Long‐term outcomes in treated males with anorexia nervosa and bulimia nervosa—A prospective, gender‐matched study

Abstract

Objective We report on the long‐term outcome of males compared to females treated for anorexia nervosa (AN) or bulimia nervosa (BN). Methods A total of 119 males with AN and 60 males with BN were reassessed 5.8 ± 4.6 and 7.5 ± 5.9 years (respectively) after treatment and compared to matched female patients. Results At follow‐up, males with AN had a higher body weight than females. For AN, remission rates (40% males vs. 41% females) did not differ at follow‐up. And at follow‐up, more males (34%) than females (19%) had an eating disorder not otherwise specified (ED‐NOS; p < .01). At follow‐up of AN, there was no binge‐eating disorder (BED) and obesity was rare. For BN, remission rates (44% males vs. 50% females) and frequency of AN, BN, BED and ED‐NOS did not differ at follow‐up. Males with AN scored lower than females at follow‐up on most subscales of the Eating Disorder Inventory (EDI) and on somatization, obsessive–compulsive symptoms, and depression (Brief Symptom Inventory). Males with BN scored lower than females with BN on perfectionism and higher on interpersonal distrust (EDI) at follow‐up. Discussion Results from the scarce literature on males with ED are inconclusive regarding longer term outcome. In the present study, males with AN showed a slightly better outcome than females. In BN, outcome was about the same in males and females. According to our study, existing treatment is equally effective in both males and females. Additional research on the need of gender‐specific diagnosis and therapy is required.

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

“…Most [13][14][15][16][17][18][19], but not all [20], have identified longer duration of illness as a predictor of worse long-term outcome. Body mass index (BMI) is also related to outcome: most studies show associations between lower admission and discharge BMI and worse outcomes in adults [11,14,16,17,[21][22][23][24][25], though research in adolescents suggests discharge BMI is less predictive of outcome when inpatient treatment is followed by structured outpatient treatment [26,27]. AN subtype has also been associated with outcome, though this has not been a consistent finding [18,28].…”

“…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][43][44][45][46][47]. Fewer have studied continuous outcomes, such as weight, symptoms, and overall clinical impairment over time [13,23,38,48,49], and these have generally been limited to short-term follow up [13,19,49] or to a single assessment point [23,25,34]. Together, these studies suggest that higher BMI at discharge and shorter duration of illness are important factors in the course of AN.…”

Mortality in males treated for an eating disorder—A large prospective study

“…These males (27 AN, 50 BN, 103 ED‐NOS) were included in the present study. Seven males with AN and six males with BN died after participating in follow‐up assessment and were included in analysis for mortality and for follow‐up (Strobel, Quadflieg, Naab, Voderholzer, & Fichter, under review).…”

Introduction to a special issue on eating disorders and related symptomatology in male populations

“…As such, the application of clinical interventions with male populations rests on inferences drawn from research conducted with largely female samples. However, in the largest prospective study to date of treatment outcomes in males with eating disorders, Strobel, Quadflieg, Naab, Voderholzer, and Fichter () and Quadflieg, Strobel, Naab, Voderholzer, and Fichter () describe a series of important outcomes in a large sample of male inpatients with eating disorders over an average follow‐up period ranging from ~5 to 9 years across the diagnostic groups.…”

“…In assessing long‐term treatment outcomes among 119 men with anorexia nervosa and 60 men bulimia nervosa, Strobel et al () noted that males with anorexia nervosa demonstrated comparable rates of remission to females with anorexia nervosa treated in the same program (male remission rate: 40%, female remission rate: 41%), and typically demonstrated greater body weight. Among male inpatients with bulimia nervosa, remission rates were slightly lower at long‐term follow (44%) relative to female inpatients treated in the same program (50%).…”