Six-year course and outcome of anorexia nervosa

Objective: Since there are discrepant findings in the literature, we studie d the longer-term course in a large sample of 103 DSM-IV anorexia nervosa ( AN) patients. Method: Assessments were made at four points of time: beginni ng of therapy, end of therapy, 2-year follow-up, and 6-year follow-up. Self -rating scales as well as expert-rating interview data were used. Eating di sorder-specific and general psychopathology were assessed. These data were also compared with data on the 6-year course of patients with bulimia nervo sa and binge earing disorder, respectively, who were treated at the same in stitution at about the same time. Results: The participation rate at the tw o follow-ups was high (97.9% of those alive). The general pattern of result s over time of those alive at 6-year follow-up was as follows: substantial improvement during therapy, moderate tin many instances nonsignificant) dec line during the first 2 years posttreatment, and further improvement from 3 to 6 years posttreatment. At the time of the 6-year follow-up, 26.8% had A N, 9.9% had bulimia nervosa-purging type (BN-P), 2.0% were classified as ea ting disorder not otherwise specified (ED-NOS) all diagnosed according to D SM-IV criteria; more than one half (55.4%) showed no major DSM-IV eating di sorder. Based on an operationalized global outcome score at 6-year followup , 34.7% had a good outcome, 38.6% an intermediate outcome, 20.8% a poor out come, and 6 of 101 persons (5.9%) were deceased. Body mass index was 17.9 /- 2.8 at the 6-year follow-up,. amenorrhea was still found in 23.9%. Discu ssion: In comparison to samples with bulimia nervosa or binge eating disord er, the 6-year course of anorexia nervosa was less favorable. Mortality was rather high and symptomatic recovery protracted; predictors of unfavorable 6-year course were the presence of binges during 4 weeks before index trea tment, psychiatric comorbidity, and low body weight at discharge from index treatment. (C) 1999 by John Wiley & Sons, Inc.