title: Stressful life events predict eating disorder relapse following remission: six-year prospective outcomes.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Higher work and social stress represent significant warning signs for triggering relapse for women with remitted BN and EDNOS.
authors: Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. carlos.grilo@yale.edu
authors: Carlos M
authors: CM
authors: Grilo
authors: Maria E
authors: ME
authors: Pagano
authors: Robert L
authors: RL
authors: Stout
authors: John C
authors: JC
authors: Markowitz
authors: Emily B
authors: EB
authors: Ansell
authors: Anthony
authors: A
authors: Pinto
authors: Mary C
authors: MC
authors: Zanarini
authors: Shirley
authors: S
authors: Yen
authors: Andrew E
authors: AE
authors: Skodol
mesh_terms: D000293:Adolescent; D000328:Adult; D001068:Feeding and Eating Disorders / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013315:Stress, Psychological / Q000523:psychology*