What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa

Abstract

BackgroundRelapse after treatment for anorexia nervosa (AN) is a significant clinical problem. Given the level of chronicity, morbidity, and mortality experienced by this population, it is imperative to understand the driving forces behind apparently high relapse rates. However, there is a lack of consensus in the field on an operational definition of relapse, which hinders precise and reliable estimates of the severity of this issue. The primary goal of this paper was to review prior studies of AN addressing definitions of relapse, as well as relapse rates.MethodsData sources included PubMed and PsychINFO through March 19th, 2016. A systematic review was performed following the PRISMA guidelines. A total of (N = 27) peer-reviewed English language studies addressing relapse, remission, and recovery in AN were included.ResultsDefinitions of relapse in AN as well as definitions of remission or recovery, on which relapse is predicated, varied substantially in the literature. Reported relapse rates ranged between 9 and 52%, and tended to increase with increasing duration of follow-up. There was consensus that risk for relapse in persons with AN is especially high within the first year following treatment.DiscussionStandardized definitions of relapse, as well as remission and recovery, are needed in AN to accelerate clinical and research progress. This should improve the ability of future longitudinal studies to identify clinical, demographic, and biological characteristics in AN that predict relapse versus resilience, and to comparatively evaluate relapse prevention strategies. We propose standardized criteria for relapse, remission, and recovery, for further consideration.

Variability in remission in family therapy for anorexia nervosa

“…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, 2010;Couturier & Lock, 2006a;Dawson, Rhodes, & Touyz, 2015). Given the fragility of partial clinical improvement (Khalsa, Portnoff, McCurdy-McKinnon, & Feusner, 2017), and the high risk of chronicity in AN (Eddy et al, 2017;Fichter, Quadflieg, Crosby, & Koch, 2017;Herpertz-Dahlmann et al, 2018), it has been argued that the bar for clinical efficacy in AN RCTs should be set high.…”

“…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.…”

Eating disorder recovery in men: A pilot study

“…Examples of explicitly operationalized comprehensive definitions (i.e., physical, behavioral, and cognitive criteria) include research by Kordy et al (2002) with different recovery and remission criteria for different eating disorders, Khalsa, Portnoff, McCurdy-McKinnon, and Feusner (2017) with a focus on anorexia nervosa (AN) and criteria provided for recovery and remission, and Bardone-Cone et al (2010) with a transdiagnostic proposal of eating disorder recovery. This pilot study considers whether the Bardone-Cone et al criteria identify a recovered group among men with a history of an eating disorder.…”

Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta‐analysis

“…A recent review (Bardone-Cone, Hunt, & Watson, 2018) analyzing contemporary formulations of both ED recovery and remission underscores that such terms are used interchangeably and how both are primarily based on the absence of ED diagnosis or eating-related behaviors, that is, the observable signs and symptoms (Bardone-Cone et al, 2010;Khalsa, Portnoff, McCurdy-McKinnon, & Feusner, 2017;de Vos et al, 2017). Recovery criteria may vary in minimum body mass index [BMI] required, type of ED behaviors which must be absent, and duration of recovery.…”