Cited by 535Eating Disorders and BehaviorsNutrition, Health and Food BehaviorChild Nutrition and Feeding Issues

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Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up

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Eddy, Kamryn T., Tabri, Nassim, Thomas, Jennifer J., Murray, Helen B., Keshaviah, Aparna, Hastings, Elizabeth, Edkins, Katherine, Krishna, Meera, Herzog, David B., Keel, Pamela K., Franko, Debra L.·2017·The Journal of Clinical Psychiatry

DOI 10.4088/jcp.15m10393PMC PMC7883487

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Abstract

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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Index
Walker, A., Schlozman, S., & Alpert, J. (2021) · Cambridge University Press eBooks · doi:10.1017/9780511846403.021
Psychosocial Interventions
Forstein, M., Marguiles, A., Goisman, R. M., Simpson, E. B., Counselman, E. F., Tepper, M. C., Greenwold, J., Schuman‐Olivier, Z., & Mehta, D. H. (2021) · Cambridge University Press eBooks · doi:10.1017/9780511846403.016
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Chapter 2. Basic Principles of Ethics
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Chapter 5. Role of Medical Guardianship
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Chapter 4. Mental Capacity in Anorexia Nervosa
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Chapter 10. Eating Disorders and Palliative Care
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Front Matter
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Chapter 6. Civil Commitment
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Chapter 11. Futility
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Chapter 1. Treatment of Eating Disorders
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Chapter 9. Harm Reduction
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Chapter 8. Novel Treatments for Patients With Severe and Enduring Eating Disorders
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Index
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Additional file 1 of Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study
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Additional file 5 of Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study
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Additional file 2 of Childhood hyperactivity, eating behaviours, and executive functions: Their association with the development of eating-disorder symptoms in adolescence
Dufour, R., Breton, É., Morin, A. J. S., Côté, S. M., Dubois, L., Vitaro, F., Boivin, M., Tremblay, R. E., & Booij, L. (2024) · Figshare · doi:10.6084/m9.figshare.24310024
Additional file 1 of Anorexia nervosa through the lens of a severe and enduring experience: ‘lost in a big world’
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Additional file 1 of Structural brain differences in recovering and weight-recovered adult outpatient women with anorexia nervosa
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Additional file 3 of Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study
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Additional file 1 of Navigating the ethical complexities of severe and enduring (longstanding) eating disorders: tools for critically reflective practice and collaborative decision-making
Jamieson, S. K., Tan, J. O. A., Piekunka, K., Calvert, S., & Anderson, S. (2024) · Figshare · doi:10.6084/m9.figshare.26962538
Additional file 1 of Childhood hyperactivity, eating behaviours, and executive functions: Their association with the development of eating-disorder symptoms in adolescence
Dufour, R., Breton, É., Morin, A. J. S., Côté, S. M., Dubois, L., Vitaro, F., Boivin, M., Tremblay, R. E., & Booij, L. (2023) · Figshare · doi:10.6084/m9.figshare.24309961
Additional file 1 of Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa
Glasofer, D. R., Muratore, A. F., Attia, E., Wu, P., Wang, Y., Minkoff, H., Rufin, T., Walsh, B. T., & STEINGLASS, J. E. (2020) · Figshare · doi:10.6084/m9.figshare.13316992
Additional file 1 of “Your mind doesn’t have room for anything else”: a qualitative study of perceptions of cognitive functioning during and after recovery from anorexia nervosa
Keeler, J. L., Konyn, C. Y., Treasure, J. L., Cardi, V., Himmerich, H., Tchanturia, K., & Mycroft, H. (2023) · Figshare · doi:10.6084/m9.figshare.22609121
Additional file 1 of The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences
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Additional file 2 of Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study
Richards, K. L., Phillips, M. D., Grycuk, L., Hyam, L., Allen, K., & Schmidt, U. (2024) · Figshare · doi:10.6084/m9.figshare.25556666
Impact of adolescent dance participation on the development of disordered eating habits
Xi, S. (2024) · Journal of High School Science · doi:10.64336/001c.126812
Additional file 1 of Lower pattern recognition memory scores in anorexia nervosa
Keeler, J. L., Lambert, E. R., Olivola, M., Owen, J., Xia, J., Thuret, S., Himmerich, H., Cardi, V., & Treasure, J. (2021) · Figshare · doi:10.6084/m9.figshare.14444829
Additional file 1 of The risk of eating disorder relapse during pregnancy and after delivery and postpartum depression among women recovered from eating disorders
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Additional file 4 of Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study
Richards, K. L., Phillips, M. D., Grycuk, L., Hyam, L., Allen, K., & Schmidt, U. (2024) · Figshare · doi:10.6084/m9.figshare.26702767
Additional file 1 of Cognitive remediation therapy for patients with eating disorders: a qualitative study
Thorsrud, T., Bang, M. A., Dahlgren, C. L., Nordfjærn, T., & Weider, S. (2024) · Figshare · doi:10.6084/m9.figshare.27019244
Additional file 2 of Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature
Hambleton, A. L., Pépin, G., Le, A., Maloney, D., Touyz, S. W., & Maguire, S. (2022) · Figshare · doi:10.6084/m9.figshare.20962341
Additional file 1 of Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature
Hambleton, A. L., Pépin, G., Le, A., Maloney, D., Touyz, S. W., & Maguire, S. (2022) · Figshare · doi:10.6084/m9.figshare.20962338
Additional file 1 of Screening, assessment and diagnosis in the eating disorders: findings from a rapid review
Bryant, E., Spielman, K., Le, A., Marks, P., Touyz, S. W., & Maguire, S. (2022) · Figshare · doi:10.6084/m9.figshare.20023169
Additional file 1 of Eating disorders symptoms and depressive symptoms in Chinese Tibetan University students: a network analysis
Wu, R., Guang, Z., Wang, Y., Xue, B., Zhang, A., Dawa, Y., Guo, C., Tong, X., Wang, S., & Lu, C. (2024) · Figshare · doi:10.6084/m9.figshare.26657194
Innovative Pharmacological Approaches to Eating Disorder Treatment
Keshen, A. R., Touyz, S. W., Lacroix, E., Hay, P., & McElroy, S. L. (2025) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2025.08.014

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: Eddy, Kamryn T.
Tabri, Nassim
Thomas, Jennifer J.
Murray, Helen B.
Keshaviah, Aparna
Keel, Pamela K.
Franko, Debra L.
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)
DOI: 10.4088/jcp.15m10393
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
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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Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up

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