Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 116
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Bora, Emre and Köse, Sezen 2016. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: A specific İmpairment of cognitive perspective taking in anorexia nervosa?. International Journal of Eating Disorders,

    Bowen, Megan M. Lambert, Michael J. Berkeljon, Arjan Orr, Tyler E. Berrett, Michael Simon, Witold and Walla, Peter 2016. Effects of feedback-assisted treatment on post-treatment outcome for eating disordered inpatients: A follow-up study. Cogent Psychology, Vol. 3, Issue. 1, p. 1191119.

    Fogarty, Sarah Smith, Caroline A. and Hay, Phillipa 2016. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eating Behaviors, Vol. 21, p. 179.

    Frank, Guido K.W. Shott, Megan E. Keffler, Carrie and Cornier, Marc-Andre 2016. Extremes of eating are associated with reduced neural taste discrimination. International Journal of Eating Disorders, Vol. 49, Issue. 6, p. 603.

    Lilenfeld, Lisa Rachelle Riso 2016. Bio-Psycho-Social Contributions to Understanding Eating Disorders.

    Nagl, Michaela Jacobi, Corinna Paul, Martin Beesdo-Baum, Katja Höfler, Michael Lieb, Roselind and Wittchen, Hans-Ulrich 2016. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. European Child & Adolescent Psychiatry, Vol. 25, Issue. 8, p. 903.

    Schlegl, Sandra Diedrich, Alice Neumayr, Christina Fumi, Markus Naab, Silke and Voderholzer, Ulrich 2016. Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome. European Eating Disorders Review, Vol. 24, Issue. 3, p. 214.

    Weigel, Angelika König, Hans-Helmut Gumz, Antje Löwe, Bernd and Brettschneider, Christian 2016. Correlates of health related quality of life in anorexia nervosa. International Journal of Eating Disorders, Vol. 49, Issue. 6, p. 630.

    Brockmeyer, Timo Zimmermann, Johannes Kulessa, Dominika Hautzinger, Martin Bents, Hinrich Friederich, Hans-Christoph Herzog, Wolfgang and Backenstrass, Matthias 2015. Me, myself, and I: self-referent word use as an indicator of self-focused attention in relation to depression and anxiety. Frontiers in Psychology, Vol. 6,

    Brown, Tiffany Klein, Kelly and Keel, Pamela K. 2015. The Wiley Handbook of Eating Disorders.

    Bryant-Waugh, Rachel and Watkins, Beth 2015. Rutter's Child and Adolescent Psychiatry.

    Gumz, Antje Kästner, Denise Raczka, Karolina A. Weigel, Angelika Osen, Bernhard Rose, Matthias Meyer, Björn Wollburg, Eileen Voderholzer, Ulrich Karacic, Matislava Vettorazzi, Eik and Löwe, Bernd 2015. Aggregating factors of the change process in the treatment of anorexia nervosa. Eating Behaviors, Vol. 19, p. 81.

    Ivanova, Iryna V. Tasca, Giorgio A. Proulx, Geneviève and Bissada, Hany 2015. Does the interpersonal model apply across eating disorder diagnostic groups? A structural equation modeling approach. Comprehensive Psychiatry, Vol. 63, p. 80.

    Legenbauer, Tanja M. and Meule, Adrian 2015. Challenges in the Treatment of Adolescent Anorexia Nervosa – Is Enhanced Cognitive Behavior Therapy The Answer?. Frontiers in Psychiatry, Vol. 6,

    Mehler, Philip S and Brown, Carrie 2015. Anorexia nervosa – medical complications. Journal of Eating Disorders, Vol. 3, Issue. 1,

    Podfigurna-Stopa, Agnieszka Czyzyk, Adam Katulski, Krzysztof Smolarczyk, Roman Grymowicz, Monika Maciejewska-Jeske, Marzena and Meczekalski, Blazej 2015. Eating disorders in older women. Maturitas, Vol. 82, Issue. 2, p. 146.

    Rosenvinge, Jan H. and Pettersen, Gunn 2015. Epidemiology of eating disorders part II: an update with a special reference to the DSM-5. Advances in Eating Disorders, Vol. 3, Issue. 2, p. 198.

    Simioni, Nicolas and Cottencin, Olivier 2015. Resurgence of anorexic symptoms during smoking cessation in patients with a history of anorexia nervosa: An unseen problem?-Report of two cases. International Journal of Eating Disorders, Vol. 48, Issue. 6, p. 798.

    Stuhldreher, Nina Wild, Beate König, Hans-Helmut Konnopka, Alexander Zipfel, Stephan and Herzog, Wolfgang 2015. Determinants of direct and indirect costs in anorexia nervosa. International Journal of Eating Disorders, Vol. 48, Issue. 1, p. 139.

    Tantillo, Mary McGraw, Jennifer Sanftner Hauenstein, Emily J. and Groth, Susan W. 2015. Partnering with patients and families to develop an innovative multifamily therapy group treatment for adults with anorexia nervosa. Advances in Eating Disorders, Vol. 3, Issue. 3, p. 269.


Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study

  • B. LÖWE (a1), S. ZIPFEL (a1), C. BUCHHOLZ (a1), Y. DUPONT (a1), D. L. REAS (a1) and W. HERZOG (a1)
  • DOI:
  • Published online: 01 July 2001

Background. Given our poor understanding of the very long-term course of anorexia nervosa, many questions remain regarding the potential for recovery and relapse. The purpose of the present study was to investigate long-term outcome and prognosis in an anorexic sample 21 years after the initial treatment.

Method. A multidimensional and prospective design was used to assess outcome in 84 patients 9 years after a previous follow-up and 21 years after admission. Among the 70 living patients, the follow-up rate was 90%. Causes of death for the deceased patients were obtained through the attending physician. Predictors of a poor outcome at the 21-year follow-up were selected based on the results of a previous 12-year follow-up of these patients.

Results. Fifty-one per cent of the patients were found to be fully recovered at follow-up, 21% were partially recovered and 10% still met full diagnostic criteria for anorexia nervosa. Sixteen per cent were deceased, due to causes related to anorexia nervosa. The standardized mortality rate was 9·8. The three groups also showed significant differences in psychosocial outcome. A low body mass index and a greater severity of social and psychological problems were identified as predictors of a poor outcome.

Conclusions. Recovery is still possible for anorexic patients after a period of 21 years. On the other hand, patients can relapse, becoming symptomatic again despite previously achieving recovery status. Only a few patients classified as having a poor outcome were found to seek any form of treatment, therefore, it is recommended that these patients should be monitored regularly and offered treatment whenever possible.

Corresponding author
Address for correspondence: Dr. Bernd Löwe, Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Hospital, Bergheimer Strasse 58, D–69115 Heidelberg, Germany.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *