title: Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up.
abstract: OBJECTIVE
  The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa.
  
  
  METHODS
  Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa were assessed at 9 and at 20 to 25 years of follow-up (mean [SD] = 22.10 [1.10] years; study initiated in 1987, last follow-up conducted in 2013) via structured clinical interview (Longitudinal Interval Follow-Up Evaluation of Eating Disorders [LIFE-EAT-II]). Seventy-seven percent of the original cohort was re-interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N = 228). Kaplan-Meier curves estimated recovery by 9-year follow-up, and McNemar test examined concordance between recovery at 9-year and 22-year follow-up.
  
  
  RESULTS
  At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa (odds ratio [OR] = 10.5; 95% CI, 3.77-29.28; McNemar χ²₁ = 31.39; P < .01) but not in bulimia nervosa (OR = 1.0; 95% CI, 0.49-2.05; McNemar χ²₁ = 0; P = 1.0).
  
  
  CONCLUSIONS
  At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Pl, Ste 200, Boston, MA 02114. keddy@mgh.harvard.edu.|Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nassim
authors.initials: N
authors.lastname: Tabri
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Helen B
authors.initials: HB
authors.lastname: Murray
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Keshaviah
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hastings
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Edkins
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Krishna
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Herzog
authors.affiliation: Department of Psychology, Florida State University, Tallahassee, Florida, USA.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Keel
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Franko
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000628:therapy*; D052018:Bulimia Nervosa / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult