Long‐term outcome of anorexia nervosa: Results from a large clinical longitudinal study

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Objective: To assess the long-term outcome and identify outcome predictors in a very large sample of inpatients treated for bulimia nervosa (BN).Method: Out of a total of 2,033 patients admitted consecutively to specialized treatment, 1,351 patients (mean age at treatment 25.94) were assessed for follow-up on average 11 (SD 6) years after admission. Also a very long-term (21 years) subsample (N = 147; mean age 25.92) was defined. Bivariate and logistic regression analyses identified predictors of poor outcome.Results: For more than 70% of the patients follow-up information could be gathered.Severity of eating disorder (ED) and other symptoms decreased over time but remained higher than in healthy controls, using published normative data. Remission rate was 38% after 11 years and 42% in the subsample after 21 years. Out of the total sample of N = 2,033 patients, 49 had died (2.4%). Persistent BN was found in 14.2% and the most frequent crossover was to ED not otherwise specified. Predictors of poor outcome were fewer follow-up years, higher drive for thinness, higher age at treatment, and less global functioning.Discussion: Based on clinical indicators, patients presented with a high level of ED and psychiatric symptomatology. With less than half of the patients remitted after 22 years, efforts are needed to improve treatment outcome. K E Y W O R D S

Section: Assessment Instrumentsmentioning

confidence: 99%

Long‐term outcome of inpatients with bulimia nervosa—Results from the Christina Barz Study

Quadflieg¹,

Fichter

2019

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“…Anorexia nervosa (AN) is one of the most severe psychiatric disorders and is often associated with a poor outcome along with significant morbidity and mortality rates (Smink, van Hoeken, & Hoek, ). In the long term, individuals with persisting AN often experience other psychiatric disorders associated with high rates of unemployment (Wentz, Gillberg, Anckarsäter, Gillberg, & Råstam, ) and suffer from somatic sequelae such as osteoporosis (Robinson, Micali, & Misra, ) and fertility problems (Fichter, Quadflieg, Crosby, & Koch, ). While the outcome of AN is thought to be more favorable if diagnosed in adolescence rather than in adulthood (Steinhausen, ), knowledge of the outcome of childhood‐onset AN is limited.…”

Section: Introductionmentioning

confidence: 99%

Outcome of childhood anorexia nervosa—The results of a five‐ to ten‐year follow‐up study

Herpertz‐Dahlmann

Dempfle

Egberts

et al. 2018

“…Despite the importance of weight‐based outcomes, this narrow measure has been reconsidered over time within wider questioning in the field regarding how to optimally operationalize AN recovery, a construct that goes beyond remission in scope and duration (Bardone‐Cone et al, ; Couturier & Lock, ; Dawson, Rhodes, & Touyz, ). Given the fragility of partial clinical improvement (Khalsa, Portnoff, McCurdy‐McKinnon, & Feusner, ), and the high risk of chronicity in AN (Eddy et al, ; Fichter, Quadflieg, Crosby, & Koch, ; Herpertz‐Dahlmann et al, ), it has been argued that the bar for clinical efficacy in AN RCTs should be set high. In this earnest effort, aptly highlighted by Bardone‐Cone, Hunt, and Watson (), the broader eating disorder community is urged to reach consensus on how to define recovery, and that this definition includes at least three key criteria; physical, behavioral, and psychological well‐being.…”

Section: Introductionmentioning

confidence: 99%

Variability in remission in family therapy for anorexia nervosa

Grange

Huryk

Murray

et al. 2019

Objective The evolution toward more stringent conceptualizations of remission in family therapy for adolescent anorexia nervosa (AN) has, with time, introduced variability in outcomes across randomized controlled trials (RCTs). An examination of remission across the history of research on family therapy for AN shows that earlier studies adopted lenient definitions and generally yielded higher rates of remission than studies of the past decade that have used stricter definitions of remission. In this study, we investigate the reactivity of remission rates to the application of different definitions of remission used within the family therapy for AN literature, within a single RCT data set. Method We conducted a secondary analysis of data from a single‐site RCT which compared the relative efficacy of two formats of family therapy in a sample of 106 Australian adolescents with AN. Using end‐of‐treatment data, we compared remission rates using 11 definitions of remission that have been used in studies of family therapy for AN spanning more than three decades. Results We found wide variability in remission rates (21.7–87.7%; Cochran's Q χ2(10, N = 106) = 303.55, p = .000], depending on which definition of remission was applied. As expected, more lenient criteria produced higher remission rates than more stringent definitions. Discussion Applying different criteria of remission to a single data set illustrates the impact of changing how remission is defined. Failure to consider the greater stringency of remission criteria in recent studies could result in false inferences concerning the efficacy of family therapy for AN over time.