Long-term outcome and psychiatric comorbidity of adolescent-onset anorexia nervosa

Abstract

Objective: To assess the outcome of adolescents with anorexia nervosa (AN) about 20 years after first treatment. Methods: Sixty-two women diagnosed with AN during adolescence were invited to participate. Of these 62 patients, 38 agreed to participate and were assessed with a battery of questionnaires and interviews. A control group of 30 women of similar age was also assessed. Results: Of the patients who completed the full assessment, 13 (34%) presented some degree of eating disorder (ED) at follow-up (10 (26%) met full Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for an ED and 3 (8%) showed partial remission of an ED). The remaining 25 (66%) patients had fully recovered from AN. The duration of untreated illness before admission was significantly associated with an increased risk of a current ED (odds ratio (OR) = 3.334 (1.3–8.7); p = .014). Of the patients who had recovered totally from their ED, 24% showed another psychiatric disorder. This percentage rose to 70% in patients with a current ED. Conclusion: Sixty-six percent of adolescents who completed the assessment achieved remission of their AN. Comorbidity was more common in the current ED group. The variable that best predicted complete remission was the number of years without treatment, showing the importance of detection and early intervention.

Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

“…The efficacy of “step down” care in preventing relapse may merit further research. The more favorable prognosis associated with shorter duration of illness [ 14 , 18 , 20 , 34 , 35 , 39 , 41 , 66 ] suggests that early intervention may be important, as well.…”

“…The impact of psychological factors such as depression, anxiety, harm avoidance, eating disorder psychopathology, and motivation for recovery have been mixed [ 12 , 13 , 33 – 38 ]. Though multiple longitudinal studies have examined the course of AN, the majority of studies focus on predictors and correlates of outcomes such as diagnostic status, mortality, and rates of relapse [ 5 , 7 , 10 – 12 , 15 , 16 , 31 , 33 – 36 , 39 – 41 ]. Prior studies on inpatient samples specifically have tended toward examining predictors of outcome unrelated to treatment (e.g., age of onset, comorbidities, family support) and report overall prognosis categorically [ 42 – 47 ].…”

Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature

“…All studies reported DUED using a statistic of central tendency. Four studies (n = 2,246) reported a component breakdown of DUED, (Beat, 2017;Brown et al, 2018;Gumz et al, 2018;Schlegl et al, 2019), two (n = 787) reported DUED and its crosssectional association with symptom severity (Bühren et al, 2013;Flynn et al, 2020), and one (n = 38) reported associations between DUED and long-term clinical outcomes (Andrés-Pepiñá et al, 2019). Three studies (n = 721) attempted to experimentally manipulate DUED (Brown et al, 2018;Flynn et al, 2020;Gumz et al, 2018), one of which (n = 142) also reported the prospective associations between DUED and clinical outcomes (McClelland et al, 2018).…”

Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden

“…A series of publications on very long-term (10–20 years) follow-up studies of inpatients with an eating disorder showed that, respectively 64% of persons previously diagnosed with anorexia nervosa, 53% of those previously diagnosed with bulimia nervosa, and 30% of those previously diagnosed with BED, still met diagnostic criteria for an eating disorder at follow-up; a further 6% for anorexia nervosa, 9% for bulimia nervosa and 31% for BED had remaining eating disorder symptoms [ 7 , 8 ▪▪ , 9 ]. Higher recovery rates of anorexia nervosa were reported in two smaller long-term (≥20 years) follow-up studies of adolescent-onset anorexia nervosa; one on an outpatient sample [ 10 ], the other on a community sample [ 11 ▪▪ ]. In both studies, around 65% of the cases were in complete remission at follow-up.…”