This commentary on serious and enduring anorexia nervosa adopts the position of a developmental psychiatrist. It argues that this perspective illuminates the etiology and course of severe and enduring anorexia nervosa (SE-AN) and could thus help to develop treatments targeting typical early characteristics of patients with SE-AN. Based on a detailed knowledge of contributing factors, a risk score for SE-AN should be designed by which the probability of chronicity could be calculated at an early stage and preventive measures be taken. As the formation of habits seems to play an important role in establishing a chronic course of AN, psychotherapeutic techniques that include "habit reversal" should be considered during the early stage. Another recommended step in preventing SE-AN is the identification of resilience factors that are associated with a late favorable outcome.