Article

Journal of Youth and Adolescence

, Volume 25, Issue 4, pp 545-562

First online:

Course and two-year outcome in anorexic and bulimic adolescents

  • M. M. FichterAffiliated withLudwig-Maximilians University of Munich
  • , N. QuadfliegAffiliated withDepartment of Psychiatry, University of Munich

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Abstract

Objective:The aim of the study was the descriptive analysis of the two-year course of bulimia nervosa (BN; N=32) and anorexia nervosa (AN; N=23) in adolescents who received intensive inpatient behavioral treatment. Methods:Assessments were made on the basis of expert ratings (Structured Interview for Anorexia and Bulimia Nervosa [SIAB-P], Psychiatric Status Rating Scale for Bulimia/Anorexia Nervosa [PSRSB], Morgan-Russell Outcome Assessment Scale and Munich Diagnostic Check List [MDCL]) and self-ratings (SIAB-S [self-rating], Anorexia Nervosa Inventory for self-rating [ANIS], Eating Disorder Inventory [EDI], SCL-90, and the Parental Bonding Instrument [FBI]). Results:Females with BN maintained their low normal weight. Females with AN maintained some of their weight increase induced during inpatient therapy. The BN group had a higher lifetime comorbidity with affective disorders while AN had a higher comorbidity with substance use disorders. The status at two-year follow-up based on the PSRSB expert rating was as follows: 50% of the BN patients also fulfilled the Diagnostic Statistical Manual, third edition, revised (DSM-III-R) criteria for BN at follow-up while only 3.1% of them fulfilled criteria for AN and 46.9% were below threshold of a diagnosis for AN or BN according to DSM-III-R; of those former BN patients below diagnostic threshold for an eating disorder at follow-up, 26.7% showed “marked symptoms,” 26.7% were classified as “partial remission,” 13.3% had “residual symptoms,” and 33.3% had normalized to their “usual self.” From the patients with AN on admission 30.4% were classified as AN according to DSM-III-R at the two-year follow-up and 21.7% as BN. The remaining 47.8% were below diagnostic threshold of DSM-III-R AN or BN (of those 45.5% with “marked symptoms,” 27.3% with “partial remission,” 9.1% with “residual symptoms,” and 18.2% had normalized to “usual self). Conclusions: At the two-year follow-up almost half of the patients with AN and almost half of those with BN had no major eating disorder (AN, BN). A considerable number of the AN patients developed BN in the two-year interval.