Clinical Summary
Clinical Summary: Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up
Patients with anorexia nervosa and bulimia nervosa are often labeled chronic when illness persists for years, raising real questions about when to keep pursuing remission versus shifting to palliative goals. This 22-year follow-up shows that recovery remains common over the long term, especially for anorexia nervosa, where improvement continued well beyond the first decade.
Design
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.
N
N = 228
Population
Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa
Duration
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)
Key Findings
- 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.
- Among participants with anorexia nervosa who were not recovered at Wave 1, 50.6% were recovered at Wave 2, showing substantial continued recovery after the first decade.
- Early recovery strongly predicted long-term recovery in anorexia nervosa (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).
- During Wave 1, individuals with anorexia nervosa were slower to recover than those with bulimia nervosa (χ21 = 38.2, P < .001); for bulimia nervosa, the median time to recovery was estimated at 3.8 years.
- Relapse after earlier recovery remained clinically relevant: 10.5% of patients with anorexia nervosa who were recovered at Wave 1 were no longer recovered at Wave 2, compared with 20.5% of patients with bulimia nervosa.
Clinical Bottom Line
Active treatment remains warranted for most patients with anorexia nervosa and bulimia nervosa, even after long illness duration. Recovery in bulimia nervosa tends to occur earlier, while recovery in anorexia nervosa continues to accrue over 2 decades.
Practice Implications
- Do not assume that anorexia nervosa becomes unrecoverable after 9 years; 50.6% of participants with anorexia nervosa who were not recovered at Wave 1 were recovered at Wave 2.
- Use early course to inform prognosis differently by diagnosis: in anorexia nervosa, 52 consecutive weeks of early recovery carried a strong long-term signal (OR = 10.5; 95% CI, 3.77-29.28; P < .01), whereas comparable early recovery in bulimia nervosa did not predict long-term recovery (OR = 1.0; 95% CI, 0.49-2.05; P = 1.0).
- Counsel patients with bulimia nervosa that recovery is often earlier rather than steadily increasing over later decades; recovery was 68.2% at both 9-year and 22-year follow-up, and median time to recovery was 3.8 years.
- Continue long-term follow-up after remission, because 10.5% of those with anorexia nervosa and 20.5% of those with bulimia nervosa who achieved recovery in the first decade were no longer recovered at Wave 2.
