Relapse from remission at two- to four-year follow-up in two treatments for adolescent anorexia nervosa

Abstract

Objective: Long-term follow-up studies documenting maintenance of treatment effects are few in adolescent anorexia nervosa (AN). This exploratory study reports relapse from full remission and attainment of remission during a 4-year open follow-up period using a convenience sample of a subgroup of 65% (n = 79) from an original cohort of 121 participants who completed a randomized clinical trial comparing family-based therapy (FBT) and adolescent-focused individual therapy (AFT).

Method: Follow-up assessments were completed up to 4 years posttreatment (average, 3.26 years). Available participants completed the Eating Disorder Examination as well as self-report measures of self-esteem and depression at 2 to 4 years posttreatment.

Results: Two participants (6.1%) relapsed (FBT: n = 1, 4.5%; AFT: n = 1, 9.1%), on average 1.98 years (SD = 0.14 years) after remission was achieved at 1-year follow-up. Ten new participants (22.7%) achieved remission (FBT: n = 1, 5.9%; AFT: n = 9, 33.3%). Mean time to remission for this group was 2.01 years (SD = 0.82 years) from 1-year follow-up. There were no differences based on treatment group assignment in either relapse from full remission or new remission during long-term follow-up. Other psychopathology was stable over time.

Conclusion: There were few changes in the clinical presentation of participants who were assessed at long-term follow-up. These data suggest that outcomes are generally stable posttreatment regardless of treatment type once remission is achieved. Clinical trial registration information-Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia Nervosa; http://www.clinicaltrials.gov/; NCT00149786.

Keywords: adolescence; adolescent-focused treatment; anorexia nervosa; family-based treatment; long-term follow-up.

Figure 1

Time to relapse by treatment from one-year follow-up (n=26; treatment: Wald chisquare=0.320, df=1, p=.57, OR = 0.443). Note: AFT = adolescent focused therapy; FBT = family-based treatment.

Figure 2

Time to remission by treatment from one-year follow-up (n=44; treatment: Wald chi-square=3.047, df=1, OR = 0.156, p=.081). Note: AFT = adolescent focused therapy; FBT = family-based treatment.