Anorexia nervosa: 30-year outcome

Abstract

Background: Little is known about the long-term outcome of anorexia nervosa.

Aims: To study the 30-year outcome of adolescent-onset anorexia nervosa.

Method: All 4291 individuals born in 1970 and attending eighth grade in 1985 in Gothenburg, Sweden were screened for anorexia nervosa. A total of 24 individuals (age cohort for anorexia nervosa) were pooled with 27 individuals with anorexia nervosa (identified through community screening) who were born in 1969 and 1971-1974. The 51 individuals with anorexia nervosa and 51 school- and gender-matched controls were followed prospectively and examined at mean ages of 16, 21, 24, 32 and 44. Psychiatric disorders, health-related quality of life and general outcome were assessed.

Results: At the 30-year follow-up 96% of participants agreed to participate. There was no mortality. Of the participants, 19% had an eating disorder diagnosis (6% anorexia nervosa, 2% binge-eating disorder, 11% other specified feeding or eating disorder); 38% had other psychiatric diagnoses; and 64% had full eating disorder symptom recovery, i.e. free of all eating disorder criteria for 6 consecutive months. During the elapsed 30 years, participants had an eating disorder for 10 years, on average, and 23% did not receive psychiatric treatment. Good outcome was predicted by later age at onset among individuals with adolescent-onset anorexia nervosa and premorbid perfectionism.

Conclusions: This long-term follow-up study reflects the course of adolescent-onset anorexia nervosa and has shown a favourable outcome regarding mortality and full symptom recovery. However, one in five had a chronic eating disorder.

Keywords: Anorexia nervosa; case–control; outcome; population based.

Fig. 1

The trajectories of eating disorders over 30 years. The eating disorder diagnoses at each of the five assessments for all 51 individuals in the anorexia nervosa group is shown. The numbers before the abbreviations in the boxes correspond to the number of individuals with the condition. The column to the left shows the number of the study and, within brackets, the mean age of the anorexia nervosa group at the time of the study. From study 1 to study 4 the eating disorder diagnoses were assigned according to the DSM-IV; the DSM-5 criteria were applied at study 5. AN, anorexia nervosa; BE, binge-eating disorder; BN, bulimia nervosa; DO, dropped out; ED, eating disorder not otherwise specified (other specified feeding or eating disorder according to the DSM-5); NO, no eating disorder.

Fig. 2

Body mass index (BMI) in the anorexia nervosa and comparison group in the original study and across the four follow-up studies. Average BMI in each group at each of the five assessments is displayed. The number below each study indicates the mean age of all participants at that assessment. Error bars indicate 95% CI. AN, anorexia nervosa; AN study 1, the original study; AN study 2, 6-year follow-up; AN study 3, 10-year follow-up; AN study 4, 18-year follow-up; AN study 5, 30-year follow-up (the present study); COMP, comparison.