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Anorexia nervosa

A review of outcome studies reported that over 20 years 50% of patients make a good recovery (normalisation of three outcome parameters: weight, menstrual pattern and eating behaviour), 30% had a fair outcome (improvement in one or two parameters), and 20% have a poor outcome (no improvement).⁶ However, most patients remain impaired in physical and social functioning, continuing to have disordered eating practices and to be overly conscious of cues related to food and weight.⁶ A 20-year follow-up of anorexic patients reported that 62% had made a good to intermediate recovery, but that mortality was up to 20%.⁷ The most common causes of death are suicide or cardiac arrhythmias.

Bulimia nervosa

The outcome of bulimia nervosa is less well described. In intermediate term studies, about 20% of patients continued to have bulimia after two to five years, while about 25% more still had some bulimic symptoms.⁸ About 30% of bulimic patients had a previous history of anorexia nervosa, but it was rare for those with normal weight to develop anorexia nervosa.

Prognostic factors

For both anorexia nervosa and bulimia nervosa, poorer prognosis is associated with lower initial minimum weight, failure to respond to previous treatments, premorbidly disturbed family relationships and severe personality disorder.^6,9 For anorexia nervosa, the presence of vomiting is a poor prognostic feature and, for bulimia nervosa, the use of purgatives. Factors likely to lead to chronic eating disorders include difficulty giving up "anorexic" thinking patterns and unresolved interpersonal and family difficulties.

We speculate that ongoing entrenched physiological patterns of starvation (e.g., feeling of fullness secondary to delayed gastric emptying) and lowered mood and feelings of helplessness, which may be associated with depression, are also perpetuating factors.

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