The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study

Strober, Michael; Freeman, Roberta; Morrell, Wendy

doi:10.1002/(sici)1098-108x(199712)22:4<339::aid-eat1>3.0.co;2-n

Cited by 821 publications

(415 citation statements)

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“…Elucidation of such outcome predictors may allow the identification of subtypes that show a particularly pernicious course. Although some predictors have emerged for AN, 9 identification of the predictors for the course or outcome of BN and EDNOS has been elusive. 6,9 It will also be important for researchers to conduct additional studies on the prospective course of eating disorders over various time windows.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Moreover, another prospective study of a treatment sample found that the average duration of AN was 10 years. 9 Even with standardized treatments of choice, BN persists, with only one third of treated individuals showing complete and lasting symptom remission (e.g., Ref. 10).…”

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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“…It has been reported as an important factor to consider in all stages of the illness, and has been identified as a predictor of poor outcome 1, 2, 3. In the DSM‐IV and DSM 5 criteria, the phrase “excessive exercise” is described in relation to fear of gaining weight for anorexia nervosa (AN) and as a compensatory behavior to control weight for bulimia nervosa (BN).…”

Section: Introductionmentioning

confidence: 99%

Validation of the exercise and eating disorders questionnaire

Danielsen

Bjørnelv

Rø

2015

Intl J Eating Disorders

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ObjectiveCompulsive exercise is a well‐known feature in eating disorders. The Exercise and Eating Disorder (EED) self‐report questionnaire was developed to assess aspects of compulsive exercise not adequately captured by existing instruments. This study aimed to test psychometric properties and the factor structure of the EED among women with eating disorders and a control group.MethodThe study included 449 female participants, including 244 eating disorders patients and 205 healthy controls. The patient group consisted of 32.4% (n = 79) AN patients, 23.4% (n = 57) BN, 34.4% (n = 84) EDNOS and 9.8% (n = 24) with BED diagnosis.ResultsThe analyses confirmed adequate psychometric properties of the EED, with a four‐factor solution: (1) compulsive exercise, (2) positive and healthy exercise, (3) awareness of bodily signals, and (4) weight and shape exercise. The EED discriminated significantly (p < .001) between patients and controls on the global score, subscales, and individual items. Test‐retest reliability was satisfactory (r = 0.86). Convergent validity was demonstrated by high correlations between the EED and the Eating Disorder Examination Questionnaire (EDE‐Q; r = 0.79).DiscussionThe EED is the first clinically derived, self‐report questionnaire to assess compulsive exercise among ED patients. The EED offers assessment that has broader clinical utility than existing instruments because it identifies treatment targets and treatment priorities. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:983–993).

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“…However, even though family-based treatments for anorexia nervosa have shown some positive clinical utility, it is still premature to conclude that this mode of intervention is the optimal treatment for adolescents. Given that treatment failure for anorexia nervosa is relatively higher in adults than in adolescents (Russell et al, 1987) and that the potential for recovery declines significantly after patients have been ill for more than 10 years (Strober, Freeman, & Morrell, 1997), it is clear that effective treatments targeting adolescent populations are critically needed.…”

Section: Treatments For Eating Disorders Anorexia Nervosamentioning

confidence: 99%

Eating disorders: National Institute of Mental Health's perspective.

Chavez¹,

Insel²

2007

American Psychologist

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The mission of the National Institute of Mental Health (NIMH) is to reduce the burden of mental and behavioral disorders through research, and eating disorders embody an important fraction of this burden. Although past and current research has provided important knowledge regarding the etiology, classification, pathophysiology, and treatment of the eating disorders, there are still significant challenges that need to be addressed. This article briefly describes some of these challenges, recent NIMH-supported research and research-related activities directed at addressing these challenges, and approaches and areas of research that hold promise for furthering the understanding and treatment of eating disorders.

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The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study

Cited by 821 publications

References 24 publications

Stability of eating disorder diagnoses: A commentary

Stability of eating disorder diagnoses: A commentary

Validation of the exercise and eating disorders questionnaire

Eating disorders: National Institute of Mental Health's perspective.

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