Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders

Objective: To study the development of personality disorders, especially th ose involving obsessions, compulsions, and social interaction problems, in a representative group of anorexia nervosa (AN) cases. Method: The prevalen ce of personality disorders, obsessive-compulsive disorder, and autism spec trum disorders at mean age 24 years (10 years after reported onset) was exa mined in 51 adolescent-onset AN cases recruited after community screening a nd 51 comparison cases matched for age, sex, and school. All 102 cases had originally been examined at age 16 years and followed up at 21 years. At 24 years, structured and validated psychiatric diagnostic interviews were per formed by a psychiatrist who was blind to original diagnosis. The majority of AN cases (94%) were weight-restored. Results: Personality disorders, par ticularly cluster C, and autism spectrum disorders were overrepresented in the AN group. Obsessive-compulsive personality disorder and/or autism spect rum disorder was diagnosed in a subgroup of AN cases in all 3 studies. This subgroup had a very poor psychosocial outcome. Conclusions: Persistent pro blems with obsessions, compulsions, and social interaction characterized a substantial minority of weight-restored AN cases at 10-year follow-up. Thes e problems appear to be constitutional rather than a result of AN, and they may warrant a different treatment approach.