Long‐term outcome of 151 cases of anorexia nervosa

Abstract

One hundred and fifty-one patients (140 females - 11 males) with anorexia nervosa (AN) from three departments (child psychiatry, psychiatry, and internal medicine) were re-examined 4-22 years (average 12.5 years) after their first contact with the Rigshospital in Copenhagen. During the years 1960-76 the number of referrals was on the increase, and relatively more patients were treated in the psychiatric departments at the end than at the beginning of the period. Mean age was 16.6 years at onset, 19.0 years at primary contact. Mean weight loss was 32%. Mean duration of treatment was 12 months. Differences between the three departments concern especially age, sex, and duration of treatment. Mean age at follow-up was 31.0 years (range 16-63 years) for surviving probands. Follow-up information originated from semi-structured personal interviews (in 80% of surviving probands) together with register data on all probands, supplemented by extensive hospital data. Nine patients (6%), including six who committed suicide, died on the average 7.3 years after primary contact (average age 27.1 years). The mortality rate was 0.5% per year. At follow-up one fourth of the surviving probands had AN and one fourth suffered from other psychiatric disorders, while one half were free from mental illness. There were no significant differences in outcome between the three departments. As a whole, the group experienced a social decline. It is concluded that a substantial part of this group of AN patients had a poor prognosis with a tendency towards chronicity, despite relatively long and intensive treatment, but, on the other hand, about one half of the probands seemed to be healthy and well functioning.

Anorexia nervosa in Italy: Clinical Features and Outcome in a Long-Term Follow-Up Study

“…However, this distribution en ables us to postulate the existence of two distinct periods in which susceptibility to AN is increased. The duration of the dis ease (1.46 years) is shorter than in other works [13,19,27] resembling the results of Theander [35] and Tolstrup et al [36], We think that this is an advantage when evalu ating the outcome of AN since it avoids the risk of selective bias towards patients with a tendency to chronicity. In fact, the rela tively low percentage of bulimia and vomit ing in our study (24 and 25%, respectively), less for example than that reported by Hsu et al [19], could be explained by the brief course of the illness.…”

“…In fact, the rela tively low percentage of bulimia and vomit ing in our study (24 and 25%, respectively), less for example than that reported by Hsu et al [19], could be explained by the brief course of the illness. It could, however, also be explained by the particular sociocultural characteristics of our population which, un like others [3,5,19,36], includes a high proportion of working class patients. While this may be partially explained by the fact that the admitting hospitals were public in stitutions, it may also reflect the spread of AN among the working classes in the early 70s (the absolute values are determined by the composition of the different classes).…”

Pregnancy after anorexia nervosa

“…When there has been a history of anorexia nervosa, weight gain and body shape changes accompanying pregnancy can provoke extreme distress (Crisp, 1984). Pregnancy after anorexia nervosa is infrequently reported, occurring in less than 10% of patients (Hsu, 1980;Hsu, Crisp, & Harding, 1979;Tolstrup, Brinch, Isager, Nielsen, Nystrup, Severin, & Olesen, 1985) and may require induction of ovulation (Hart, Kase, & Kimball, 1970). We describe two cases, different from the four pregnancies with spontaneous ovulation previously described (Abraham, Beumont, Booth, & Smith, 1981;Ho, 1985;Strimling, 1984;Weinfeld, Dubay, Burchell, Millerick, & Kennedy, 1977): both gained weight during pregnancy and had normal-weight babies.…”

Total body nitrogen as a predictor of clinical status in anorexia nervosa

“…A similar relationship has been demonstrated in other serious medical illnesses . Patients with anorexia nervosa have been shown to deplete protein in the course of becoming ill (Russell et al, 1983), and their course may become chronic as has been demonstrated in 20% or more of sufferers (Tolstrup et al, 1985;Ratnisurya, Ester, Szmukler, & Russell, 1991). The mortality rate in these patients is not inconsiderable, approaching the chronicity rates in long-term outcome studies.…”