Factors associated with recovery from anorexia nervosa: a population-based study.
BACKGROUND
To examine factors associated with the outcome of anorexia nervosa among women from the general population.


METHODS
Women (N = 2,881) from the 1975-1979 birth cohorts of Finnish twins were screened for lifetime DSM-IV anorexia nervosa (N = 55 cases) using questionnaires and the SCID interview. Potential factors associated with the likelihood of recovery were addressed in the same assessment. Recovery was defined as restoration of weight, menstruation, and the absence of bingeing and purging for at least one year prior to assessment. Using two-tailed t tests and Pearson's chi-square tests, we contrasted recovered (N = 39) and unrecovered (N = 16) women. We then used logistic regression adjusted for duration of illness and Cox proportional hazard models to account for the variable lengths of illness on prognostic factors.


RESULTS
Unrecovered women were more likely to suffer from depressive symptoms prior to eating disorder onset (18.8% vs. 2.6%, p = 0.04), remain unemployed (18.8% vs. 2.6%, p = 0.04), report dissatisfaction with their current partner/spouse (p = 0.02), and report high perfectionism (p = 0.05) than were recovered women. When duration of illness was accounted for in the analyses, premorbid depression was the sole factor significantly associated with decreased likelihood of recovery (hazard ratio 0.17, 95% confidence interval: 0.03-0.89).


CONCLUSIONS
Predicting the course of anorexia remains fraught with difficulty, but premorbid depressive symptoms are associated with poor outcome of anorexia nervosa in the general population.
Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
Anna
A
Keski-Rahkonen
Anu
A
Raevuori
Cynthia M
CM
Bulik
Hans W
HW
Hoek
Aila
A
Rissanen
Jaakko
J
Kaprio
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000856:Anorexia Nervosa / Q000150:complications / Q000523:psychology; D052018:Bulimia Nervosa / Q000150:complications; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D004200:Diseases in Twins / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D011379:Prognosis; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015431:Weight Loss; D055815:Young Adult
anorexia nervosa; epidemiology; outcome; prognosis; twin study