“In contrast to the extant literature characterizing eating disorders as chronic illnesses, our longitudinal data demonstrate that continued symptom improvement and meaningful recovery are possible in anorexia nervosa beyond the first decade of follow-up,” wrote Kamryn Eddy, Ph.D., of the Massachusetts General Hospital Eating Disorders Clinical and Research Program and colleagues. “For bulimia nervosa, if recovery is not observed by nine-year follow-up, it is less likely to occur in the subsequent decade.”
Eddy and colleagues recruited women with a DSM-III-R diagnosis of anorexia nervosa or bulimia nervosa from Boston-area outpatient services from 1987 to 1991. During the first wave of the study, participants were interviewed every 6 to 12 months for nine years. In the second wave, participants were re-contacted by telephone between 20 and 25 years after the start of the trial and asked to assess symptoms in the past year. Eating disorder recovery was defined as an anorexia and bulimia psychiatric status rating (PSR) score of two or less for 52 consecutive weeks.
Of the initial 246 women in the study, 176 participated in the 20- to 25-year follow-up. During the first wave, 31.4% of participants with anorexia and 68.2% with bulimia had recovered. By the second wave, 62.8% of participants with anorexia and 68.2% of those with bulimia had recovered. Approximately half of those with anorexia who had not recovered by nine years progressed to recovery at 22 years.
“While for most patients with anorexia nervosa and bulimia nervosa, recovery is durable, we found that 10.5% of those with anorexia nervosa and 20.5% of those with bulimia nervosa who achieved recovery in the first decade had relapsed at long-term follow-up,” the authors wrote.
“The message of recovery for the majority of individuals with eating disorders is promising, but the subtext remains that one-third of patients will remain ill with an eating disorder even at long-term follow-up. Further, time to recovery even for those who do achieve it is long, and a subset of those who recover will relapse,” they wrote. “Ongoing efforts to increase effectiveness of prevention and treatment, improve early response rates, and identify individuals who are most vulnerable to a chronic course are critical.”
More information on this topic can be found in the Handbook of Assessment and Treatment of Eating Disorders from APA Publishing. APA members may purchase the book at a discount here.