Long-term Outcome of Bulimia Nervosa

Keel, Pamela K.; Mitchell, James E.; Miller, Kevin F.; Davis, Traci L.; Crow, Scott J.

doi:10.1001/archpsyc.56.1.63

Cited by 331 publications

(287 citation statements)

References 22 publications

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“…In our sample, the short and intermediate remission rate in BN was higher than the estimate given in an overview by Keel and Mitchell. 14 The remission rate for AN in our sample was similar to that given in the overview by Steinhausen. 15 Presently there is a discussion on the validity of the BED diagnostic category.…”

Section: Resultssupporting

confidence: 88%

Long-term stability of eating disorder diagnoses

Fichter

Quadflieg²

2007

Int. J. Eat. Disord.

121

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Objective: Data on the stability of eating disorder (ED) diagnoses (DSM-IV) over 12 years are presented for a large sample (N 5 311) of female eating disordered patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).Method: Assessments were made at the beginning of therapy and 2-, 6-, and 12-year follow-ups. Diagnoses were derived from the Structured Inventory for Anorexic and Bulimic Eating Disorders. Possible diagnostic outcome categories were AN, BN, BED, NOS, no ED, and deceased.Results: At all follow-ups, more patients changed from AN or BED to BN than vice versa. No diagnostic crossover from AN to BED or vice versa occurred. BED showed the greatest variability and AN had the greatest stability over time.While the long-term outcome of BN and BED is similar, AN had a considerably worse long-term outcome than either BN or BED. Conclusion

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Section: Resultssupporting

confidence: 88%

Long-term stability of eating disorder diagnoses

Fichter

Quadflieg²

2007

Int. J. Eat. Disord.

121

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“…In this study, only a diagnosis of AN was tested as a predictor for outcome in BN. However, previous studies indicate that it is not so much the diagnosis of AN that is related to outcome in BN, 20,21 but certain aspects of the disorder, such as low body weight. 22 Agras et al 22 argue that a history of severe dietary restraint (resulting in low body weight) might be an important predictor for a worse outcome in BN.…”

Section: Long-term Stability Of Eating Disorder Diagnoses (Fichter Andmentioning

confidence: 95%

“…Although results from prior studies are mixed, some suggest that longer duration of more severe eating disorder symptoms at presentation predict a worse outcome of BN. 23 Finally, it is possible that patients with psychiatric comorbidity simply show a more protracted course, as one disorder may hinder recovery from another disorder. It might be useful to test whether patients with a lifetime history of mood disorders or anxiety disorders show a more protracted course than their counterparts without a history of these comorbid conditions.…”

Section: Long-term Stability Of Eating Disorder Diagnoses (Fichter Andmentioning

confidence: 99%

Stability of eating disorder diagnoses: A commentary

Stice

Spoor

2007

Int. J. Eat. Disord.

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Eat ing disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are one of the most prevalent psychiatric problems for girls and young women, result in subjective distress and functional impairment, and increase risk for future onset of obesity, depression, suicide attempts, anxiety disorders, substance abuse, and health problems. 1,2 Although these eating disorders are clearly associated with functional impairment, less is known about the course of these eating disorder diagnoses over time. The purpose of this commentary is to discuss the findings of two articles on the longitudinal course of eating disorder diagnoses that appear in this special issue to discuss implications for nosology, and to offer suggestions regarding future research in this area.Long-term Stability of Eating Disorder Diagnoses (Fichter, & Norbert) This manuscript reports data on the stability of eating disorders over a 12-year period in a large treatment sample (N 5 311). Assessments were conducted at the beginning of therapy and at 2-year, 6-year, and 12-year follow-ups. The 12-year stability rate was 41.4% for AN, 34.4% for BN, 3.0% for BED, and 3.2% for other eating disorder not otherwise specified diagnoses (EDNOS). Results suggest moderate longitudinal instability of AN and BN, and pronounced longitudinal intability of BED and other EDNOS conditions. This instability was due to recovery, relapse, and diagnostic crossover. Most crossovers occurred from AN to BN and from BED to BN. Long-term outcome for BN and BED was encouraging, with both showing high recovery rates. The long-term outcome for AN was worse relative to BN and BED. Furthermore, the longitudinal course of BN and BED seemed to be nearly identical with similar percentages of remission and relapse. Relapse rates were low in this treatment sample.Before discussing the implications of these findings for nosology and future research directions, it is important to compare the findings from this study with other studies that have been previously published. Although research indicates that the overarching diagnosis of ''eating disorder'' is relatively stable, 3 several studies suggest that there is considerable longitudinal instability of the specific eating disorder diagnoses of AN, BN, and EDNOS in treatment samples, resulting from recovery, relapse, and crossover between and within the eating disorder diagnoses. 3,4-6 The recovery rates for AN and BN were moderate to high at each of the follow-up assessments in Fichter and Quadflieg study, which is similar to the rates reported by 7 who found that at 5-year follow-up, 56% of patients with AN, 74% of patients with BN, and 78% of patients with EDNOS no longer met criteria for any eating disorder diagnosis.Recovery rates of other treatment studies, however, are somewhat lower. For example, Fichter and Quadflieg reported a remission rate of 43.8% in AN and 56.8% in BN over a 2-year period; these recovery rates increased to about 60% for AN and about 70% for BN over a 6-12-year period....

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“…Anorexics have less than a 50% chance of recovery within 10 years after the onset of the disorder, 25% develop into chronicity, and mortality can be as high as 25% (2). Bulimics have a better prognosis, but fewer than 50% recover, and 30% continue to binge eat and purge (2,3).…”

mentioning

confidence: 99%

“…There is a considerable amount of data on the time course and outcome of anorexia and bulimia nervosa (2)(3)(4), but the effect of treatment interventions has not been extensively evaluated. Hence, there is little scientific evidence for the selection of one kind of treatment rather than another.…”

mentioning

confidence: 99%

Randomized controlled trial of a treatment for anorexia and bulimia nervosa

Bergh

Brodin

Lindberg

et al. 2002

Proc. Natl. Acad. Sci. U.S.A.

144

120

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Evidence for the effectiveness of existing treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the control group (n ‫؍‬ 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging (bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen patients went into remission after a median of 14.4 months (range 4.9 -26.5) of treatment, but only one patient went into remission while waiting for treatment (P ‫؍‬ 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months (quartile range 9.6 > 32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained in remission for 12 months (quartile range 6 -36). Because the risk of relapse is maximal in the first year after remission, we suggest that most patients treated with this method recover. E ating disorders, i.e., anorexia and bulimia nervosa, are serious health problems in young women (less than 5% of patients are men), characterized by a disordered intake of food. Thus, anorexics eat only small amounts of food and lose body weight; bulimics eat large quantities of food and vomit or use other methods to maintain normal body weight. About 1% of all women develop anorexia at the age of 14-19 years, and 1-3% develop bulimia when 20-23 years old (1). Anorexics have less than a 50% chance of recovery within 10 years after the onset of the disorder, 25% develop into chronicity, and mortality can be as high as 25% (2). Bulimics have a better prognosis, but fewer than 50% recover, and 30% continue to binge eat and purge (2, 3).There is a considerable amount of data on the time course and outcome of anorexia and bulimia nervosa (2-4), but the effect of treatment interventions has not been extensively evaluated. Hence, there is little scientific evidence for the selection of one kind of treatment rather than another. In fact, it was recently pointed out that the effects of most treatments are unknown (5). Evaluation of medical interventions should be done in randomized controlled trials (RCT) (6). Three RCTs have compared treatment effects in young anorexic patients. In the first, family therapy was effective in comparison with individual therapy in 10 patients who had been ill for about 1 year and who had been treated on average once before (7). The treatment had no effect in 70 other patients who participa...

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Long-term Outcome of Bulimia Nervosa

Cited by 331 publications

References 22 publications

Long-term stability of eating disorder diagnoses

Long-term stability of eating disorder diagnoses

Stability of eating disorder diagnoses: A commentary

Randomized controlled trial of a treatment for anorexia and bulimia nervosa

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