Twelve-year course and outcome predictors of anorexia nervosa.
OBJECTIVE
The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).


METHODS
Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained.


RESULTS
The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic-strictly empirically based-model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder.


CONCLUSIONS
Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome.
Fichter
Manfred M
MM
Department of Psychiatry, University of Munich, Munich, Germany. MFichter@Schoen-Klinken.de
Quadflieg
Norbert
N
Hedlund
Susanne
S
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D002032:Bulimia / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D002908:Chronic Disease; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology; D007406:Interview, Psychological; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010552:Personality Assessment; D010555:Personality Inventory; D011379:Prognosis; D012725:Sexual Behavior