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Ten-year follow-up of anorexia nervosa: clinical course and outcome

  • E. D. Eckert (a1), K. A. Halmi (a1), P. Marchi (a1), W. Grove (a1) and R. Crosby (a1)...
Synopsis
Synopsis

The clinical course and outcome of anorexia nervosa are presented in a 10-year followup study of 76 severely ill females with anorexia nervosa who met specific diagnostic criteria and had participated in a well-documented hospital treatment study. Information was obtained on 100% of the subjects. A comprehensive assessment was made in 93% of the living subjects in specific categories of weight, eating and weight control behaviours, menstrual function, anorexic attitudes, and psychological, sexual, social and vocational adjustment. Five subjects had died, which gives a crude mortality rate of 6·6%. Standardized mortality rates demonstrated an almost 13-fold increase in mortality in the anorexia nervosa subjects. Only eighteen (23·7%) were fully recovered. Sixty-four per cent developed binge-eating at some time during their illness, 57% at least weekly. Twenty-nine (41%) were still bulimic at follow-up. The high frequency and chronicity of the bulimic symptoms plus the high rate of weight relapse (42% during the first year after hospital treatment) suggest that intensive intervention is needed to help anorexics restore and maintain their weight within a normal range and to decrease abnormal eating and weight control behaviours.

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Corresponding author
1Address for correspondence: Dr Elke D. Eckert, Box 393 Mayo Building, University of Minnesota Hospitals, Minneapolis, Minnesota 55455, USA.
References
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American Psychiatric Association (1987). Diagnostic and Stalistical Manual of Mental Disorders (revised 3rd edn.) APA: Washington, DC.
Bassoe H. H. & Eskeland I. (1982). A prospective study of 133 patients with anorexia nervosa. Acta Psychiatrica Scandinavica 65, 127133.
Dally P. & Gomez I. (1979). Anorexia Nervosa. William Heinemann Medical Books: London.
Eckert E. D., Goldberg S. C., Halmi K. A., Casper R. C. & Davis J. M. (1979). Behaviour therapy in anorexia nervosa. British Journal of Psychiatry 134, 5559.
Eckert E. D., Goldberg S. C., Halmi K. A., Casper R. C. & Davis J. M. (1982). Depression in anorexia nervosa. Psychological Medicine 12, 115122.
Feighner J. P., Robins E., Guze S. B., Woodruff R. A. Jr, Winokur J. & Munoz R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5763.
Garfinkel P. E., Moldofsky H. & Garner D. M. (1977). The outcome of anorexia nervosa: significance of clinical features, body image, and behavior modification. In Anorexia Nervosa (ed Vigersky R. A.), pp. 315329. Raven Press: New York.
Goldberg S. C., Halmi K. A., Eckert E. D., Casper R. & Davis J. M. (1979). Cyproheptadine in anorexia nervosa. British Journal of Psychiatry 134, 6770.
Hall A., Slim E., Hawker F. & Salmond C. (1984). Anorexia nervosa: long-term outcome in 50 female patients. British Journal of Psychiatry 145, 407413.
Halmi K., Brodland G. & Regas C. (1975). A follow-up study of 79 patients with anorexia nervosa: an evaluation of prognostic factors and diagnostic criteria. Life History Review Psychopathology 4, 290300.
Halmi K. A., Eckert E., Marchi P., Sampugnaro V., Apple R. & Cohen J. (1991). Comorbidity of psychiatric diagnosis in anorexia nervosa. Archives of General Psychiatry 48, 712718.
Halmi K. A., Goldberg S. C., Eckert E., Casper R. & Davis J. M. (1977). Pretreatment evaluation in anorexia nervosa. In Anorexia Nervosa (ed. Vigersky R. A.), pp. 4354. Raven Press: New York.
Hollingshead A. B. & Redlich F. C. (1958). Social Class and Mental Illness, pp. 398407. John Wiley and Sons: New York.
Hsu L. K. G. (1980). Outcome of anorexia: a review of the literature (1954 to 1978). Archives of General Psychiatry 37, 10411046.
Hsu L. K. G. (1988). The outcome of anorexia nervosa: a reappraisal. Psychological Medicine 18, 807812.
Hsu L. K. G., Crisp A. H. & Harding B. (1979). Outcome of anorexia nervosa. Lancet i, 6165.
Isager T., Brinch M., Kreiner S. & Tolstrup K. (1985). Death and relapse in anorexia nervosa: survival analysis of 151 cases. Journal of Psychiatric Research 19, 515521.
Keys A., Fidanza F., Karvonen M. J., Kimura N. & Taylor H. L. (1972). Indices of relative weight and obesity. Journal of Chronic Disease 25, 329343.
Lavori P. W., Keller M. B. & Klerman G. I. (1984). Relapse in affective disorder: a reanalysis of the literature using life table methods. Journal of Psychiatric Research 18, 1325.
Martin F. E. (1985). The treatment and outcome of anorexia nervosa in adolescents: a prospective study and five-year follow-up. Journal of Psychiatric Research 19, 509514.
Morgan H. G., Purgold J. & Welbourne J. (1983). Management and outcome in anorexia nervosa. British Journal of Psychiatry 143, 282287.
Morgan H. G. & Russell G. F. M. (1975). Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa: four-year follow-up study of 41 patients. Psychological Medicine 5, 355371.
Patton G. C. (1988). Mortality in eating disorders. Psychological Medicine 18, 947951.
Pierloot R. A., Wellens W. & Houben M. E. (1975). Elements of resistance to a combined medical and psychotherapeutic program in anorexia nervosa. Psychotherapy and Psychosomatics 26, 101117.
Ratnasuriya R. H., Eisler I., Szmukler G. I. & Russell G. F. M. (1991). Anorexia nervosa: Outcome and prognostic factors after 20 years. British Journal of Psychiatry 158, 495502.
Robins L., Helzer J., Groughton I. & Ratcliffe K. (1981). The NIMH diagnotic interview schedule: its history, characteristics and validity. Archives of General Psychiatry 38, 381389.
Russell G. F. M. (197). General management of anorexia nervosa and difficulties in assessing the efficacy of treatment. In Anorexia Nervosa (ed. Vigersky R. A.), pp. 277289. Raven Press: New York.
Russell G. F. M. (1979). Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine 9, 429448.
Sagardoy R. C., Ashton A. F., Mateos J. L. A., Perez C. B. & Carrasco J. S. D. (1989). Between 5 and 9 years follow-up in the treatment of anorexia nervosa. Psychotherapy and Psychosomatics 52, 133139.
Santonastaso P., Favaretto G. & Canton G. (1987). Anorexia nervosa in Italy: clinical features and outcome in a long-term follow-up study. Psychopathology 20, 817.
Schork E. J., Eckert E. D. & Halmi K. A. (1994). The relationship between psychopathology, eating disorders diagnosis and clinical outcome at 10 year follow-up in anorexia nervosa. Comprehensive Psychiatry 35, 113123.
Schwartz D. M. & Thomspon M. G. (1981). Do anorectics get well? Current research and future needs. American Journal of Psychiatry 3, 319323.
Steinhausen H. C., Rauss-Mason C. & Seidel R. (1991). Follow-up studies of anorexia nervosa: a review of four decades of outcome research. Psychological Medicine 21, 447454.
Steinhausen H. C. & Glanville K. (1983). A long-term follow-up of adolescent anorexia nervosa. Acta Psychiatrica Scandinavica 68, 110.
Sturzenberger S., Cantwell D. P., Burroughs J., Salkin B. & Green J. K. (1977). A follow-up study of adolescent psychiatric inpatients with anorexia nervosa. Journal of the American Academy of Child Psychiatry 16, 703715.
Swift W. J. (1982). The long-term outcome of early onset anorexia nervosa. Journal of the American Academy of Child Psychiatry 1, 3846.
Szmukler G. I. & Russell G. F. M. (1986). Outcome and prognosis of anorexia nervosa. In Handbook of Eating Disorder (ed. Brownell K. D. & Foreyt J. P.), pp. 283300. Basic Books: New York.
Theander S. (1970). Anorexia nervosa: a psychiatric investigation of 94 female cases. Acta Psychiatrica Scandinavica Suppl 214, 1194.
Theander S. (1985). Outcome and prognosis in anorexia nervosa and bulimia: some results of previous investigations, compared with those of a Swedish long-term study. Journal of Psychiatric Research 19, 493508.
Tolstrup K., Brinch M., Isager T., Neilsen S., Nystrup J., Severin B. & Olesen N. S. (1985). Long-term outcome of 151 cases of anorexia nervosa. Acta Psychiatrica Scandinavica 71, 380387.
Toner B. B., Garfinkel P. E. & Garver D. M. (1986). Long-term follow-up of anorexia nervosa. Psychosomatic Medicine 48, 520529.
Warren W. (1968). A study of anorexia nervosa in young girls. Journal of Child Psychology and Psychiatry and Allied Disciplines 9, 2740.
Ziolko H. U. (1978). Zur Katamnese der pubertaetsmagersucht. Archives of Psychiatry and Neurological Sciences 225, 117125.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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