Hostname: page-component-669899f699-7xsfk Total loading time: 0 Render date: 2025-05-03T14:00:18.679Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  09 July 2009

E. D. Eckert ,
K. A. Halmi ,
P. Marchi ,
W. Grove  and
R. Crosby
E. D. Eckert*
Affiliation:
Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry, Cornell University Medical College, New York Hospital—Westchester Division, the Department of Psychology, New York University, New York, USA
K. A. Halmi
Affiliation:
Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry, Cornell University Medical College, New York Hospital—Westchester Division, the Department of Psychology, New York University, New York, USA
P. Marchi
Affiliation:
Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry, Cornell University Medical College, New York Hospital—Westchester Division, the Department of Psychology, New York University, New York, USA
W. Grove
Affiliation:
Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry, Cornell University Medical College, New York Hospital—Westchester Division, the Department of Psychology, New York University, New York, USA
R. Crosby
Affiliation:
Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry, Cornell University Medical College, New York Hospital—Westchester Division, the Department of Psychology, New York University, New York, USA
*
1Address for correspondence: Dr Elke D. Eckert, Box 393 Mayo Building, University of Minnesota Hospitals, Minneapolis, Minnesota 55455, USA.
Get access Rights & Permissions [Opens in a new window]

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.

Type
Research Article
Information
Psychological Medicine , Volume 25 , Issue 1 , January 1995 , pp. 143 - 156
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

American Psychiatric Association (1987). Diagnostic and Stalistical Manual of Mental Disorders (revised 3rd edn.) APA: Washington, DC.Google Scholar
Bassoe, H. H. & Eskeland, I. (1982). A prospective study of 133 patients with anorexia nervosa. Acta Psychiatrica Scandinavica 65, 127–133.CrossRefGoogle ScholarPubMed
Dally, P. & Gomez, I. (1979). Anorexia Nervosa. William Heinemann Medical Books: London.Google Scholar
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, 55–59.CrossRefGoogle ScholarPubMed
Eckert, E. D., Goldberg, S. C., Halmi, K. A., Casper, R. C. & Davis, J. M. (1982). Depression in anorexia nervosa. Psychological Medicine 12, 115–122.CrossRefGoogle ScholarPubMed
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, 57–63.CrossRefGoogle ScholarPubMed
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. 315–329. Raven Press: New York.Google ScholarPubMed
Goldberg, S. C., Halmi, K. A., Eckert, E. D., Casper, R. & Davis, J. M. (1979). Cyproheptadine in anorexia nervosa. British Journal of Psychiatry 134, 67–70.CrossRefGoogle ScholarPubMed
Hall, A., Slim, E., Hawker, F. & Salmond, C. (1984). Anorexia nervosa: long-term outcome in 50 female patients. British Journal of Psychiatry 145, 407–413.CrossRefGoogle ScholarPubMed
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, 290–300.Google Scholar
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, 712–718.CrossRefGoogle ScholarPubMed
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. 43–54. Raven Press: New York.Google ScholarPubMed
Hollingshead, A. B. & Redlich, F. C. (1958). Social Class and Mental Illness, pp. 398–407. John Wiley and Sons: New York.CrossRefGoogle Scholar
Hsu, L. K. G. (1980). Outcome of anorexia: a review of the literature (1954 to 1978). Archives of General Psychiatry 37, 1041–1046.CrossRefGoogle Scholar
Hsu, L. K. G. (1988). The outcome of anorexia nervosa: a reappraisal. Psychological Medicine 18, 807–812.CrossRefGoogle ScholarPubMed
Hsu, L. K. G., Crisp, A. H. & Harding, B. (1979). Outcome of anorexia nervosa. Lancet i, 61–65.CrossRefGoogle Scholar
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, 515–521.CrossRefGoogle ScholarPubMed
Keys, A., Fidanza, F., Karvonen, M. J., Kimura, N. & Taylor, H. L. (1972). Indices of relative weight and obesity. Journal of Chronic Disease 25, 329–343.CrossRefGoogle ScholarPubMed
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, 13–25.CrossRefGoogle ScholarPubMed
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, 509–514.CrossRefGoogle ScholarPubMed
Morgan, H. G., Purgold, J. & Welbourne, J. (1983). Management and outcome in anorexia nervosa. British Journal of Psychiatry 143, 282–287.CrossRefGoogle ScholarPubMed
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, 355–371.CrossRefGoogle ScholarPubMed
Patton, G. C. (1988). Mortality in eating disorders. Psychological Medicine 18, 947–951.CrossRefGoogle ScholarPubMed
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, 101–117.CrossRefGoogle ScholarPubMed
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, 495–502.CrossRefGoogle ScholarPubMed
Robins, L., Helzer, J., Groughton, I. & Ratcliffe, K. (1981). The NIMH diagnotic interview schedule: its history, characteristics and validity. Archives of General Psychiatry 38, 381–389.CrossRefGoogle Scholar
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. 277–289. Raven Press: New York.Google Scholar
Russell, G. F. M. (1979). Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine 9, 429–448.CrossRefGoogle ScholarPubMed
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, 133–139.CrossRefGoogle Scholar
Santonastaso, P., Favaretto, G. & Canton, G. (1987). Anorexia nervosa in Italy: clinical features and outcome in a long-term follow-up study. Psychopathology 20, 8–17.CrossRefGoogle Scholar
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, 113–123.CrossRefGoogle ScholarPubMed
Schwartz, D. M. & Thomspon, M. G. (1981). Do anorectics get well? Current research and future needs. American Journal of Psychiatry 3, 319–323.Google Scholar
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, 447–454.CrossRefGoogle ScholarPubMed
Steinhausen, H. C. & Glanville, K. (1983). A long-term follow-up of adolescent anorexia nervosa. Acta Psychiatrica Scandinavica 68, 1–10.CrossRefGoogle ScholarPubMed
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, 703–715.CrossRefGoogle ScholarPubMed
Swift, W. J. (1982). The long-term outcome of early onset anorexia nervosa. Journal of the American Academy of Child Psychiatry 1, 38–46.CrossRefGoogle Scholar
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. 283–300. Basic Books: New York.Google Scholar
Theander, S. (1970). Anorexia nervosa: a psychiatric investigation of 94 female cases. Acta Psychiatrica Scandinavica Suppl 214, 1–194.Google Scholar
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, 493–508.CrossRefGoogle ScholarPubMed
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, 380–387.CrossRefGoogle ScholarPubMed
Toner, B. B., Garfinkel, P. E. & Garver, D. M. (1986). Long-term follow-up of anorexia nervosa. Psychosomatic Medicine 48, 520–529.CrossRefGoogle ScholarPubMed
Warren, W. (1968). A study of anorexia nervosa in young girls. Journal of Child Psychology and Psychiatry and Allied Disciplines 9, 27–40.CrossRefGoogle ScholarPubMed
Ziolko, H. U. (1978). Zur Katamnese der pubertaetsmagersucht. Archives of Psychiatry and Neurological Sciences 225, 117–125.Google Scholar