ANOREXIA-NERVOSA IN A LONG-TERM PERSPECTIVE - RESULTS OF THE HEIDELBERG-MANNHEIM STUDY

The long-term outcome of 84 anorexia nervosa patients was studied over a period of 12 years using global clinical ratings and differential p hysical findings in addition to standardized psychometric measurements . An unusual polarization into good and fatal outcomes was found, with a high recovery rate of 54% and a high mortality rate of 11%. When ps ychiatric and somatic comorbidity and psychosocial functioning were in cluded in the assessment, the recovery rate was only 41% after 12 year s. Clear cases of anorexia decreased steadily from 100% at clinical pr esentation to 67% after 2 years, 40% after 4 years, and 23% after 6 ye ars. There was almost no further decline after the ninth year of follo w-up (17%). Purging, physical symptoms, advanced age at clinical prese ntation, and a high social status were predictors for an unfavorable c ourse. About 22% of the patients had suffered a relapse after remissio n. At first presentation, they were young and had a short duration of illness but showed severe psychiatric disorders. Results are discussed in terms of methodological and clinical issues involved in the long-t erm follow-up of anorexia nervosa patients.