Natural Course of Bulimia Nervosa and of Eating Disorder Not Otherwise Specified

Grilo, Carlos M.; Pagano, Maria E.; Skodol, Andrew E.; Sanislow, Charles A.; McGlashan, Thomas H.; Gunderson, John G.; Stout, Robert L.

doi:10.4088/jcp.v68n0511

Cited by 100 publications

(17 citation statements)

References 52 publications

(84 reference statements)

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“…Ben-Tovim et al 9 reported that the 5-year course of BN and EDNOS were nearly identical, with remission rates of 74 and 78%, respectively. In our previous analysis of 5-year course, 10 BN and EDNOS differed little with both categories showing similar patterns of remissions (74 and 83%, respectively) and relapses (47 and 42%, respectively). Thus, emerging data for BN and EDNOS suggest that their longer-term outcomes appear comparable.…”

Section: Introductionmentioning

confidence: 75%

“…While some predictors have emerged for AN, such as older onset, longer duration, and lower weight, 2,11 reliable predictors for the natural course or treatment outcomes of BN and EDNOS have not been identified. 2,10 The literature contains hints that for BN, psychiatric comorbidity, personality disturbances, general psychosocial distress, and poor self-esteem may predict poorer outcomes. 1,9,12,13 Other long-term studies, however, have failed to support hypothesized clinical predictors.…”

Section: Introductionmentioning

confidence: 99%

“…1,9,12,13 Other long-term studies, however, have failed to support hypothesized clinical predictors. In the case of EDNOS, Ben-Tovim et al 9 were unable to identify any predictors of 5-year outcomes, and for BN and EDNOS, Grilo et al 10 reported that personality disorders were unrelated to remissions or relapses.…”

Section: Introductionmentioning

confidence: 99%

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Stressful life events predict eating disorder relapse following remission: Six‐year prospective outcomes

Grilo

Pagano

Stout

et al. 2011

Intl J Eating Disorders

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Objective To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not-otherwise-specified (EDNOS) and test for the effects of stressful life events (SLE) on relapse after remission from these eating disorders. Method 117 female patients with BN (N = 35) or EDNOS (N = 82) were prospectively followed for 72 months using structured interviews performed at baseline, 6- and 12-months, and then yearly thereafter. ED were assessed with the structured clinical interview for DSM-IV, and monitored over time with the longitudinal interval follow-up evaluation. Personality disorders were assessed with the diagnostic interview for DSM-IV-personality-disorders, and monitored over time with the follow-along-version. The occurrence and specific timing of SLE were assessed with the life events assessment interview. Cox proportional-hazard-regression-analyses tested associations between time-varying levels of SLE and ED relapse, controlling for comorbid psychiatric disorders, ED duration, and time-varying personality-disorder status. Results ED relapse probability was 43%; BN and EDNOS did not differ in time to relapse. Negative SLE significantly predicted ED relapse; elevated work and social stressors were significant predictors. Psychiatric comorbidity, ED duration, and time-varying personality-disorder status were not significant predictors. Discussion Higher work and social stress represent significant warning signs for triggering relapse for women with remitted BN and EDNOS.

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Section: Introductionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Stressful life events predict eating disorder relapse following remission: Six‐year prospective outcomes

Grilo

Pagano

Stout

et al. 2011

Intl J Eating Disorders

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“…It appears that PDs have important effects on outcomes of some, but not other, psychiatric disorders (40). Studies have reported mixed findings for PDs predicting remission from panic disorder (34,41), that PDs have negative effects on remission from generalized anxiety and social phobia (34), but that PDs are unrelated to both remission and relapse in eating disorders (33). Our findings here suggest that PDs are robust moderators of accelerated relapse in MDD.…”

Section: Discussionmentioning

confidence: 99%

“…Relapse was defined as two consecutive weeks with PSR ratings of 5 or greater. These definitions follow those used in the NIMH-CDS (8,11) and other major longitudinal studies of MDD (9) and parallel those used in longitudinal studies of other psychiatric disorders (33,34), although alternative definitions have been proposed (35). …”

Section: Methodsmentioning

confidence: 99%

Personality Disorders Predict Relapse After Remission From an Episode of Major Depressive Disorder

Grilo¹,

Stout²,

Markowitz³

et al. 2010

J. Clin. Psychiatry

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117

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Objective To examine prospectively the course of major depressive disorder (MDD) and to test for the moderating effects of personality disorder (PD) co-morbidity on relapse after remission from an episode of MDD. Method Participants were 303 patients (196 women and 107 men) with current MDD at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. MDD and Axis I psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV and Axis II PDs were assessed with the Diagnostic Interview for DSM-IV PD. The course of MDD was assessed with the Longitudinal Interval Follow-up Evaluation at 6- and 12-months and then yearly through 6 years. Survival analyses were used to analyze time to remission and time to relapse. Results 260 (86%) of 303 patients remitted from MDD; lifetable survival analyses revealed that patients with MDD who had PDs at baseline had significantly longer time to remission from MDD than patients without PDs. Among the 260 patients whose MDD remitted, 183 (70%) relapsed. MDD patients with PDs -- specifically those with borderline and obsessive-compulsive PDs -- at baseline had significantly shorter time to relapse than MDD patients without PDs. Cox proportional hazards regression analyses revealed that the presence of PDs at baseline (hazard ratio 1.5) and recurrent-type MDD (hazard ratio 2.2), but not gender (hazard ratio 1.03) or dysthymic disorder (hazard ratio 0.97), significantly predicted time to relapse. Conclusions PDs at baseline were robust predictors prospectively of accelerated relapse after remission from an episode of MDD. PDs at baseline significantly moderated eventual time to relapse in MDD among patients who remitted from an episode of MDD, even when controlling for other potential negative prognostic predictors.

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The Economic Effect of Planet Health on Preventing Bulimia Nervosa

Wang

Austin²

2011

Arch Pediatr Adolesc Med

111

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Objectives: To assess the economic effect of the schoolbased obesity prevention program Planet Health on preventing disordered weight control behaviors and to determine the cost-effectiveness of the intervention in terms of its combined effect on prevention of obesity and disordered weight control behaviors.Design: On the basis of the intervention's short-term effect on disordered weight control behaviors prevention, we projected the number of girls who were prevented from developing bulimia nervosa by age 17 years. We further estimated medical costs saved and qualityadjusted life years gained by the intervention over 10 years. As a final step, we compared the intervention costs with the combined intervention benefits from both obesity prevention (reported previously) and prevention of disordered weight control behaviors to determine the overall cost-effectiveness of the intervention. Setting: Middle schools.Participants: A sample of 254 intervention girls aged 10 to 14 years.Intervention: The Planet Health program was implemented during the school years from 1995 to 1997 and was designed to promote healthful nutrition and physical activity among youth. Main Outcome Measures:Intervention costs, medical costs saved, quality-adjusted life years gained, and costeffectiveness ratio.Results: An estimated 1 case of bulimia nervosa would have been prevented. As a result, an estimated $33 999 in medical costs and 0.7 quality-adjusted life years would be saved. At an intervention cost of $46 803, the combined prevention of obesity and disordered weight control behaviors would yield a net savings of $14 238 and a gain of 4.8 quality-adjusted life years.

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Natural Course of Bulimia Nervosa and of Eating Disorder Not Otherwise Specified

Cited by 100 publications

References 52 publications

Stressful life events predict eating disorder relapse following remission: Six‐year prospective outcomes

Stressful life events predict eating disorder relapse following remission: Six‐year prospective outcomes

Personality Disorders Predict Relapse After Remission From an Episode of Major Depressive Disorder

The Economic Effect of Planet Health on Preventing Bulimia Nervosa

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