Elsevier

Journal of Psychiatric Research

Volume 96, January 2018, Pages 183-188
Journal of Psychiatric Research

Predictors of long-term recovery in anorexia nervosa and bulimia nervosa: Data from a 22-year longitudinal study

https://doi.org/10.1016/j.jpsychires.2017.10.008Get rights and content

Abstract

Objective

The objective of this study was to investigate predictors of long-term recovery from eating disorders 22 years after entry into a longitudinal study.

Method

One hundred and seventy-six of the 228 surviving participants (77.2%) were re-interviewed 20-25 years after study entry using the Longitudinal Interval Follow-up Evaluation to assess ED recovery. The sample consisted of 100 women diagnosed with anorexia nervosa (AN) and 76 with bulimia nervosa (BN) at study entry.

Results

A comorbid diagnosis of major depression at the start of the study strongly predicted having a diagnosis of AN-Restricting type at the 22-year assessment. A higher body mass index (BMI) at study intake decreased the odds of being diagnosed with AN-Binge Purge type, relative to being recovered, 22 years later. The only predictor that increased the likelihood of having a diagnosis of BN at the 22-year assessment was the length of time during the study when the diagnostic criteria for BN were met.

Conclusions

Together, these results indicate that the presence and persistence of binge eating and purging behaviors were poor prognostic indicators and that comorbidity with depression is particularly pernicious in AN. Treatment providers might pay particular attention to these issues in an effort to positively influence recovery over the long-term.

Section snippets

Participants

Participants were recruited from Boston-area outpatient eating disorder services (1987-1991) if they met the following inclusion criteria: DSM-III-R (American Psychiatric Association, 1987) AN or BN diagnosis; female; minimum age of 12 years; residence within 200 miles of Boston; English speaking; and no evidence of organic brain syndrome or terminal illness.

Of the 294 women meeting study criteria, 250 (85.0%) agreed to participate, and four dropped out prior to the first follow-up. Thus, the

Recovery rates at 22 years

Recovery status at Wave II for the observed and imputed data is presented in Table 1. At the 22-year follow-up, nearly two-thirds of the sample had recovered. Specifically, 62.8% of those originally diagnosed with AN and 68.2% of those originally diagnosed with BN met the criteria for recovery (Eddy et al., 2017).

Predictors of non-recovery status (AN-R, AN-BP, or BN) relative to recovery at 22 years

Results from the multinomial logistic regression analysis examining predictors of non-recovery status (AN-R, AN-BP, and BN) relative to recovery at 22 years are presented in Table 2.

Discussion

The goal of the current study was to identify predictors of long-term recovery in eating disorders. In our analyses examining the odds of having a particular diagnosis at 22 years (AN-R, AN-BP, or BN), a diagnosis of major depression at the start of the study strongly and uniquely predicted having a diagnosis of AN-R relative to being recovered at the 22-year assessment. For AN-BP, the picture was different. Not surprisingly, having more clinically significant symptoms of anorexia and bulimia

Financial support

Support for this study came from grants from the National Institute of Mental Health (D.B.H., R01 MH-38333): and (D.B.H. and K.T.E., R03 MH-094832).

Conflicts of interest

None.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Acknowledgements

The authors wish to thank the participants for giving their time to help us learn more about the course and outcome of eating disorders and the research assistants who have worked on this project throughout the years.

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