Skip to main content

Advertisement

SpringerLink
Log in

Prognostic factors and outcome in anorexia nervosa: a follow-up study

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Background and aims

Anorexia nervosa is an eating disorder characterized by food restriction, irrational fear of gaining weight and consequent weight loss. High mortality rates have been reported, mostly due to suicide and malnutrition. Good outcomes largely vary between 18 and 42 %. We aimed to assess outcome and prognostic factors of a large group of patients with anorexia nervosa. Moreover we aimed to identify clusters of prognostic factors related to specific outcomes.

Methods

We retrospectively reviewed data of 100 patients diagnosed with anorexia nervosa previously hospitalized in a tertiary level structure. Then we performed follow-up structured telephone interviews.

Results

We identified four dead patients, while 34 % were clinically recovered. In univariate analysis, short duration of inpatient treatment (p = 0.003), short duration of disorder (p = 0.001), early age at first inpatient treatment (p = 0.025) and preserved insight (p = 0.029) were significantly associated with clinical recovery at follow-up. In multiple logistic regression analysis, duration of first inpatient treatment, duration of disorder and preserved insight maintained their association with outcome. Moreover multiple correspondence analysis and cluster analysis allowed to identify different typologies of patients with specific features. Notably, group 1 was characterized by two or more inpatient treatments, BMI ≤ 14, absence of insight, history of long-term inpatient treatments, first inpatient treatment ≥30 days. While group 4 was characterized by preserved insight, BMI ≥ 16, first inpatient treatment ≤14 days, no more than one inpatient treatment, no psychotropic drugs intake, duration of illness ≤4 years.

Conclusions

We confirmed the association between short duration of inpatient treatment, short duration of disorder, early age at first inpatient treatment, preserved insight and clinical recovery. We also differentiated patients with anorexia nervosa in well-defined outcome groups according to specific clusters of prognostic factors. Our study might help clinicians to evaluate prognosis of patients with anorexia nervosa.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Papadopoulos FC, Ekbom A, Brandt L, Ekselius L (2009) Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry 194:10–17. doi:10.1192/bjp.bp.108.054742

    Article  PubMed  Google Scholar 

  2. Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68:724–731. doi:10.1001/archgenpsychiatry.2011.74

    Article  PubMed  Google Scholar 

  3. Berkman ND, Lohr KN, Bulik CM (2007) Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord 40:293–309. http://www.ncbi.nlm.nih.gov/pubmed/17370291

  4. Nielsen S, Moller-Madsen S, Isager T, Jorgensen J, Pagsberg K, Theander S (1998) Standardized mortality in eating disorders–a quantitative summary of previously published and new evidence. J Psychosom Res 44:413–34. http://www.ncbi.nlm.nih.gov/pubmed/9587884

  5. Signorini A, De Filippo E, Panico S, De Caprio C, Pasanisi F, Contaldo F (2007) Long-term mortality in anorexia nervosa: a report after an 8-year follow-up and a review of the most recent literature. Eur J Clin Nutr 61:119–22. http://www.ncbi.nlm.nih.gov/pubmed/16885933

  6. Brewerton TD, Costin C (2011) Treatment results of anorexia nervosa and bulimia nervosa in a residential treatment program. Eat Disord 19:117–131. doi:10.1080/10640266.2011.551629

    Article  PubMed  Google Scholar 

  7. Brewerton TD, Costin C (2011) Long-term outcome of residential treatment for anorexia nervosa and bulimia nervosa. Eat Disord 19:132–144. doi:10.1080/10640266.2011.551632

    Article  PubMed  Google Scholar 

  8. Lee S, Chan YY, Hsu LK (2003) The intermediate-term outcome of Chinese patients with anorexia nervosa in Hong Kong. Am J Psychiatry 160:967–72. http://www.ncbi.nlm.nih.gov/pubmed/12727702

  9. Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159:1284–1293. http://www.ncbi.nlm.nih.gov/pubmed/12153817

  10. Mustelin L, Raevuori A, Bulik CM, Rissanen A, Hoek HW, Kaprio J, Keski-Rahkonen A (2015) Long-term outcome in anorexia nervosa in the community. Int J Eat Disord. doi:10.1002/eat.22415

    Google Scholar 

  11. Smink FR, van Hoeken D, Hoek HW (2013) Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 26:543–548. doi:10.1097/YCO.0b013e328365a24f

    Article  PubMed  Google Scholar 

  12. Fichter MM, Quadflieg N, Hedlund S (2006) Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord 39:87–100. http://www.ncbi.nlm.nih.gov/pubmed/16231345

  13. Wentz E, Gillberg IC, Anckarsater H, Gillberg C, Rastam M (2009) Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry 194:168–174. doi:10.1192/bjp.bp.107.048686

    Article  PubMed  Google Scholar 

  14. Couturier J, Lock J (2006) What is recovery in adolescent anorexia nervosa? Int J Eat Disord 39:550–5. http://www.ncbi.nlm.nih.gov/pubmed/16791851

  15. Jeammet P, Brechon G, Payan C, Gorge A, Fermanian J (1991) The outcome of anorexia nervosa: a prospective study of 129 patients evaluated at least 4 years after their first admission. Psychiatr Enfant 34:381–442. http://www.ncbi.nlm.nih.gov/pubmed/1798811

  16. Morgan HG, Russell GF (1975) Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa: four-year follow-up study of 41 patients. Psychol Med 5:355–71. http://www.ncbi.nlm.nih.gov/pubmed/1197538

  17. Couturier J, Lock J (2006) What is remission in adolescent anorexia nervosa? A review of various conceptualizations and quantitative analysis. Int J Eat Disord 39:175–83. http://www.ncbi.nlm.nih.gov/pubmed/16485268

  18. 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 22:339–60. http://www.ncbi.nlm.nih.gov/pubmed/9356884

  19. Keski-Rahkonen A, Raevuori A, Bulik CM, Hoek HW, Rissanen A, Kaprio J (2014) Factors associated with recovery from anorexia nervosa: a population-based study. Int J Eat Disord 47:117–123. doi:10.1002/eat.22168

    Article  PubMed  Google Scholar 

  20. Zerwas S, Lund BC, Von Holle A, Thornton LM, Berrettini WH, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, La Via M, Mitchell J, Rotondo A, Strober M, Woodside DB, Kaye WH, Bulik CM (2013) Factors associated with recovery from anorexia nervosa. J Psychiatr Res 47:972–979. doi:10.1016/j.jpsychires.2013.02.011

    Article  PubMed  PubMed Central  Google Scholar 

  21. American Psychiatric Association (1994) Diagnostic and statistical manual for mental disorders. 4th edn. Washington, DC

  22. American Psychiatric Association (1980) Diagnostic and statistical manual for mental disorders, 3rd edn. Washington, DC

  23. American Psychiatric Association (2013) Diagnostic and statistical manual for mental disorders, 5th edn. Washington, DC

  24. Dalle Grave R, Calugi S, Marchesini G (2008) Is amenorrhea a clinically useful criterion for the diagnosis of anorexia nervosa? Behav Res Ther 46:1290–1294. doi:10.1016/j.brat.2008.08.007

    Article  PubMed  Google Scholar 

  25. Attia E, Roberto CA (2009) Should amenorrhea be a diagnostic criterion for anorexia nervosa? Int J Eat Disord 42:581–589. doi:10.1002/eat.20720

    Article  PubMed  Google Scholar 

  26. Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB (2008) Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry 165:245–250. doi:10.1176/appi.ajp.2007.07060951

    Article  PubMed  PubMed Central  Google Scholar 

  27. Espindola CR, Blay SL (2013) Long term remission of anorexia nervosa: factors involved in the outcome of female patients. PLoS One 8:e56275. doi:10.1371/journal.pone.0056275

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Wentz E, Gillberg C, Gillberg IC, Rastam M (2001) Ten-year follow-up of adolescent-onset anorexia nervosa: psychiatric disorders and overall functioning scales. J Child Psychol Psychiatry 42:613–22. http://www.ncbi.nlm.nih.gov/pubmed/11464966

  29. Keel PK, Dorer DJ, Franko DL, Jackson SC, Herzog DB (2005) Postremission predictors of relapse in women with eating disorders. Am J Psychiatry 162:2263–2268. http://www.ncbi.nlm.nih.gov/pubmed/16330589

  30. Pohjolainen V, Ryynänen OP, Räsänen P, Roine RP, Koponen S, Karlsson H (2014) Bayesian prediction of treatment outcome in anorexia nervosa: a preliminary study. Nord J Psychiatry 7:1–6. doi:10.1002/eat.20676

    Google Scholar 

  31. Ratnasuriya RH, Eisler I, Szmukler GI, Russell GF (1991) Anorexia nervosa: outcome and prognostic factors after 20 years. Br J Psychiatry 158:495–502. http://www.ncbi.nlm.nih.gov/pubmed/2054565

  32. van Son GE, van Hoeken D, van Furth EF, Donker GA, Hoek HW (2010) Course and outcome of eating disorders in a primary care-based cohort. Int J Eat Disord 43:130–8. http://www.ncbi.nlm.nih.gov/pubmed/25286982

  33. Carsky M, Selzer MA, Terkelsen K, Hurt SW. The PEH. A questionnaire to assess acknowledgment of psychiatric illness. J Nerv Ment Dis 180:458–64. http://www.ncbi.nlm.nih.gov/pubmed/1624928

  34. Lebart M (1997) Piron. Statistique exploratoire multidimensionelle, 2nd edn, 1997, Dunod, Paris

  35. Cattell RB (1966) The scree test for the number of factors. Multivar Behav Res 1:245–276

    Article  CAS  Google Scholar 

  36. Morineau A (1984) Note sur la caractérisation statistique d’une classe et les valeurs tests. Bulletin Technique Centre Statistique Informatique Appliquées 2:20–27

    Google Scholar 

  37. Bachner-Melman R, Zohar AH, Ebstein RP (2006) An examination of cognitive versus behavioral components of recovery from anorexia nervosa. J Nerv Ment Dis 194:697–703. http://www.ncbi.nlm.nih.gov/pubmed/16971822

  38. Herzog DB, Sacks NR, Keller MB, Lavori PW, von Ranson KB, Gray HM (1993) Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa. J Am Acad Child Adolesc Psychiatry 32:835–842. http://www.ncbi.nlm.nih.gov/pubmed/8340307

  39. Gillberg IC, Rastam M, Gillberg C (1994) Anorexia nervosa outcome: six-year controlled longitudinal study of 51 cases including a population cohort. J Am Acad Child Adolesc Psychiatry 33:729–39. http://www.ncbi.nlm.nih.gov/pubmed/8056736

  40. Nicholls DE, Lynn R, Viner RM (2011) Childhood eating disorders: British national surveillance study. Br J Psychiatry 198:295–301. doi:10.1192/bjp.bp.110.081356

    Article  PubMed  Google Scholar 

  41. Pinter O, Probst M, Vandereycken W, Pieters G, Goris M (2004) The predictive value of body mass index for the weight evolution in anorexia nervosa. Eat Weight Disord 9:232–235. http://www.ncbi.nlm.nih.gov/pubmed/15656020

  42. Konstantakopoulos G, Tchanturia K, Surguladze SA, David AS (2011) Insight in eating disorders: clinical and cognitive correlates. Psychol Med 41:1951–1961. doi:10.1017/S0033291710002539

    Article  CAS  PubMed  Google Scholar 

  43. Franko DL, Keel PK, Dorer DJ, Blais MA, Delinsky SS, Eddy KT, Charat V, Renn R, Herzog DB (2004) What predicts suicide attempts in women with eating disorders? Psychol Med 34:843–53. http://www.ncbi.nlm.nih.gov/pubmed/15500305

  44. Herzog DB, Nussbaum KM, Marmor AK (1996) Comorbidity and outcome in eating disorders. Psychiatr Clin North Am 19:843–59. http://www.ncbi.nlm.nih.gov/pubmed/9045226

Download references

Acknowledgments

We wish to thank Dr. Pasquale Striano for his precious collaboration and Prof. Salvatore Striano for his important teaching.

Author information

Authors and Affiliations

  1. Section of Psychotherapy, Section of Psychiatry, Department of Neurosciences, “Federico II” University, Naples, Italy

    Luca Errichiello & Ignazio Senatore

  2. Local Health Authority of Matera, Operating Unit Adult Mental Health, Policoro Hospital, Policoro (Matera), Italy

    Davide Iodice

  3. Department of Public Health, “Federico II” University, Naples, Italy

    Dario Bruzzese

  4. Department of Economics and Statistics, “Federico II” University, Naples, Italy

    Marco Gherghi

Authors
  1. Luca Errichiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Davide Iodice
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dario Bruzzese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Gherghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ignazio Senatore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Errichiello.

Ethics declarations

Conflict of interest

All authors have nothing to disclose. On behalf of all authors, the corresponding author states that there is no conflict of interest: the authors have no financial or personal relationships with a third party whose interests could be positively or negatively influenced by the article’s content.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Errichiello, L., Iodice, D., Bruzzese, D. et al. Prognostic factors and outcome in anorexia nervosa: a follow-up study. Eat Weight Disord 21, 73–82 (2016). https://doi.org/10.1007/s40519-015-0211-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-015-0211-2

Keywords

Search

Navigation