Twelve-year course and outcome of bulimia nervosa.
BACKGROUND
Since little is known about the long-term course and outcome of bulimia nervosa, the authors designed a 12-year prospective longitudinal study with five cross-sectional assessments based on a large sample of consecutively treated females with bulimia nervosa (purging type) (BN-P).


METHODS
One hundred and ninety-six females with BN-P were assessed (1) at the beginning of treatment, (2) at the end of treatment, (3) at 2-year follow-up, (4) at 6-year follow-up, and (5) at 12-year follow-up. In self-ratings as well as expert ratings based on interviews we assessed specific eating-disorder and general psychopathology.


RESULTS
The general pattern of results over time showed substantial improvement during treatment, slight (in most cases non-significant) decline during the first two years after the end of treatment, and further improvement and stabilization until 12-year follow-up. At that point the majority of patients (70.1 %) showed no major DSM-IV eating disorder, 13.2% had eating disorders not otherwise specified, 10.1 % had BN-P and 2% had died. Very few had undergone transition to anorexia nervosa or binge-eating disorders. Logistic regression analyses showed that psychiatric co-morbidity was the best and most stable predictor for eating-disorder outcome at 2, 6 and 12 years.


CONCLUSIONS
Course and outcome of BN-P was generally more favourable than for anorexia nervosa.
Fichter
Manfred M
MM
Department of Psychiatry, University of Munich, Prien, Germany. mfichter@schoen-kliniken.de
Quadflieg
Norbert
N
D000328:Adult; D002032:Bulimia / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome