The outcome of anorexia nervosa in the 20th century
Abstract
OBJECTIVE: The present review addresses the outcome of anorexia nervosa and whether it changed over the second half of the 20th century. METHOD: A total of 119 study series covering 5,590 patients suffering from anorexia nervosa that were published in the English and German literature were analyzed with regard to mortality, global outcome, and other psychiatric disorders at follow-up. RESULTS: There were large variations in the outcome parameters across studies. Mortality estimated on the basis of both crude and standardized rates was significantly high. Among the surviving patients, less than one-half recovered on average, whereas one-third improved, and 20% remained chronically ill. The normalization of the core symptoms, involving weight, menstruation, and eating behaviors, was slightly better when each symptom was analyzed in isolation. The presence of other psychiatric disorders at follow-up was very common. Longer duration of follow-up and, less strongly, younger age at onset of illness were associated with better outcome. There was no convincing evidence that the outcome of anorexia nervosa improved over the second half of the last century. Several prognostic features were isolated, but there is conflicting evidence. Most clearly, vomiting, bulimia, and purgative abuse, chronicity of illness, and obsessive-compulsive personality symptoms are unfavorable prognostic features. CONCLUSIONS: Anorexia nervosa did not lose its relatively poor prognosis in the 20th century. Advances in etiology and treatment may improve the course of patients with anorexia nervosa in the future.
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“Premature death, due to medical complications secondary to starvation (e.g., cardiac failure) or suicide, range from 5% to 20% with the aggregate mortality rate approximately 5.6% per decade (Birmingham et al., 2005; Steinhausen, 2002).”
BackgroundInfluentialPsychological treatments for people with severe and enduring anorexia nervosa: A mini review
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The Neuropsychological Profile of Severe and Enduring Anorexia Nervosa: A Systematic Review
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“Although we do not have specific data related to the economic burden of treatment in Spain, various Cost Of Illness (COI) studies conducted in other European countries indicate that the direct costs for diagnosis and treatment of patients (medical expenditures, nonmedical costs, out-of-pocket expenses of the patient a…”
BackgroundAssisted death in eating disorders: a systematic review of cases and clinical rationales
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“Steinhausen (116) found that while duration of illness was a predictor of poor outcomes, studies that used a longer duration of follow-up showed better outcomes.”
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Chapter 12. Eating Disorders and Physician-Assisted Death
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- Authors
- Steinhausen, H.-C.
- Affiliations
- University of Zurich (CH)
- Corresponding author
- Steinhausen, Hans-Christoph
- Venue
- American Journal of Psychiatry
- Published
- 2002-08-01
- Volume
- 159
- Issue
- 8
- Pages
- 1284-1293
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2113750392
- Cited by
- 1,761
- References
- 109
- Citations by year
- 2026: 30 · 2025: 45 · 2024: 73 · 2023: 65 · 2022: 76 · 2021: 98 · 2020: 98 · 2019: 88 · 2018: 79 · 2017: 83 · 2016: 78 · 2015: 90 · 2014: 89 · 2013: 109 · 2012: 102
- FWCI
- 8.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- anorexia nervosa, long-term outcomes, mortality, recovery, psychiatric comorbidity, prognostic factors, bulimia nervosa, disease duration, age of onset, eating disorders
- MeSH terms
- Adolescent, Adult, Anorexia Nervosa, Mental Disorders, Cause of Death, Chronic Disease, Compulsive Personality Disorder, Female, Follow-Up Studies, Hospitalization, Humans, Length of Stay, Male, Prognosis, Comorbidity, Survival Analysis, Outcome Assessment, Health Care, Age of Onset
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