SYNOPSISIn 1983 we presented a systematic analysis of the available literature on the course of anorexia nervosa (Steinhausen & Glanville, 1983a). The survey was based on 45 English and German language studies published between 1953 and 1981. During the past decade there has been a striking increase of publications related to eating disorders in general. This pertains as well to follow-up studies on anorexia nervosa. In addition to studies compiled in our previous report, we were able to locate another 22 follow-up studies published in major English and German language journals between 1981 and 1989.

This outcome study of adolescent eating disorders provides further evidence that the long-term course of the disorders in terms of the eating pathology is better than can be expected after a few years. Very little can be said with regard to individual prognosis.

A consecutive series of 60 adolescent patients with eating disorders was followed up after a mean period of 58 months. At intermediate follow-up, 4 (6.65) of the former patients were reported deceased, and 6 could either not be traced or refused to cooperate. Follow-up assessment revealed the following diagnostic pattern in 50 patients who were followed up: 5 (10%) of the patients still suffered from anorexia nervosa, 2 (4%) from anorexia nervosa with bulimia, 7 (14%) from partial syndromes of anorexia nervosa, 2 (4%) from partial syndromes of bulimia nervosa, and 34 (68%) had recovered. Questionnaire findings indicated that the improvements that occurred during inpatient treatment were intact at follow-up. No significant findings were revealed by the analysis of a large scale of potential prognostic factors.

S ingle follow-up studies have identified a low body weight at referral as a poor prognostic indicator for intermediate or long-term follow-up (1, 2). Morgan and Russell (3) observed an association between low body weight (less than 60% average body weight, roughly equivalent to a body mass index of 12.5 kg/m 2 in females aged 17-19 years) at referral and poor general outcome after 5 years. In a previous study (4), we found that 24 patients with body mass indexes less than 13 kg/m 2 at referral had significantly lower body mass indexes at follow-up than 57 patients who had higher body mass indexes at referral; the mean follow-up period was 11.7 years. Possible explanations for the discrepancies regarding the prognostic implications of a low body weight at referral include small sample sizes and crude categorizations of the weight outcome.The hypothesis of the present study was that a low body mass index at referral predicts a low body mass index at long-term follow-up. To test this hypothesis we assessed body mass indexes at referral and at follow-up in a large study group (N=272) to determine their interrelationship and to assess the influence of age at onset, age at referral, and age at follow-up, respectively. METHODThe study group was a composite of five study cohorts with a total of 341 consecutively ascertained inpatients with anorexia nervosa. Twenty-four of the patients were males. The ascertainment, diagnostic assessment according to DSM-III-R, and outcome of these study cohorts have been described in detail elsewhere (4-9). For the present analysis, all 24 of the males, seven females with additional somatic diseases at referral, and seven pretreated females whose body mass indexes at referral were greater than 17.5 kg/m 2 were excluded; 31 additional females could not be traced at follow-up. The final study group included 272 females whose body mass indexes at referral and body mass indexes at follow-up or time of death were available. Their mean ages at referral and at follow-up were 16.7 years (SD=4.5, range=10-42) and 26.2 years (SD=6.9, range=15-58), respectively. Mean length of follow-up was 9.5 years (SD=5.3, range=0-33.6) and included the survival times of the 12 patients who had died after a mean of 4.2 years (SD=4.0, range=0-13). Deaths were related to the sequelae of emaciation in 10 patients and to suicide in two patients.The patients' body mass indexes at referral were plotted against their body mass indexes at follow-up and Pearson's correlation was calculated. Body mass indexes were plotted in 1-kg/mg 2 intervals from 9 to 27 kg/mg 2 . Patients with low body mass indexes at referral were compared with patients with higher body mass indexes at referral by using repeated U tests. Significance was adjusted for multiple testing (10). We also charted the proportion of patients whose body mass indexes at follow-up were 17.5 kg/m 2 or less, those whose body mass indexes were in the fifth percentile or below, and those whose body mass indexes were in the 10th percentile or below. Body mass index ...

The outcome of adolescent eating disorders is relatively similar across cultures, and better than in patients with later onset of the disorder.

Within a prospective longitudinal outcome study of the eating disorders with onset during adolescence, 26 former patients were reassessed at short-term (19-38 months) and intermediate-term (48-72 months) follow-up periods. It was shown that the outcome was worse at short-term follow-up. In addition, the changes of diagnostic categories within the spectrum of the eating disorders were studied. It is concluded that outcome studies require repeated assessments to study the various patterns of course of the eating disorders.

Questionnaire scores were compared across three outcome groups in a follow‐up of eating‐disordered patients with onset of the disease during adolescence. Among a total of 40 patients, 7 continued to suffer from either anorexia or bulimia nervosa. Seven additional patients displayed partial syndromes and 26 had recovered. Both a semantic differential measuring body image and the Eating Attitudes Test (EAT) demonstrated limited evidence of clinical sensitivity by differentiating the three outcome groups. The Eating Disorders Inventory (EDI) did not discriminate the three outcome groups. Obviously, clinical interviews and self‐report questionnaires tackle different facets of the eating disorders and, therefore, both should be used in outcome studies. © 1993 by John Wiley & Sons, Inc.

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