Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up
Open accessAbstract
OBJECTIVE: The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa. METHODS: Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa were 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) via structured clinical interview (Longitudinal Interval Follow-Up Evaluation of Eating Disorders [LIFE-EAT-II]). Seventy-seven percent of the original cohort was re-interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N = 228). 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. RESULTS: 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. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa (odds ratio [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). CONCLUSION: At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.
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Anorexia nervosa is a treatable psychiatric disorder.
“AN is a treatable psychiatric disorder.”
From Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined (2022) · cites this paper as [8]
Recovery from anorexia nervosa is often protracted, occurring after years and sometimes decades of illness.
“although recovery is often protracted occurring after years, and sometimes decades of illness [8]”
From Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined (2022) · cites this paper as [8]
The majority of individuals with anorexia nervosa will eventually recover.
“Evidence suggests the majority of those affected will eventually recover”
From Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined (2022) · cites this paper as [8]
Data from naturalistic, long-term follow-up studies suggest that only 40-62% of individuals recover from anorexia nervosa over a period of 20 years.
“Data from naturalistic, long-term follow-up studies suggest that only 40-62% of individuals recover from anorexia nervosa over a period of 20 years (Zipfel et al. 2000; Eddy et al. 2017; Fichter et al. 2017).”
From A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa (2020) · cites this paper as Eddy et al. 2017
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“Around 20 percent of individuals who experience anorexia nervosa (AN) have a protracted illness course [3, 4].”
BackgroundWhat kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure
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- Authors
- Eddy, K. T., Tabri, N., Thomas, J. J., Murray, H. B., Keshaviah, A., Hastings, E., Edkins, K., Krishna, M., Herzog, D. B., Keel, P. K., & Franko, D. L.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Florida State University (US)
- Northeastern University (US)
- Corresponding author
- Eddy, Kamryn T.
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2016-12-20
- Volume
- 78
- Issue
- 02
- Pages
- 184-189
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC7883487
- OpenAlex
- W2564469912
- Cited by
- 535
- References
- 31
- Citations by year
- 2026: 43 · 2025: 59 · 2024: 86 · 2023: 77 · 2022: 62 · 2021: 75 · 2020: 67 · 2019: 28 · 2018: 21 · 2017: 13 · 2013: 1
- FWCI
- 27.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R03MH094832, R01MH038333)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- anorexia nervosa, bulimia nervosa, eating disorders, long-term recovery, recovery trajectories, early recovery, longitudinal follow-up, women, palliative care, relapse and remission, multiple imputation
- MeSH terms
- Adult, Anorexia Nervosa, Female, Follow-Up Studies, Humans, Interview, Psychological, Longitudinal Studies, Middle Aged, Prognosis, Bulimia Nervosa, Young Adult
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