Short- and long-term outcome of males treated for anorexia nervosa: a review of the literature
To give an overview of existing studies on the short- and long-term outcome for males treated for anorexia nervosa and to compare the outcome between adolescents and adults as well as between males and females.
A systematic literature search was conducted in PubMed, PsycINFO and PSYNDEX and complemented by a manual search of the references from all relevant studies.
Out of 1064 search results, 18 studies met our inclusion criteria. A combined total of 1129 males of varying age groups were followed 0.5–27 years post-treatment. For 1009 individuals, only vital status was ascertained. Length of follow-up and outcome definitions varied considerably. Limited data—especially in adults—prevented adequate age comparisons. In both adolescents and adults outcome and mortality differed widely across studies with no firm evidence for gender differences. Outcome in mixed samples of adolescents and adults was inconsistent. Studies rarely compared the genders statistically, and when they did, the results were nonsignificant.
Knowledge on the outcome of males treated for anorexia nervosa is scarce. Only few studies comprising insufficient numbers of males exist. Results based on these findings are inconclusive and in part contradicting. Further research is needed, including large sample sizes of reliably diagnosed males, adequate follow-up intervals, follow-up assessments with carefully defined outcome criteria, and comparisons to matched female patient samples.
Level of Evidence
Level I, Systematic review.
KeywordsShort-term Long-term Outcome Males Treated Anorexia nervosa Eating disorder
We express our gratitude to the Swiss Anorexia Nervosa Foundation (SANS) for its generous support. We also thank Susanne Hedlund, Ph.D., for her thoughtful revisions of the English text (language) and Tessa Pfeiffer, B.Sc., and Jana Taylor, B.Sc., for their contributions in obtaining full text versions of all relevant articles.
This work was supported by Grant no. 51-15 from the Swiss Anorexia Nervosa Foundation (SANS).
Compliance with ethical standards
Conflict of interest
The authors declare that there is no competing interest.
This article does not contain any studies with human participants performed by any of the authors.
For this type of study informed consent is not required.
- 6.Núñez-Navarro A, Agüera Z, Krug I, Jiménez-Murcia S, Sánchez I, Araguz N, Gorwood P, Granero R, Penelo E, Karwautz A, Moragas L, Saldaña S, Treasure J, Menchón JM, Fernández-Aranda F (2012) Do men with eating disorders differ from women in clinics, psychopathology and personality? Eur Eat Disord Rev 20:23–31. https://doi.org/10.1002/erv.1146 CrossRefPubMedGoogle Scholar
- 10.American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders, 3rd edn. American Psychiatric Association, WashingtonGoogle Scholar
- 11.American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders—revised, 3rd edn. American Psychiatric Association, WashingtonGoogle Scholar
- 12.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, WashingtonGoogle Scholar
- 13.American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders–text revision, 4th edn. American Psychiatric Association, WashingtonGoogle Scholar
- 14.World Health Organization (1978) International classification of diseases, 9th edn. World Health Organization, GenevaGoogle Scholar
- 15.World Health Organization (1992) The ICD-10 classification of mental and behavioral disorders: clinical description and diagnostic guidelines. World Health Organization, GenevaGoogle Scholar
- 16.Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R (1972) Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 26:57–63. https://doi.org/10.1001/archpsyc.1972.01750190059011 CrossRefPubMedGoogle Scholar
- 19.Müller B, Herpertz S, Heussen N, Neudörfl A, Wewetzer C, Remschmidt H, Herpertz-Dahlmann B (2000) Personality disorders and psychiatric morbidity over the course of juvenile anorexia nervosa: results of a prospective 10-year catamnesis. Z Kinder Jugendpsychiatr Psychother 28:81–91. https://doi.org/10.1024//1422-4922.214.171.124 CrossRefPubMedGoogle Scholar
- 24.Strober M, Freeman R, Morrell W (1997) The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord 22:339–360. https://doi.org/10.1002/(SICI)1098-108X(199712)22:4%3C339::AID-EAT1%3E3.0.CO;2-N CrossRefPubMedGoogle Scholar
- 29.Gueguen J, Godart N, Chambry J, Brun-Eberentz A, Foulon C, Divac SM, Guelfi J-D, Rouillon F, Falissard B, Huas C (2012) Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. Int J Eat Disord 45:537–545. https://doi.org/10.1002/eat.20987 CrossRefPubMedGoogle Scholar
- 30.Huas CA, Godart N, Foulon C, Pham-Scottez A, Divac S, Dechartres A, Lavoisy G, Guelfi JD, Rouillon F, Falissard B (2011) Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatr Scand 123:62–70. https://doi.org/10.1111/j.1600-0447.2010.01627.x CrossRefPubMedGoogle Scholar
- 34.Oyebode F, Boodhoo JA, Schapira K (1988) Anorexia nervosa in males: clinical features and outcome. Int J Eat Disord 7:121–124. https://doi.org/10.1002/1098-108X(198801)7:1%3C121::AID-EAT2260070113%3E3.0.CO;2-U CrossRefGoogle Scholar
- 37.Zerwas S, Tidselbak Larsen J, Petersen L, Thornton LM, Mortensen PB, Bulik CM (2015) The incidence of eating disorders in a Danish register study: associations with suicide risk and mortality. J Psychiatr Res 65:16–22. https://doi.org/10.1016/j.jpsychires.2015.03.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Ratnasuriya RH, Eisler I, Szmukler GI, Russell GFM (1991) Outcome and prognostic factors after 20 years. Br J Psychiatry 158:495–502. https://doi.org/10.1111/j.1749-6632.1989.tb53297.x CrossRefPubMedGoogle Scholar
- 39.Jeammet PH, Brechon G, Payan C, George A, Fermanian J (1991) The outcome of anorexia nervosa: a prospective study of 129 patients evaluated at least 4 years after their first admission. Psych Enf 34:381–442Google Scholar
- 42.Purgold J (1985) Anorexia nervosa and bulimia: a standard outcome schedule, an explanation of the Morgan-Russell scales. Department of Mental Health, University of Bristol, BristolGoogle Scholar
- 43.Hebebrand J, Himmelmann GW, Heseker H, Schäfer H, Remschmidt H (1996) Use of percentiles for the body mass index in anorexia nervosa: diagnostic, epidemiological, and therapeutic considerations. Int J Eat Disord 19:359–369. https://doi.org/10.1002/(SICI)1098-108X(199605)19:4%3C359 CrossRefPubMedGoogle Scholar
- 47.Møller-Madsen S, Nystrup J, Nielsen S (1996) Mortality in anorexia nervosa in Denmark during the period 1970–1987. Acta Psychiatr Scand 94:454–459. https://doi.org/10.1111/j.1600-0447.1996.tb09890.x CrossRefPubMedGoogle Scholar
- 48.Kask J, Ramklint M, Kolia N, Panagiotakos D, Ekbom A, Ekselius L, Papadopoulos FC (2017) Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients. Psychol Med 47:1489–1499. https://doi.org/10.1111/j.2044-8341.1986.tb02676.x CrossRefPubMedGoogle Scholar
- 52.Tolstrup K, Brinch M, Isager T, Nielsen S, Nystrup J, Severin B, Olesen NS (1985) Long-term outcome of 151 cases of anorexia nervosa. The Copenhagen anorexia nervosa follow-up study. Acta Psychiatr Scand 71:380–387. https://doi.org/10.1111/j.1600-0447.1985.tb02537.x CrossRefPubMedGoogle Scholar