Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study

Background. Given our poor understanding of the very long-term course of an orexia nervosa, many questions remain regarding the potential for recovery and relapse. The purpose of the present study was to investigate long-term outcome and prognosis in an anorexic sample 21 years after the initial trea tment. Method. A multidimensional and prospective design was used to assess outcom e in 84 patients 9 years after a previous follow-up and 21 years after admi ssion. Among the 70 living patients, the follow-up rate was 90 %. Causes of death for the deceased patients were obtained through the attending physic ian. Predictors of a poor outcome at the 21-year follow-up were selected ba sed on the results of a previous 12-year follow-up of these patients. Results. Fifty-one per cent of the patients were found to be fully recovere d at follow-up, 21 % were partially recovered and 10 % still met full diagn ostic criteria for anorexia nervosa. Sixteen per cent were deceased, due to causes related to anorexia nervosa. The standardized mortality rate was 9( .)8. The three groups also showed significant differences in psychosocial o utcome. A low body mass index and a greater severity of social and psycholo gical problems were identified as predictors of a poor outcome. Conclusions. Recovery is still possible for anorexic patients after a perio d of 21 years. On the other hand, patients can relapse, becoming symptomati c again despite previously achieving recovery status. Only a few patients c lassified as having a poor outcome were found to seek any form of treatment , therefore, it is recommended that these patients should be monitored regu larly and offered treatment whenever possible.