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Course and two-year outcome in anorexic and bulimic adolescents

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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.

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Authors and Affiliations

  1. Ludwig-Maximilians University of Munich, Germany

    M. M. Fichter (Professor of Psychiatry)

  2. Department of Psychiatry, University of Munich, Germany

    N. Quadflieg (Clinical Psychologist and Researcher)

Authors
  1. M. M. Fichter
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  2. N. Quadflieg
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Additional information

Supported by Grant No. FKZ 0701623-8 of the Bundesministerium für Forschung und Technologie, Germany.

Received M.D. in 1981 from the University of Heidelberg, Germany and his training in psychiatry at UCLA and at the Max Planck Institute of Psychiatry and the University of Munich, Germany. Major research interests are eating disorders, risk factors and course of mental disorders, and psychiatric epidemiology.

Received his degree in psychology (Dipl. Psych) at the University of Munich, Germany. Major research interests are eating disorders.

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Fichter, M.M., Quadflieg, N. Course and two-year outcome in anorexic and bulimic adolescents. J Youth Adolescence 25, 545–562 (1996). https://doi.org/10.1007/BF01537548

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