Six recovered anorectic patients, followed-up after 20 years of the onset of their illness, described their experience of recovery. "Personality strength," "self-confidence," "being ready," and "being understood" were the factors most commonly identified as important for recovery. Tolstrup et al., 1985). Briefly stated, at 4 to 12 years after the onset of illness, about 50% have recovered in terms of weight and menstruation, 25% are still emaciated and amenorrheic, and the remainder are at various stages of recovery. The mean crude mortality rate in these series is 3%. However, long-term (20 year) follow-up suggests that many of the chronically ill patients and even some of the apparently recovered anorectics may eventually succumb to the illness (Ratnasuriya, Eisler, Szmukler, & Russell, 1989; Theander, 1985). Furthermore, some weight recovered patients instead develop bulimia nervosa. Thus, prognosis for a significant minority of anorectics is clearly grim.
The intermediate term outcome of anorexia nervosa in women and men has recently been clarifiedGreater understanding of the process of recovery from this distressing and potentially fatal illness is clearly important. Surprisingly, very little has been written on this topic and almost nothing is known about what facilitates recovery even on an experiential level. Case Register between 1965 and 1973 (Szmukler, McCance, McCrone, & Hunter, 1986), 1. the 2 to 3 hour interview each patient was encouraged to describe her experience of the anorectic illness, and if she had recovered from it, the factors that helped her recover. Perhaps with the benefit of hindsight, the greater objectivity and openness that came with age, and in some patients the benefit of psychotherapy, all the patients were able to describe clearly their experience with the anorectic illness.
Recently we have conducted a follow-up study to determine the long-term mortality of two cohorts of anorectic patients: those who appeared on the Aberdeen PsychiatricWe have chosen to present six of these cases to illustrate the process of recovery from the anorectic illness. We are fully aware of the limitations of our approach (subjective, anecdotal, retrospective, uncontrolled, etc.), but since so little has been written about the experience of recovery from the illness, we believe that this report may yet fill a gap in the literature. Perhaps it may even stimulate a clearer formulation of, for instance, what the focus should be in controlled treatment studies.
