title: Distinguishing recovery from remission in a cohort of bulimic women: how should asymptomatic periods be described?
abstract: BACKGROUND
  Empirical definitions of remission and recovery from eating disorders are needed to understand outcome data and compare results across studies.
  
  
  METHODS
  106 treatment-seeking women with bulimia nervosa, who had abstained from binging and purging for at least 4 weeks, were followed prospectively. Relapse was defined as at least 4 consecutive weeks of either binging and purging weekly or binging two or more times per week, regardless of purging. Recovery was differentiated from remission based on the probability of relapse. The minimum number of weeks after which the risk of relapse leveled off was used as the cut-off to distinguish between the two outcomes. Kaplan-Meier methods were used to estimate the weekly probability of relapse.
  
  
  RESULTS
  When defining remission as at least 4 weeks of being asymptomatic, a quarter of the women relapsed within 11 weeks. By 37 weeks, only 49% of the women remained asymptomatic (95% CI, 41-61). The probability of relapse was substantial for approximately a year after a woman ceased to binge and purge.
  
  
  CONCLUSIONS
  Bulimia nervosa is an episodic disorder. As a conservative approach, periods of being asymptomatic that last less than 1 year should be labeled as remissions, not recoveries.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Field
authors.forename: D B
authors.initials: DB
authors.lastname: Herzog
authors.forename: M B
authors.initials: MB
authors.lastname: Keller
authors.forename: J
authors.initials: J
authors.lastname: West
authors.forename: K
authors.initials: K
authors.lastname: Nussbaum
authors.forename: G A
authors.initials: GA
authors.lastname: Colditz
mesh_terms: D002032:Bulimia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D011237:Predictive Value of Tests; D011336:Probability; D012008:Recurrence; D012074:Remission Induction; D011795:Surveys and Questionnaires; D016896:Treatment Outcome