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Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa: four-year follow-up study of 41 patients

Published online by Cambridge University Press:  09 July 2009

H. G. Morgan  and
G. F. M. Russell
H. G. Morgan*
Affiliation:
Department of Mental Health, University of Bristol, Department of Psychiatry, Royal Free Hospital, London
G. F. M. Russell
Affiliation:
Department of Mental Health, University of Bristol, Department of Psychiatry, Royal Free Hospital, London
*
1Address for correspondence: Department of Mental Health, University of Bristol, 39 St. Michael's Hill, Bristol BS2 8DZ
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Synopsis

This is a prognostic study on 41 patients with anorexia nervosa (including three males) who satisfied defined diagnostic criteria. The patients had all been admitted to a metabolic unit where the mainstay of treatment was nursing care aimed at rapid restoration of body weight. A follow-up was conducted after a minimum lapse of four years after each patient's discharge from hospital. The outcome of the patient's illness was expressed in terms of an ‘average outcome score’ and a ‘general outcome’. The series included a relatively high proportion of patients with a long illness who had received previous psychiatric treatment. Their families tended to come from higher social classes; a disturbed relationship with the patient was frequent. Premorbid disturbances in personality development were also common. The immediate response to treatment was excellent, with the majority of the patients returning to a normal weight, but relapses after discharge were common and readmissions were necessary in half the patients. At follow-up, the patients fell into the following defined categories: ‘good’ (39%), ‘intermediate’ (27%), ‘poor’ (29%), died (5%). Most of the patients who failed to recover continued to display the clinical features characteristic of anorexia nervosa. Among predictors of an unfavourable outcome were found a relatively late age of onset, a longer duration of illness, previous admissions to psychiatric hospitals, a disturbed relationship between the patient and other members of the family, and premorbid personality difficulties. It is suggested that the long-term outcome found in a series will depend more on factors influencing patient referral according to the severity of their illness, rather than on the method of treatment itself. The illness may last several years before eventual improvement or recovery, and a follow-up study must be extended over at least four years to be meaningful. An accurate prediction of eventual outcome is almost impossible, but late recoveries justify an optimistic outlook and continued therapeutic endeavour.

Type
Original Article
Information
Psychological Medicine , Volume 5 , Issue 4 , November 1975 , pp. 355 - 371
Copyright
Copyright © Cambridge University Press 1975

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References

Beumont, P. J. V., Beardwood, C. J., and Russell, G. F. M. (1972). The occurrence of the syndrome of anorexia nervosa in male subjects. Psychological Medicine, 2, 216–231.CrossRefGoogle ScholarPubMed
Beck, J. C., and Brochner-Mortensen, K. (1954). Observations on the prognosis in anorexia nervosa. Acta Medica Scandinavica, 149, 409–430.CrossRefGoogle ScholarPubMed
Bruch, H. (1965). Anorexia nervosa and its differential diagnosis. Journal of Nervous and Mental Disease, 141, 555–566.CrossRefGoogle Scholar
Campbell, A. A. (1971). Critical Evaluation of Treatments for Anorexia Nervosa. Thesis: University of London.Google Scholar
Cremerius, J. (1965). Zur Prognose der Anorexia Nervosa. Archiv Psychiatrie für und Nervenkrankheiten, 207, 378–393.CrossRefGoogle ScholarPubMed
Crisp, A. H. (1965a). Clinical and therapeutic aspects of anorexia nervosa—a study of 30 cases. Journal of Psychosomatic Research, 9, 67–78.CrossRefGoogle ScholarPubMed
Crisp, A. H. (1966a). A treatment regime for anorexia nervosa. British Journal of Psychiatry, 112, 505–512.CrossRefGoogle Scholar
Crisp, A. H. (1965b). Some aspects of the evolution, presentaztion and follow-up of anorexia nervosa. Proceedings of the Royal Society of Medicine, 58, 814–820.CrossRefGoogle ScholarPubMed
Crisp, A. H. (1967). A Psychosomatic Study of Anorexia Nervosa: a Controlled Study of some Aspects of the Constitution and Premorbid Feeding Behaviour of Patients. Thesis: University of London.Google Scholar
Crisp, A. H. (1966b). Anorexia nervosa in an identical twin. Postgraduate Medical Journal, 42, 86–92.CrossRefGoogle Scholar
Crisp, A. H. (1970). Anorexia nervosa, ‘feeding disorder’, ‘nervous malnutrition’ or ‘weight phobia’? World Review of Nutrition and Dietetics, 12, 452–504.CrossRefGoogle ScholarPubMed
Crisp, A. H., and Toms, D. A. (1972). Primary anorexia nervosa or weight phobia in the male: report on 13 cases. British Medical Journal, 1, 334–338.CrossRefGoogle ScholarPubMed
Dally, P. (1969). Anorexia Nervosa. Heinemann: London.Google Scholar
Geigy, (1962a). Average weight of adults (Society of Actuaries: Build and Blood Pressure Study, Chicago, 1959). p. 623, Documenta Geigy. Scientific Tables. Geigy Pharmaceuticals: Manchester.Google Scholar
Geigy, (1962b). Wilcoxon's Rank Test, p. 124. Documenta Geigy. Scientific Tables. Geigy Pharmaceuticals: Manchester.Google Scholar
SirGull, W. W. (1874). Anorexia nervosa (apepsia hysterica, anorexia hysterica) Transactions of the Clinical Society of London, 7, 22–28.Google Scholar
SirHurst, A. (1939). Discussion on anorexia nervosa. Proceedings of the Royal Society of Medicine, 32, 744–745.Google Scholar
Kay, D. W. K., and Leigh, D. (1954). The natural history, treatment and prognosis of anorexia nervosa, based on a study of 38 patients. Journal of Mental Science, 100, 411–431.CrossRefGoogle ScholarPubMed
Kay, D. W. K., and Schapira, K. (1965). The prognosis in anorexia nervosa. In Anorexia Nervosa. Symposium, Göttingen, 1965. Edited by Meyer, J. N. E. and Feldman, H.. Thieme: Stuttgart.Google Scholar
Kay, D. W. K., Schapira, K., and Brandon, S. (1967). Early factors in anorexia nervosa compared with non-anorexic groups. Journal of Psychosomatic Research, 11, 133–139.CrossRefGoogle ScholarPubMed
Kendell, R. E., Hall, D. J., Hailey, A., and Babigian, H. M. (1973). The epidemiology of anorexia nervosa. Psychological Medicine, 3, 200–203.CrossRefGoogle ScholarPubMed
Lesser, L. I., Ashenden, B. J., Debuskey, M., and Eisenberg, L. (1960). Anorexia Nervosa in Children. American Journal of Orthopsychiatry, 30, 572–580.CrossRefGoogle ScholarPubMed
Meyer, J. V. E. (1961). Das Syndrom der Anorexia Nervosa. Katamnestische Untersuchungen. Archiv für Psychiatrie und Nervenkrankheiten, 202, 31–59.CrossRefGoogle Scholar
Russell, G. F. M. (1970). Anorexia nervosa: its identity as an illness and its treatment. In Modern Trends in Psychological Medicine, 2, pp. 131–164. Edited by Price, J. H.. Butter-worths: London.Google Scholar
Russell, G. F. M. (1973). The management of anorexia nervosa. In Symposium, Anorexia Nervosa and Obesity, pp. 44–62. Edited by Robertson, R. F.. Royal College of Physicians of Edinburgh: Edinburgh.Google Scholar
Russell, G. F. M., Loraine, J. A., Bell, E. T., and Harkness, R. A. (1965). Gonadotrophin and oestrogen excretion in patients with anorexia nervosa. Journal of Psychosomatic Research, 9, 79–85.CrossRefGoogle ScholarPubMed
Sainsbury, P., and Kreitman, N. (eds). (1963). Methods of Psychiatric Research. An Introduction for Clinical Psychiatrists. Oxford University Press: London.Google Scholar
Slade, P. D., and Russell, G. F. M. (1973). Awareness of body dimensions in anorexia nervosa: cross-sectional and longitudinal studies. Psychological Medicine, 3, 188–199.CrossRefGoogle ScholarPubMed
Susser, M. W., and Watson, W. (1962). Sociology in Medicine, p. 69. Oxford University Press: London.Google Scholar
Theander, S. (1970). Anorexia nervosa. A psychiatric investigation of 94 female cases. Acta Psychiatrica Scandi-navica, Suppl. 214.Google Scholar
Thomä, H. (1967). Anorexia Nervosa. International Universities Press: New York.Google Scholar
Warren, W. (1968). A study of anorexia nervosa in younggirls. Journal of Child Psychology Psychiatry, 9, 27–40.CrossRefGoogle Scholar
Williams, E. (1958). Anorexia nervosa: a somatic disorder. British Medical Journal, 2, 190–195.CrossRefGoogle ScholarPubMed