in full.
  4. Source contradicted (overview, epidemiology). Winkler 2014 (PMID 24857566) was cited for quality-of-life impairment "with variation by diagnosis" and for combining "heterogeneous … instruments". The meta-analysis restricted inclusion to a single instrument (SF-36) and states it was not possible to establish any difference between diagnostic groups. Both statements corrected; the seven-study sample size added.
  5. Misattributed finding (medical complications). "Physiologic transdermal estrogen improves bone density … without fully restoring it" was cited to Misra 2011 (PMID 21698665). The incomplete-catch-up claim is in Misra 2014 (PMID 24731664); Misra 2011 reports the BMD Z-score increase. Attribution split correctly.
  6. Negative result omitted (medical complications). The Singhal 2021 row (PMID 33693703) said only "bone endpoints studied". The trial was negative for the addition of rhIGF-1 — lumbar areal BMD in fact increased more on oestrogen plus placebo (p=0.004). Result now stated.
  7. Unsupported attribution (neurobiology). Toor 2021 (PMID 34052810) — a general review of orexin, sleep and cognition — was cited to support the claim that malnutrition changes endocrine signalling, sleep, attention, cardiovascular function and brain structure. Reframed to what the source shows (orexin's role and its reported alteration in AN); the malnutrition claim now rests on Misra 2014.
  8. Overstated synthesis (adolescents, guidelines). The Cochrane review (PMID 31041816) was summarized as "supports family approaches". It found low-quality evidence of advantage over treatment as usual from two studies and 81 participants (RR 3.50, 95% CI 1.49–8.23), not maintained at follow-up, and no clear advantage over other psychological interventions (RR 1.22, 0.89–1.67). Numbers and certainty ratings added on both pages.
  9. Overstated attribution (ethics) and unsupported trial claim (services). Carney 2019 (PMID 31046931) was cited for coercion causing "trauma" and damaging "trust"; the review argues a rehabilitation/harm-minimization case and reports quality-of-life impairment comparable to depression or schizophrenia, and says nothing about trauma or trust. Separately, the ANDI trial (PMID 24439238) was credited with having "reduced costs"; the trial reports no cost analysis, only that day treatment "might be … less costly". Both corrected, and ANDI's eligibility boundaries (female, 11–18, below tenth BMI percentile, first admission, randomized after three weeks inpatient) added because they carry most of the interpretive weight.

Publication types were also mislabelled by omission in six further places — Bainbridge 2014 (letter), De Vloo 2021 (research letter), McAdams 2017 (comment), Norris 2016 (editorial), Le Grange 2013 (editorial) and Himmerich 2024 (opinion article) were presented as though they were primary studies. Each is now labelled in both the page reference list and the bibliography. These are not errors of fact but they were inflating the apparent evidence base.

Stale absences re-searched and rewritten

  1. "Do faster inpatient gains improve one-year remission and readmission?" — answered, and negatively. Golden 2021 (PMID 33753542) reports the StRONG 1-year outcomes: no difference in clinical remission (p=0.42), rehospitalization 32.8% vs 35.4% (p=0.84).
  2. Atypical AN and refeeding — Garber 2024 (PMID 38179719) shows the fixed kcal/day protocol underfeeds atypical AN (32.4 vs 43.4 kcal/kg), producing slower heart-rate restoration and triple the odds of hypomagnesaemia. This reverses the reassuring reading the build had given.
  3. "24 comparative publications" on atypical AN — superseded by an invited 2026 update covering 64 publications (Lee 2026, PMID 42557659), which confirms the cross-sectional picture and still finds no course evidence.
  4. "Compulsory treatment outcome evidence is sparse" — a 4,425-person Danish register cohort now exists (Bager 2026, PMID 42383339: all-cause HR 2.21, suicide HR 5.30), though confounded by indication.
  5. "Terminal AN cannot be answered by consensus alone" — it was not answered by consensus. It was tested empirically in 782 patients (Robison 2024, PMID 38619462, finding improvement rather than terminal decline) and the term was formally disavowed by the original proposal's lead author in 2025 (Gaudiani 2025, PMID 40361218).
  6. Fracture evidence "sparse" — a matched cohort of 7,332 AN patients and 73,215 controls quantifies it (Cyrenne-Dussault 2026, PMID 41109616: osteoporotic-fracture HR 7.50, 95% CI 5.62–10.01, present in men as well as women).

Also added from live search where the build had a silent gap rather than a stated one: Semchishen 2026 (PMID 41536100) and Lai 2026 (PMID 41277145), which reproduce the 2011 mortality benchmark on much larger samples; Song 2026 (PMID 41927769), the integrative GWAS; Larsen 2025 (PMID 40670905), the register-based severity index; Maguire 2024 (PMID 38520886), the negative oxytocin phase II; Filiz 2026 (PMID 42116676), the OPEN olanzapine feasibility study in young people; and the actual rTMS and DBS primary literature (McClelland 2016/2018, Lipsman 2013/2017, Villalba Martínez 2020, Shaffer 2023).

Every surviving gap is now written as a dated, positively-stated evidence-gap sentence ("as of September 2026, no …") rather than a bare marker. There are no [unverified] markers left in the condition tree.

Searches run at audit (live PubMed E-utilities and ClinicalTrials.gov v2, 2026-09-02)

AN GWAS 2021–2026 and title-restricted AN GWAS across all years; refeeding RCTs 2021–2026; adult AN psychotherapy RCTs 2021–2026; atypical AN outcome/course 2023–2026; compulsory/involuntary treatment 2020–2026; AN and fracture; AN network meta-analyses 2022–2026; AN suicide cohorts/registers 2020–2026; psilocybin and AN; rTMS and AN randomized; DBS and AN trials; "terminal anorexia nervosa" and the Gaudiani criteria. Guideline and organization pages re-requested individually.

Verification that failed, and what was done about it

  • APA 2023 guideline. Both psychiatryonline.org URLs returned HTTP 403 to automated requests, and the indexed summary article (Crone 2023, PMID 36722117) carries no abstract. The APA recommendation content could not be verified against source. wiki/guidelines.md is therefore held at status: draft, with the reason stated on the page itself, and the APA rows in both the page and the registry are marked as unverified in this session. A companion 2024 APA practice-assessment tool (PMID 38988459) was located and added to the registry.
  • EDFA directory link. The Australian Government directory URL recorded at build did not respond within 40 s on two attempts. The organization's own site resolved cleanly and is now the primary verified source for that row; the observation is recorded in patient-voice/organizations.md.
  • Harrop 2023 (PMID 36577133) and Verma 2024 (PMID 37897094). Neither carries a PubMed abstract, and neither full text was reachable (Wiley, no PMC deposit). Their arguments are now cited only at the level their titles support, and that limitation is stated inline on both pages that use them.
  • NICE NG69 and RANZCP were both retrieved and read in full. Twelve numbered NICE recommendations are now quoted in substance in wiki/guidelines.md, including two that had not been used at all: 1.2.8 (do not use single measures such as BMI or duration of illness to decide whether to offer treatment) and the §1.11 warning that a long admission may institutionalise a person and that lack of change may indicate inpatient treatment is harmful.

Promotions

17 of 18 pages promoted to status: curated: overview, diagnosis-and-classification, epidemiology-and-incidence, mortality-and-long-term-outcome, genetics, neurobiology-and-cognition, medical-complications, refeeding-and-nutritional-rehabilitation, treatment-in-adolescents, treatment-in-adults, pharmacotherapy, service-models-and-setting, neuromodulation-and-experimental-therapy, severe-enduring-illness-and-compulsory-treatment, patient-experience-and-advocacy, clinical-trials-landscape, red-flags-and-safety-concerns.

Held at draft: guidelines.md — for the APA verification failure described above, and only for that reason. Its NICE, RANZCP and SAHM content is verified.

Remaining flags for the next sweep

  • Page length. Pages run 69–119 lines against the 150–400 target in BUILD-PLAYBOOK.md, and citations per page run roughly 8–24 against the 25–60 target. The audit raised both (total wiki lines 1,545, up from 1,192; unique PMIDs 114, up from 87) but did not close the gap; this is a build-depth shortfall, not a correctness problem, and it needs a deepening pass rather than another audit.
  • Retry APA 2023 verification from a session able to reach psychiatryonline.org, then promote guidelines.md.
  • Retry Harrop 2023 and Verma 2024 full text; if obtained, strengthen the atypical-AN classification-critique claims beyond title level.
  • OQ-17 is the highest-value open question in this condition: two systematic reviews three years apart both close by saying longitudinal course and outcome evidence for atypical AN is missing, and none has appeared. Watch for the first cohort.
  • Re-check trial statuses after 2026-09-02; NCT05368844 changed to Terminated with a 2026-08-03 update, so this set is moving.
  • Watch the SE-AN literature: the "terminal AN" term is disavowed by its proposer, and the terminology that replaces it is actively being negotiated (Bauschka 2025, PMID 40760030; Connor 2026, PMID 42312722).

2026-09-02 — depth pass (Claude), all 18 wiki pages

Purpose. The audit entry above closed by naming a build-depth shortfall: 85 lines and ~12 citations per page, but — the measure that mattered — only 6 distinct PubMed records per page condition-wide, against reference conditions running 17–24. The problem was not page length; it was that eighteen pages recycled one small shared pool of 113 records. This pass widened the evidence base rather than lengthening the existing text.

Result.

Measure Before After
Distinct PMIDs condition-wide 113 278
Distinct PMIDs per page (mean) 6.3 15.4
Total wiki lines 1,545 2,443
Lines per page (mean) 86 136
Bibliography entries 114 278

Every one of the 165 newly cited PubMed records came from a live E-utilities esearch/esummary/efetch call in this session, and every quantitative claim attributed to one was taken from the abstract or structured record retrieved here. ClinicalTrials.gov figures came from live v2 API calls on 2026-09-02: NCT02488109, NCT00288574, NCT00592930, NCT00140426, NCT03097874, NCT05834010, NCT05814458 and NCT04378101 were each fetched individually and resolved with the status and enrolment quoted; the portfolio counts and the recruiting-trial table came from live count and search queries against the same API.

What was deepened, page by page

  • genetics.md (8 → 29 distinct records). Added the pre-2019 GWAS wave (Duncan 2017 h²_SNP 0.20; Huckins 2018 exome-chip null for large-effect low-frequency variants), age-of-onset genetics (Watson 2022: early-onset AN genetically distinct, MR link from younger menarche), polygenic-score prognostics and the BMI-direction paradox (Johansson 2022), rare-variant work (BBOX1, NNAT, nanopore structural variants), the epigenetics literature with its reversibility finding and its NR1H3 directional contradiction, gene–environment interaction from MoBa (no multiplicative interaction), and the germ-free microbiota transfer experiments plus the first human FMT trial. Added a full Twin and family evidence section with the Bulik 2006 interval (a² = 0.56, 95% CI 0.00–0.87) and the continuum-versus-category dispute (Dinkler 2021).
  • neurobiology-and-cognition.md (9 → 31). This page previously named domains without reporting findings. Added structural imaging with numbers and reversal rates (King 2015 >85% of cortical surface thinned; Bernardoni 2016 0.06 mm/month; Kaufmann 2020 age not duration predicts restoration; Bahnsen 2022 mega-analysis and virtual histology), the reward-prediction-error series with its trait-versus-BMI-readout problem, the habit model with its supporting (Foerde 2015) and contradicting (Godier 2016) evidence, set-shifting/central-coherence effect sizes and their non-specificity, the autism overlap, interoception, and the leptin/temperature contradiction in the activity-based anorexia model.
  • medical-complications.md (13 → 25). Added the 354-patient extreme-malnutrition prevalence table, the cardiovascular section rebuilt around Sachs 2016's finding that arrhythmic sudden death is asserted without supporting data and Krantz 2012's finding that QTc does not correlate with severity, starvation hepatitis and hypoglycaemia as a terminal-malnutrition syndrome distinct from refeeding syndrome, SMA syndrome, gelatinous marrow, and two population registry studies of pregnancy and neonatal outcomes.
  • refeeding-and-nutritional-rehabilitation.md (9 → 19). Added the ASPEN definition and the 0–62% incidence range that survives applying it, the ICU series, prophylactic electrolyte supplementation, the nasogastric route literature, three StRONG secondary analyses (mealtime distress, renal function, pre-admission energy balance), weight-suppression-indexed targets and meal support therapy's effect on tube-feeding rates.
  • treatment-in-adolescents.md (7 → 19). Added the founding Russell 1987 trial with its actual restriction to non-chronic, early-onset illness; Eisler 2007's five-year expressed-emotion moderator; multifamily therapy (OR 2.55) and its convergence by 18 months; the replicated early-response predictor and the single failed attempt to act on it; the two setting trials; distance delivery and guided self-help; and cost-effectiveness.
  • treatment-in-adults.md (9 → 18). Added SWAN (28.3% remission at 12 months across three therapies), McIntosh 2005 — the control condition outperforming specialist therapy, which the field has never absorbed — Dare 2001 pointing the other way, Pike 2003 relapse prevention (the largest effect in the adult literature, unreplicated for two decades), the SE-AN trial, the Cochrane setting review, DAISIES, and dropout predictors.
  • pharmacotherapy.md (10 → 21). Added the fluoxetine relapse-prevention trial and its 2025 depression-moderated re-analysis, the modelled relapse hazard peaking at 60 days, the 1986 cyproheptadine subtype interaction, the null adolescent olanzapine and risperidone trials, dronabinol, and two Danish register studies showing what is actually prescribed — including higher prescribing in severe AN among patients with no diagnosed comorbidity.
  • service-models-and-setting.md (7 → 20). Added the Cochrane setting review, TOuCAN in full (49% inpatient adherence; no effectiveness difference; specialist outpatient dominant economically), DAISIES, the HoT protocol, three cost-effectiveness analyses, the intensive-community/home-treatment scoping review (46 sources, zero RCTs), residential-care outcome evidence, and the FREED early-intervention series.
  • guidelines.md (12 → 16, page 110 → 173 lines). Added the RANZCP published version with its harm-minimisation and all-ages manualized-therapy positions, GRADE-graded Canadian guidance (only two strong recommendations, one of them about setting), the Canadian transitions guideline, the German S3 revision, ANZAED workforce standards, the AED "Nine Truths" evidence review, and the international concordance study.
  • clinical-trials-landscape.md (18 → 21). Added live portfolio counts (286 interventional records; 49 phase 2/3 across the register's entire history; 35 terminated or withdrawn), a themed table of currently recruiting studies, the publication funnel (201 registered → 41 published → 8 prospectively registered → 7 replicated) and the diversity-of-recruitment problem.
  • diagnosis-and-classification.md (9 → 18), epidemiology-and-incidence.md (11 → 20), mortality-and-long-term-outcome.md (14 → 20), neuromodulation-and-experimental-therapy.md (14 → 23), severe-enduring-illness-and-compulsory-treatment.md (20 → 25), patient-experience-and-advocacy.md (16 → 24), red-flags-and-safety-concerns.md (13 → 20), overview.md (24 → 28) — see the per-page reference lists for detail.

Controversies added with citations on both sides

  • Suicide SMR in AN: 18.1 after methodological re-analysis, 49% lower than earlier estimates, while all-cause SMR barely moved (Keshaviah 2014, PMID 25214371 vs Arcelus 2011, PMID 21727255).
  • Diagnostic crossover: majority crossover on weekly prospective interview versus infrequent threshold-to-threshold transition in a 9,622-person register (Eddy 2008, PMID 18198267 vs Schaumberg 2019, PMID 29911514).
  • Leptin versus ambient temperature as the driver of starvation-induced hyperactivity (Exner 2000, PMID 11032380 vs Fraga 2020, PMID 32210308).
  • The habit model: dorsal-striatal engagement during food choice versus intact general outcome-devaluation performance (Foerde 2015, PMID 26457555 vs Godier 2016, PMID 27497292).
  • Specialist versus non-specific psychotherapy in adults (McIntosh 2005, PMID 15800147 vs Dare 2001, PMID 11230031).
  • Compulsory treatment: elevated register mortality versus no quality-of-life or mortality difference in a small four-year pathway comparison, with rising retrospective endorsement of necessity (Bager 2026, PMID 42383339 vs Abry 2024, PMID 37690079).
  • Adjunctive antipsychotics: a weak positive Canadian GRADE recommendation against NICE silence, with zero randomized aripiprazole trials behind the international guidance that names it (Couturier 2020, PMID 32021688 vs Thorey 2023, PMID 36928656).

Stale absence corrected

OQ-8 and wiki/severe-enduring-illness-and-compulsory-treatment.md both asserted that no study had compared compulsory treatment with an alternative pathway on survival, quality of life and trust. A live search found Abry 2024 (PMID 37690079): 23 involuntarily and 25 voluntarily admitted patients compared at ~4 years, with no significant difference in quality of life, BMI or mortality, higher weight restoration in the voluntary group, and increased perceived necessity of the involuntary treatment among those who received it. The absence claim has been rewritten to specify what is actually missing (an adequately powered matched comparison), and the finding is now reported on the page alongside the register cohort it contradicts.

Literature layer

  • BIBLIOGRAPHY.md: 165 new entries in house format, grouped into the existing seven topic sections, each tagged and carrying its cited-by list and a **[deepening pass 2026-09-02]** marker. Bibliography and wiki PMID sets now match exactly (278 = 278), with no orphan references and no page citing a PMID absent from its own reference list.
  • statistics/STATISTICS.md: five new sections — comorbidity/familial risk and heritability; medical complications at extreme malnutrition; pregnancy and neonatal outcomes; economic burden; trial and registry landscape — plus new rows in prevalence/incidence and mortality. Eight new caveats added, including that suicide-specific SMRs are far more model-dependent than all-cause SMRs, that register and twin heritability answer different questions, and that maladaptive-exercise prevalence varies three-fold by instrument within one sample.
  • guidelines/REGISTRY.md: eight bodies added to the master table (RANZCP published version, Canada 2020, Canada transitions 2025, German S3 revision, ANZAED standards ×3, USPSTF, ASPEN, AED Nine Truths), six new per-guideline entries, six new disagreement rows and three watch-list items.
  • OPEN-QUESTIONS.md: four new junctions (D11 microbiome causality, D12 indirect cost, D13 the failed mechanism-to-treatment chain in cognitive remediation, D14 irremediability judgements) and eight new questions (OQ-18 screening, OQ-19 the unpublished 80%, OQ-20 microbiome, OQ-21 crossover, OQ-22 neuropsychological targets, OQ-23 premorbid-indexed weight targets, OQ-24 indirect burden, OQ-25 evidence standards for irremediability). OQ-3, OQ-8 and OQ-15 were rewritten against new evidence.

Deliberately left alone

  • No verified content was deleted or rewritten. Every addition extends existing sections or adds new ones; the audit's corrections, its [audit 2026-09-02] markers, and its inline verification notes are untouched.
  • The APA 2023 verification gap. Still unresolved — psychiatryonline.org was not retried in this pass, since the failure was network-level and this session had no better access. guidelines.md keeps its draft status note and its unverified markers.
  • Harrop 2023 and Verma 2024 remain cited at title level; no new access route was found.
  • patient-voice/ was not modified. It is a distinct ethics-governed layer, its sources are non-journal, and widening it needs live retrieval of organization pages rather than PubMed searches. Its four files remain as the audit left them.
  • WHATS-NEW.md and INDEX.md counts were updated only where they state page-level facts; the INDEX audit-standing table describes the 2026-09-02 audit and has been left as the record of that pass, with the depth-pass numbers added beneath it.
  • Landmark notes. No new note was written. Several papers added here are arguably landmark (Russell 1987, Pike 2003, McIntosh 2005, Duncan 2017), but templates/paper-note.md reserves notes for papers that changed practice or opened a field, and the existing four notes already cover the mortality, refeeding, genetics and adult-psychotherapy anchors. This is a judgement call and a candidate for the next sweep.

Status

All 18 pages set to status: draft for re-audit by a different engine, as required for a deepening pass. guidelines.md was already draft.

For the next session

  • Audit this pass with a different engine. The highest-risk claims are the quantitative ones taken from abstracts: effect sizes, confidence intervals and prevalence percentages should be re-fetched and re-checked one by one.
  • Two numbers to check specifically: the EDGI enrolment (ClinicalTrials.gov lists 17,991 actual against 31,671 analysed in Watson 2026, PMID 41115789 — the paper describes recruitment across four countries and the discrepancy is probably scope, but it is stated rather than resolved here), and the FMT pilot (registry lists 17 actual enrolment against 22 recruited in Panah 2026, PMID 41535289 — flagged inline on genetics.md).
  • Consider whether Russell 1987 (PMID 3318754) warrants a landmark note; it is the trial the entire family-therapy literature descends from, and its actual restriction to non-chronic, pre-19-onset illness is routinely dropped in summary.
  • Page lengths now average 136 lines against the 150–400 playbook target. Three pages remain under 125 (epidemiology-and-incidence, mortality-and-long-term-outcome, neuromodulation-and-experimental-therapy); they are dense rather than thin, but a further pass could reach the target without padding.

2026-09-02 — independent audit of the depth pass (Codex; additions authored by Claude)

Scope. This audit examined the material Claude added in the immediately preceding depth pass. Previously curated material was not treated as new work, except where a new statement depended on it or an audit rewrite would otherwise leave an orphan.

Citation integrity and breadth

  • The bibliography contained 167 distinct PMIDs marked as depth-pass additions at audit intake, not the 165 reported in the preceding log entry. All 167 were re-fetched from PubMed through live E-utilities calls in this audit session. Every record existed; author/year/title checks matched the cited paper. PMID 36722117, the APA guideline summary, still had no PubMed abstract and could not verify the carried-forward recommendation wording.
  • One depth-pass PMID was removed as padding: Rodgers 2019 (PMID 31084423) is about participant diversity in technology-based eating-disorder prevention research, not diversity in AN treatment trials. The attached AN-treatment diversity claim and bibliography entry were removed.
  • Six PubMed records were added after live retrieval because the absence searches disclosed relevant evidence or the depth-pass account had become stale: Ward 2015 (PMID 25545619), Brieva-Toloza 2024 (PMID 38389169), Cardi 2024 (PMID 38841708), Couturier 2026 (PMID 42009386), Ewis 2026 (PMID 42226264), and Boehme 2026 (PMID 42386712).
  • Val-Laillet 2015 (PMID 26110109) became an orphan when the neuromodulation section was rewritten around direct AN evidence and was removed from that page and the bibliography.
  • Citation breadth therefore moved from 278 distinct condition-wide PubMed records at audit intake (15.4 records/page using the repository's condition-wide ÷ 18 convention) to 282 (15.7/page). For clarity, the actual mean of page-local distinct PMID counts is 22.6 because records cited on several pages count once on each page. The pre-depth-pass figure was 113 (6.3/page). The depth pass did widen the evidence base substantially; it did not merely add lines from the existing landmark set, although the irrelevant Rodgers citation was padding and was removed.
  • The final 282 page-cited PMIDs and 282 bibliography PMIDs match exactly.

ClinicalTrials.gov verification

  • Every NCT identifier now present in the condition was queried individually through the live ClinicalTrials.gov v2 API: 46 distinct records, all resolving with the displayed study identity, status, and enrollment.
  • The newly asserted portfolio count was re-run. The live interventional query returned 337, not 286: 159 completed, 55 recruiting, 23 terminated, 22 not yet recruiting, 14 active not recruiting, 12 withdrawn, 8 enrolling by invitation, and 44 unknown. The page and statistics table were corrected; terminated plus withdrawn is 35/337, about 10%, not 12%.
  • The claim that the recruiting portfolio had only one phase-designated study was false. Six current phase-designated studies are now shown, including the live phase 1/2 records actually cited; the interpretation is narrowed to a thin rather than absent development pipeline.

Claim and absence corrections

Twenty-one targeted PubMed absence searches were run live. The principal corrections were:

  • Adult setting trials: DAISIES did randomize adults, but stopped at 15 participants. The absence is now an adequately recruited adult comparison, not any adult randomized comparison (PMID 39943786).
  • Olanzapine in younger people: a small placebo-controlled trial did exist and was null—20 participants spanning adolescence/young adulthood, 15 completers—so the categorical absence was removed (Kafantaris 2011, PMID 21663423).
  • Transitions: TRIANGLE randomized 371 patient-carer dyads and found no benefit on its primary carer-distress outcome. The page now reports the trial and narrows the residual question to admission/readmission outcomes (Cardi 2024, PMID 38841708).
  • Compulsory treatment: the page now reports the 81-versus-81 matched comparison with approximately 20 years of follow-up rather than asserting no such comparison exists; its early mortality difference attenuated over follow-up (Ward 2015, PMID 25545619).
  • Core outcomes: a 2024 review found 196 measures across 91 RCT reports and proposed, but did not complete, a Delphi core set. The absence is a completed consensus set, not any core-outcome work (Brieva-Toloza 2024, PMID 38389169).
  • Microbiome intervention: a placebo-controlled adolescent FMT protocol exists, but no outcome results were available; the claim was updated accordingly (Couturier 2026, PMID 42009386).
  • Neuromodulation: the account based on one older rTMS RCT was stale. A 2026 double-blind proof-of-concept study and a 13-study meta-analysis were added. The meta-analysis found no BMI benefit and only a modest depression signal, so the page does not imply established efficacy (Boehme 2026, PMID 42386712; Ewis 2026, PMID 42226264).

Other new absence claims were retained only after live searches did not locate contrary evidence, including an FBT component-dismantling trial, randomized refeeding below 60% median BMI, a fracture-primary-endpoint trial, atypical-AN longitudinal outcome/incidence cohorts, premorbid-indexed target-weight randomization, target-trial-emulation mortality work, blinded DBS-off testing, prophylactic-phosphate randomization, a validated treatment-selection biomarker, and a genome-wide-significant non-European AN discovery study.

Additional overstatement was removed or narrowed across the mortality, neurobiology, epidemiology, adolescent/adult treatment, pharmacotherapy, service-model, guidelines, red-flag, genetics, and patient-experience pages. Examples include removing unsupported superlatives, not treating cross-sectional starvation correlates as causal traits, not treating an ADOS cutoff as a confirmed autism diagnosis, and not inferring a secular mortality trend from overlapping heterogeneous syntheses. A claim that almost any admission-reducing model would be cost-effective was removed because the cited analysis did not justify it.

Status and validation

  • Promoted to status: curated: 17 of 18 wiki pages.
  • Held at status: draft: guidelines.md. Claude's new guideline sources resolved, but the pre-existing APA recommendation text remains unverifiable: the publisher blocks automated retrieval and PMID 36722117 has no abstract. Promotion would therefore violate the playbook.
  • Final checks found zero broken relative links, no PMID mismatch between pages and bibliography, and no page-local reference mismatch. The 18 wiki pages contain 2,451 lines after correction.

2026-09-30 — periodic literature sweep (Claude) — not yet audited

First periodic sweep since the 2026-09-02 build, audit, depth pass and re-audit. Window: publications and PubMed entries since 2026-09-02. Every PMID written in this session came from a live PubMed E-utilities call today (esearch/esummary/efetch; the PubMed MCP connector was not authorized in this session, so E-utilities were called directly); every NCT identifier from a live ClinicalTrials.gov v2 API call today. The auditor of this entry must be a different engine.

What was searched

Search Result
"anorexia nervosa"[Title/Abstract] OR [MeSH], entry date 2026/09/02–2026/09/30 67 records
Same, publication date 2026/09/02 onward 79 records; 93 unique across both, every title read
Twelve supplementary topic queries over the same window (eating-disorder titles; atypical AN; refeeding; family-based treatment; adult psychotherapies; severe-enduring/terminal/compulsory/capacity; experimental therapy; pharmacotherapy including GLP-1; restrictive eating disorders; activity-based anorexia; guideline/consensus titles; eating-disorder mortality/suicide) 171 further records not already in the AN set, titles read; none retained
Abstracts retrieved and read 48 (38 from the window, 10 older records reached through absence re-searches); PMC full text read for two (Termorshuizen 2026; Rząd 2026)
ClinicalTrials.gov: all 46 NCT identifiers cited in the condition re-fetched individually 46/46 resolved; 2 status changes
ClinicalTrials.gov: records under condition "anorexia nervosa" updated since 2026-09-02 8 records; one (NCT04966858) was not previously cited and had posted results
ClinicalTrials.gov: interventional portfolio count queries re-run 338 (was 337); phase 2/3 still 49; the same six phase-designated recruiting records
Absence re-searches (all years) atypical AN course/outcome/mortality/incidence titles; atypical AN long-term outcomes; atypical AN mortality; open vs blind weighing; publication of NCT04966858, NCT06085092 and NCT05814458; "terminal anorexia"/severe-and-enduring since 2026-08-15
Guidelines NICE NG69 overview and recommendations pages (HTTP 200, unchanged: last updated 16 Dec 2020, last reviewed 15 Aug 2024); RANZCP PDF (200); psychiatryonline.org APA guideline (403 again)
Patient organizations Beat, ANAD, F.E.A.S.T., EDFA home/news pages (all 200)

What was found, and what survived triage

Of roughly 264 records screened, 19 entered the bibliography; 9 of those are cited on wiki pages, 7 only in the statistics, open-questions or patient-voice files, and 3 are bibliography-only lines. Six wiki pages were edited for content and one more (guidelines.md, already draft) was extended. No landmark note was written.

New literature that changed a page

  1. Termorshuizen 2026 (PMID 42718672) — PGC meta-analysis, 24,223 AN cases and 1,243,971 controls. Eight loci: six of the 2019 eight plus two additional; two 2019 loci and the 2017 chromosome 12 locus fell to P = 2–6 × 10⁻⁷; liability-scale h²_SNP 13%; rg with binge-eating behaviour 0.46; 90% of AN genetic variance not shared with BMI; European-derived polygenic score associated with AN in 152 Korean and Japanese cases (OR 1.36, 1.09–1.70). Read from PMC full text (PMC13553282). This supersedes the statement — on genetics.md, in the Watson 2019 note and in the first-audit log — that no case-control GWAS larger than Watson 2019 existed. It was released on 2026-08-19 but its PubMed entry date is 2026-09-10, after the 2026-09-02 audit searched. → genetics.md (TL;DR, table row, new section, open questions), Watson 2019 note, STATISTICS, OQ-1, D1, INDEX summary. Judged not to need its own landmark note: it confirms rather than reframes, and the existing Watson note now carries it.
  2. Rząd 2026 (PMID 42739834) — final analysis of the tDCS trial whose interim analysis the page described (NCT05814458 confirmed in the PMC full text, PMC13566796). 40 randomized 20:20, all completed; no group × time interaction on EAT-26 (p = 0.450); the interim active-arm signal "was no longer maintained". → neuromodulation-and-experimental-therapy.md, STATISTICS, OQ-10. The registry record still reads active-not-recruiting.
  3. Appolinario 2026 (PMID 42758807) — Brazilian Psychiatric Association guideline. → REGISTRY and guidelines.md, abstract level only.
  4. Keshen 2026 (PMID 42742590) — Delphi consensus that GLP-1 receptor agonists should generally be avoided in active AN and atypical AN. → REGISTRY and guidelines.md. Not added to red-flags-and-safety-concerns.md or pharmacotherapy.md; see follow-ups.
  5. Watson 2026 CREAT (PMID 42683660) and Han 2026 (PMID 42753153) — one paragraph each on genetics.md (discordant monozygotic twins; AN–bone-density pleiotropy with an in-vitro NCAM1 result).

Trial-registry findings that changed a page

  1. NCT04966858 (i-STRONG) — the most consequential finding of the sweep, and it is a stale absence rather than new literature. refeeding-and-nutritional-rehabilitation.md, OQ-16 and junction D5 all stated that weight-indexed (kcal/kg) refeeding had "never been randomized" and that such a trial was "designable now". The trial was registered in July 2021, completed with 77 participants with atypical AN, and posted results on 2026-09-25: time to medical stability 7.83 days (SE 1.54) with 50 kcal/kg/day versus 7.21 days (SE 0.58) with 2,000 kcal/day; hypophosphataemia 0 vs 2; serious adverse events 4/38 vs 6/36. No statistical analysis, delivered-dose data or 12-month outcomes are posted and no publication was found. The record was missed at build, audit and depth pass because it is not among the NCT IDs the condition cited and the asserted absence was tested in PubMed, not in the registry. → refeeding page (TL;DR, evidence table, new paragraphs, open question), clinical-trials page, STATISTICS, REGISTRY disagreement row and watch list, guidelines.md, OQ-6, OQ-16, D5. All wording is confined to what the registry posts; nothing is described as equivalent or non-inferior.
  2. NCT06085092 (open vs blind weighing) recruiting → completed, 70 actual, no results posted. NCT06624397 (carer programme) recruiting → unknown status. Portfolio counts updated to the 2026-09-30 figures with the 2026-09-02 figures retained alongside. → clinical-trials-landscape.md, STATISTICS. The page's sentence that open-versus-blind weighing rests on "no randomized evidence at all" was narrowed: a 216-patient multisite trial exists as a 2020 protocol with no outcome report located (Murray 2020b, PMID 33094860).

A second stale absence, found while checking a follow-up from the previous log

  1. The previous log named OQ-17 (course of atypical AN) the highest-value open question and asked the sweep to "watch for the first cohort". A title-restricted all-years search found that course studies already existed: Golden 2024 (PMID 37507351), one-year outcomes of 48 atypical-AN and 63 AN participants from the StRONG cohort, and Hagan 2024 (PMID 38303677), symptom trajectories in a college cohort including 125 with atypical AN. The claims "no cohort study reports … recovery or relapse rates", "without producing a single course estimate", "left the longitudinal gap untouched", "still no course or outcome cohort" and the STATISTICS row "0 identified" were therefore too broad. They are narrowed to what the re-searches still support: no mortality data and no recovery or relapse rates beyond one year, and no population incidence estimate. → mortality-and-long-term-outcome.md, diagnosis-and-classification.md, guidelines.md, STATISTICS, OQ-17. These are 2024 papers outside the sweep window; they are included because leaving a known-false absence in place is worse than exceeding the window. Two other hits were read and excluded: Strober 1999 (PMID 10065390) uses a pre-DSM-5 meaning of "atypical", and Agostino 2021 (PMID 34874405) counts hospital assessments of AN and atypical AN combined, which is not a population incidence estimate.

Statistics-only, open-question-only or patient-voice-only additions

Wang 2026 (PMID 42715667) and Liu 2026 (PMID 41553370), two GBD 2021 secondary analyses; Calardo 2026 (PMID 42770931), 23.6% one-year readmission in 9,829 hospitalized young people; Fornaro 2026 (PMID 42777340), umbrella review, personality disorder in 49% of AN; Rienecke 2026 (PMID 42287759), causes of death in 35 of 370 severe-AN patients; Majuri 2026 (PMID 40858910), labour-market outcomes to age 33 (→ OQ-24); Duffy 2026 (PMID 42694663), service evaluation of autism-affirming nasogastric-feeding resources (→ patient-voice). OQ-20 gained a registered, not-yet-recruiting randomized FMT pilot (NCT07574892).

Bibliography lines only

Wronski 2026 (PMID 42168586), limbic volumes across nutritional states in 547 participants; Mevorach 2026 (PMID 42687501), bradycardia in atypical AN versus post-bariatric weight loss; Adams 2026 (PMID 42633653), ethics of terminality constructs (entered PubMed 2026-08-23, the hit for the previous log's SE-AN terminology watch).

Patient-organization material

Beat launched "Not Designed For Me: Transforming Eating Disorder Support for Autistic People" on 9 September 2026. Landing page and launch announcement read; the report PDF was not retrieved. → new theme in patient-voice/themes.md, source row, organizations re-check note. The announcement includes an individual's story; per CONVENTIONS §3 no name or identifying detail was recorded.

Read and deliberately given nothing

Most of the window. Named here so the auditor can disagree: Banks 2026 (PMID 41927327; two-hospital UK audit, biochemical refeeding syndrome 24.1%); Elhag 2026 (42738961; single-centre refeeding cohort); Hersleth 2026 (42717077; olanzapine and SSRI concentrations vs BMI, n=65, null) and the TORPEDO protocol (42744370); Conceição 2026 (42798771; atypical-AN criteria after bariatric surgery); Wilson 2026 (42713706; CBT-E predictors, n=62); King 2026 (42750364); Peng 2026 (42777039; mouse circuit study of activity-based anorexia); Kolb 2026 (42723061; gut hormones normal after recovery); Emekli 2026 (42723169); Mota 2026 (42435748) and Bergen 2026 (42717474), cross-disorder genetics; Zhang 2026 (42781822; single-arm pilot of the online FBT-DBT caregiver programme now being tested in NCT07734779); Ronkainen 2026 (41026941; primary-care family-based coaching, 43% response at 6.6 years); McCulloch 2026 (42722996); Ranzenhofer 2026 (42687138; two-item screener, no outcome data, so OQ-18 is unchanged); Kim 2026 (42702938); Woodrow 2026 (42724807); Cassioli 2026 (42786426); Monaco 2026 (42756482); Bozzola 2026 (42755939); Fredrickson 2026 (42792358); and the case reports, animal studies and psychometric papers.

What was changed

  • Wiki pages edited and demoted curated → draft, last-curated 2026-09-30 (6): genetics.md, neuromodulation-and-experimental-therapy.md, refeeding-and-nutritional-rehabilitation.md, clinical-trials-landscape.md, mortality-and-long-term-outcome.md, diagnosis-and-classification.md. Each edit was checked against the abstract, PMC full text or registry record retrieved today, but none has been independently audited, so all six are demoted.
  • guidelines.md: extended; stays draft for the unchanged APA reason.
  • Untouched and still curated (11): overview, epidemiology, neurobiology, medical complications, adolescents, adults, pharmacotherapy, service models, severe-enduring/compulsory, patient experience, red flags.
  • Literature layer: BIBLIOGRAPHY (+19, marked [sweep 2026-09-30]; 301 PMIDs); STATISTICS (+19 rows, one corrected row, three caveats); REGISTRY (+2 documents, currency re-check, two disagreement-row changes, three watch-list items); Watson 2019 note (new standing section); patient-voice themes.md, sources.md, organizations.md.
  • OPEN-QUESTIONS.md: OQ-1, OQ-6, OQ-10, OQ-16, OQ-17, OQ-20, OQ-24 and junctions D1, D5 revised; none closed, none opened.
  • INDEX.md: statuses, counts and a sweep-standing table; frontmatter set to draft because it now describes unaudited edits.
  • Counts after the sweep: 291 distinct PMIDs on wiki pages (was 282); 301 in the bibliography; 48 distinct NCT identifiers (was 46). All 19 new PMIDs and both new NCT identifiers were re-fetched in a closing verification call and resolved. Every page's in-text PMIDs still match its own reference list; zero wiki PMIDs are missing from the bibliography. The bibliography is now a superset of the wiki set by 10 records (the statistics-only, open-question-only, patient-voice-only and bibliography-only entries), which ends the exact page–bibliography equality recorded on 2026-09-02; each such entry says so in its "cited by" field.
  • WHATS-NEW.md was not edited; it is generated by tools/build_recency.py at publish.

Verification that failed or was not attempted

  • APA 2023 — third failed attempt. psychiatryonline.org returns HTTP 403 to automated requests and Europe PMC lists PMID 36722117 as subscription-only with no abstract. This will not resolve by retrying from an automated session; it needs a person with access or an authenticated route.
  • Harrop 2023 (PMID 36577133) and Verma 2024 (PMID 37897094) — Europe PMC: subscription-only, no abstract, not in PMC. Still cited at title level.
  • BMJ news feature, "Eating disorders: doctors and patients left in 'nightmare situation' amid long waits, unsafe care, and preventable deaths" (PMID 42727964, 11 Sep 2026) — no abstract; bmj.com returned 403. It probably reports a UK inquiry or report relevant to service-models-and-setting.md and the patient-voice layer, but nothing was written from it because nothing could be read.
  • MDPI, NICE (via the fetch tool) and Beat (via the fetch tool) returned 403 or refused connections; NICE and Beat were then retrieved by direct request, and the MDPI paper was read from PMC instead.
  • Brazilian guideline and Delphi consensus — abstract level only.
  • Beat report — landing page only; Beat's 23 July 2026 prevalence estimate (1 in 20; 3.5 million in the UK, all eating disorders) was seen, predates the window, and was noted in organizations.md but not entered in STATISTICS because its methods page was not read.

Judgement calls made without asking

  • Corrected two out-of-window absence errors (items 6 and 8) rather than confining the sweep to papers dated after 2026-09-02.
  • Reported registry-posted results for NCT04966858 on a wiki page although they are not peer-reviewed, labelled as such at every mention.
  • Demoted all six edited pages rather than claiming source-verified exemption, since the verifier and the author were the same engine.
  • Left overview.md untouched. Two of its sentences are now dated rather than wrong: it describes Watson 2019 without mentioning the larger 2026 GWAS, and it reports the 2026 review as "still finding the longitudinal course evidence missing".
  • Appended this entry at the end of the file, matching where the last three entries were placed, although the file header says newest first.

For the auditor and the next sweep

  • Audit priorities, in order: (a) the NCT04966858 numbers against the live registry record, and whether a publication has appeared; (b) the Termorshuizen table on genetics.md against PMC13553282, especially the "partial replication" reading and the side-by-side h²_SNP row; (c) the narrowed atypical-AN absence — re-run the searches and check whether Lee 2026 itself cites Golden 2024 or Hagan 2024; (d) the GBD 2021 rows, where the Liu abstract does not say whether +38.79% is a count or a rate.
  • Asserted absences should be tested against ClinicalTrials.gov as well as PubMed. Item 6 sat in the registry for five years while three passes certified the absence from PubMed alone. The other "no randomized trial has…" statements (below 60% median BMI; prophylactic phosphate; premorbid-indexed weight targets; fracture endpoint; FBT dismantling) were not re-tested against the registry in this sweep and should be.
  • Watch for: publication of i-STRONG; results or publication for NCT06085092; an outcome report from the Murray 2020b weighing trial; a registry status update for NCT05814458; atypical-AN outcomes beyond one year.
  • Page candidates left for a decision: the GLP-1RA consensus on red-flags-and-safety-concerns.md or pharmacotherapy.md; Rienecke 2026 in the causes section of the mortality page; Mevorach 2026 on medical-complications.md; Wronski 2026 on neurobiology-and-cognition.md; GBD 2021 on epidemiology-and-incidence.md (which still cites only GBD 2019); Adams 2026 on the severe-enduring page; the two overview.md sentences above.
  • Retrieve: the Brazilian guideline's AN recommendation table; the Beat autism report PDF and Beat's prevalence-methods page; whatever report the BMJ feature covers.
  • Carried forward unchanged from 2026-09-02: EDGI registry enrolment (17,991) versus the 31,671 analysed in Watson 2026, and the FMT pilot's 17 registered versus 22 reported — both registry figures were re-fetched today and have not changed; the Russell 1987 landmark-note question; page lengths (mean now 139 lines).
  • Pre-existing defects noticed and not fixed: the reference list of mortality-and-long-term-outcome.md jumps from 14 to 21; PMID 38988459 appears in the guideline registry but not in the bibliography; this log's entries are not in the order its header states.
  • Next window: use an entry-date floor of about 2026-09-23 rather than 2026-09-30. PubMed indexing lagged release by about three weeks for the most important paper in this sweep (released 2026-08-19, entered 2026-09-10).

2026-10-07 — independent audit of Claude Opus 5's D14 closure and D15 opening (Codex, auditor)

Records and checks. Re-fetched Roff 2024 (PMID 39143961), Eddy 2017 (PMID 28002660), Crow 2023 (PMID 37057340) and Robison 2024 (PMID 38619462) through live PubMed E-utilities; publication types and DOI Crossref updated-by fields show no retraction or expression of concern. Read Roff's live PMC11322357 full text, specifically Discussion §§5.1.2–5.1.3. A live PubMed search combining anorexia, irremediability/terminality, long-term prognosis and calibration/validation terms returned zero indexed abstracts; that narrow result does not establish universal absence.

Figures and correction. Eddy's AN recovery figures resolve at 31.4% by 9 years and 62.8% by 22 years, with about half of those unrecovered at 9 years recovered at 22. Roff explicitly tests duration and treatment-resistance rationales against that long-term literature and cites Eddy in §5.1.2, so D14 remains correctly CLOSED. No requested number failed verification. D15 is a distinct, unanswered quantitative prognosis question, but Claude overstated a common assisted-death "profile" and assumed an existing cohort contains all proposed predictors. Only 19 of Roff's more than 60 cases have detailed summaries. Revised D15 to specify a prespecified predictor set, individual-level longitudinal data and external validation, without treating a group recovery probability as an ethical decision rule. No page status changed.

Judgement. D14's closure can be relied on. D15 remains open in its narrower form; the required dataset and any usable prognostic accuracy remain to be established.

2026-10-21 — periodic literature sweep (Claude) — not yet audited

Second periodic sweep. Every PMID written today came from a live PubMed E-utilities call in this session (the PubMed MCP connector was not authorized, so esearch/esummary/efetch were called directly); every NCT identifier came from a live ClinicalTrials.gov v2 call today. The full query manifest is at literature/sweeps/2026-10-21.json. The auditor must be a different engine.

Window. Requested: publications since 2026-10-07. Used: PubMed entry date ≥ 2026-09-23 plus publication date ≥ 2026-10-07. The earlier entry-date floor follows the previous log's advice about indexing lag, and it also covers 2026-09-30 to 2026-10-07, which no sweep had searched (the 2026-10-07 entry was a junction audit, not a sweep). Note also that the 2026-09-30 sweep has still not had its full independent audit; the 2026-10-07 Codex entry audited D14/D15 only.

Sources actually queried

Source Query Result
PubMed AN [tiab] OR [MeSH], EDAT ≥ 2026/09/23 59
PubMed Same, DP ≥ 2026/10/07 45; 91 unique, 7 already in the condition; every title read
PubMed — Cochrane "Cochrane Database Syst Rev"[jour] × (anorexia, eating disorder*, refeeding, malnutrition, family therapy), EDAT ≥ 2026/09/23 0. Widened to EDAT ≥ 2025-01-01: 1 record (PMID 40326567, weight-neutral obesity interventions; not relevant). No new or updated Cochrane review on any AN topic.
PubMed 12 topic queries (ED trials/meta-analyses; refeeding; atypical AN; FBT/family therapy; guideline/consensus titles; mortality/suicide titles; drugs and neuromodulation incl. GLP-1/psilocybin/ketamine; incidence/prevalence; severe-enduring/compulsory/assisted death; restrictive/low-weight ED; weighing; i-STRONG) 51 records outside the core set, titles read; 0 guideline or mortality-title records
PubMed Publication searches for NCT05814458, NCT06085092, NCT05509257, NCT02795455 (all years) 6 records; surfaced Schulz 2026 (below)
PubMed OQ-23 absence re-test: AN × target/goal/premorbid weight × randomized (all years) 5 records, none randomizes a weight target
Abstracts read 18
ClinicalTrials.gov All 48 cited NCT IDs re-fetched individually 48/48 resolved; 1 status change
ClinicalTrials.gov Condition "anorexia nervosa", last update ≥ 2026-09-23 14 records
ClinicalTrials.gov Interventional portfolio counts by status; phase 2/3; recruiting phase-designated 341 (was 338); phase 2/3 49; 5 recruiting phase-designated (was 6)
ClinicalTrials.gov Condition AN × weight-target terms (OQ-23 absence) 5 records, none randomizes a weight target
Europe PMC AN, FIRST_PDATE 2026-09-23 to 2026-10-21, NOT SRC:MED 49 — preprints (Research Square, medRxiv, bioRxiv, PsyArXiv, Preprints.org) and PMC copies of MEDLINE records; none cited
Crossref updated-by for all 14 added DOIs none retracted, corrected or under concern; PubMed publication types agree. No mailto sent: LIFEBANK_CONTACT_EMAIL is unset
Guidelines NICE NG69 page HTTP 200; unchanged (last updated 16 Dec 2020, last reviewed 15 Aug 2024). PubMed guideline/consensus title search: 0
Patient organisations Beat news, ANAD news, F.E.A.S.T., EDFA, AED (200); NEDA (403) Beat 9 Oct 2026 CEO statement on the UK Government's review of mental health, autism and ADHD prevalence (headline only, not entered); ANAD 15 Oct learning-library item on LGBTQ+ men (not entered)

Not queried: Unpaywall (contact variable unset); Cochrane Library/CENTRAL and SciELO/LILACS (HTTP 403, so no claim is made about them); WHO ICTRP and non-US registries (no question in this sweep concerned non-US trials; the two new non-US registrations are on ClinicalTrials.gov). Every absence below is an absence in PubMed and ClinicalTrials.gov only.

What survived triage

Of about 140 records screened, 14 entered the bibliography. Four are cited on wiki pages, the rest in STATISTICS, OPEN-QUESTIONS or patient-voice, or as bibliography-only lines. No landmark note was written; nothing in the window reframes the field.

Wiki changes

  1. Sysko 2026 (PMID 42310840) — RCT, 60 adolescents with low-weight eating disorders, six sessions of interoceptive exposure (IE) vs FBT, 27 healthy controls. IE ate more at post-treatment test meals (+98 kcal, d = 0.82; +137 kcal, d = 0.45); no difference in %EBW. Registered as NCT02795455 (completed, 90 actual including controls, no results posted). The registered primary outcome is fMRI-EMG response to food images; neither abstract leads with it. The publication search for the NCT number also found Schulz 2026 (PMID 40015474), a companion fMRI report from the same trial (18 IE vs 21 FBT; left anterior insula activation during extinction of palatable food cues, g = 1.59). It went online in February 2025, outside the window; it is included because it reports the same trial. → treatment-in-adolescents.md (new row in "Beyond single-family therapy"), clinical-trials-landscape.md (registration row).
  2. Ino 2026 (PMID 42286444) — 66,785 US AN hospitalizations (National Inpatient Sample 2017–2022). Nasogastric feeding, parenteral nutrition, gastrostomy or restraint in 6.8%, rising from 5.8% to 8.1%; restraint alone 1.7%. Mehler 2026 (PMID 42870371) is an invited commentary taking the opposing position. The page wording states that administrative codes do not record consent. → severe-enduring-illness-and-compulsory-treatment.md (new paragraph under Compulsory treatment), STATISTICS.
  3. Registry: NCT05509257 (naltrexone neuroimaging in teens, early phase 1) went from recruiting to active, not recruiting (updated 2026-10-16). The "six phase-designated recruiting records" sentence is now five. The portfolio table was rebuilt with three dated columns (341 / 338 / 337). Two new registrations were added: NCT07877675, a double-masked placebo-controlled crossover of capsule FMT in 60 females in Denmark with a microbiome-composition primary outcome, and NCT07860320, an iTBS/cTBS/sham crossover in 30 participants in Portugal with an fMRI connectivity primary outcome. → clinical-trials-landscape.md; NCT07877675 also → OQ-20.

Open questions

  • OQ-20 gained NCT07877675. It is the first placebo-controlled adult FMT trial, but it is designed to show engraftment, not benefit. The claim that no placebo-controlled clinical outcome has been reported still holds. D11 is unchanged.
  • OQ-23 sharpened with two observational cohorts. Woltmann 2026 (PMID 42314025): menses resumed at a median 92.0 %mBMI, 6.5 units below premorbid. Franklin 2026 (PMID 42868898): 40% of adolescents with premorbid overweight who missed their treatment goal weight still met a priori recovery criteria. The "no trial has randomized a weight target" absence was re-tested in PubMed and ClinicalTrials.gov and holds in those two sources.

Statistics only: de Geus 2026 (PMID 42897606), duration of untreated eating disorder of 19.9 months for AN; Katzman 2026 (PMID 42841822), divergent post-pandemic paediatric admissions at two Canadian hospitals; Ino 2026 and Woltmann 2026 as above.

Patient voice: Henningsson 2026 (PMID 42832022), seven Swedish adolescents on compulsory inpatient care → patient-voice/sources.md. Read at abstract level; no individual identified.

Bibliography only: Rasmussen 2026 (PMID 42900863; family history in 18.1% of people with any eating disorder, not AN-specific); Dani 2026 (PMID 42177039; IGF-1 graded current AN < weight-restored < controls, a candidate for medical-complications.md); Learner 2026 (PMID 42417543; refeeding kcal need not age-dependent, n = 417); Simons 2026 (PMID 42391410; uncontrolled multifamily-therapy cohort); Kota 2026 (PMID 42878114; Markov cost-utility model, which by its own statement does not isolate the CBT-E effect).

Read and given nothing (listed so the auditor can disagree): Huang 2026 (42891047; GBD analysis with no abstract in PubMed; PMC copy exists, not read); Borus 2026 (42894249; standardized meal plan QI, non-significant); Orlandi 2026 (42415684); Latva-Rasku 2026 (42855800; PET insulin sensitivity); Tsiaka 2026 (42322664; TBT-S Greece); Austin 2026 (42302126; transition meta-aggregation); Sharpe 2026 (42894418; FREED-Mobile feasibility, all EDs); Asaria 2026 (42850661; letter); Öğütlü 2026 (42875372; CBT-FE proposal); Collantoni 2026 (42857906; single-case iTBS); Gargiullo 2026 (42884588; microbiota cross-sectional); animal activity-based-anorexia studies; case reports; psychometric and cross-disorder genetics papers. Preprints of possible later interest: a medRxiv register-based severity-trajectory/polygenic study (doi:10.64898/2026.09.28.26364163) and a Research Square accelerated theta-burst TMS trial (doi:10.21203/rs.3.rs-10820743/v1). Neither was resolved through Crossref or cited.

What was changed

  • Demoted curated → draft, last-curated 2026-10-21: treatment-in-adolescents.md, severe-enduring-illness-and-compulsory-treatment.md. Each edit was checked against the abstract or registry record retrieved today, but author and verifier are the same engine.
  • clinical-trials-landscape.md: already draft; last-curated 2026-10-21.
  • Literature layer: BIBLIOGRAPHY +14 (marked [sweep 2026-10-21]; 315 PMIDs); STATISTICS +4 rows; patient-voice sources.md +1; OPEN-QUESTIONS OQ-20 and OQ-23 revised, none opened or closed; INDEX counts, statuses and a new sweep-standing table; manifest literature/sweeps/2026-10-21.json.
  • Counts: 295 distinct PMIDs on wiki pages (was 291), 315 in the bibliography (was 301), 51 NCT identifiers (was 48). Every page's in-text PMIDs match its reference list, and zero wiki PMIDs are missing from the bibliography (scripted check).
  • No guideline registry change: no new or updated guideline was found.

For the auditor and the next sweep

  • Audit priorities: (a) the Sysko row, especially the registered-versus-reported primary-outcome sentence, against NCT02795455; (b) the Ino percentages and the "consent not recorded" qualifier (PMC13655940 is open, so the full text should be read); (c) the five-versus-six phase-designated recruiting count.
  • Still outstanding from 2026-09-30: a full independent audit of that sweep's six demoted pages; the APA 2023 text; the GLP-1RA consensus placement; the GBD 2021 rows; the reference numbering gap on the mortality page. The "no randomized trial" absences on the refeeding page (below 60% median BMI, prophylactic phosphate, fracture endpoint, FBT dismantling) have still not been re-tested against the registry.
  • Watch for: publication of i-STRONG (NCT04966858; none found today); results for NCT06085092; the NCT05509257 readout (primary completion estimated 2026-12); the NCT05814458 registry update (still active, not recruiting, last updated 2026-02-02); peer-reviewed versions of the two preprints above.
  • Next window: entry date ≥ about 2026-10-14.