Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-24T06:42:55.661Z Has data issue: false hasContentIssue false

Predictability of a favorable outcome in anorexia nervosa

Published online by Cambridge University Press:  16 April 2020

HC Deter*
Affiliation:
Department of Psychosomatics, University Medical Center Benjamin Franklin, Free University Berlin, Germany
D. Schellberg
Affiliation:
Department of Psychosomatics, University Medical Center, Heidelberg, Germany
W. Köpp
Affiliation:
Department of Psychosomatics, University Medical Center Benjamin Franklin, Free University Berlin, Germany
HC Friederich
Affiliation:
Department of Psychosomatics, University Medical Center, Heidelberg, Germany
W. Herzog
Affiliation:
Department of Psychosomatics, University Medical Center, Heidelberg, Germany
*
*Corresponding author. Department of Psychosomatics, University Medical Center Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail address: deter@medizin.fu-berlin.de (H.C. Deter).
Get access

Abstract

Objective

In a long-term follow-up of anorexia nervosa (AN) patients, somatic, psychological and social variables at clinical presentation should be investigated using a multilevel approach.

Methods

This study isolated predictors known from the literature over longer time periods and carried out a separate investigation of predictors in a sample of 81 AN patients of the Heidelberg–Mannheim study over a mean period of 12 years (range 9–19 years). Separate hierarchic regression analyses on the basis of the course of the Morgan–Russell categories were calculated for four individually recorded areas: anamnestic, psychological, somatic and social data sets.

Results

Age at the onset of the disease, purging behavior, low serum albumin, high glutamic-oxalo acetic transaminase (GOT) psychopathology (ANSS) and social pathology had the highest predictive value qualities. In survival analysis overall assessment of all six main predictors at clinical presentation could differentiate all patients who recovered from those who remained ill (log-rank test P = 0.019).

Conclusions

A small number of variables were important for detecting a good or poor long-term course of AN. At onset of the disease, it seems necessary to evaluate these psychological, somatic and social predictors.

Type
Original article

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agras, WS, Kraemer, HCThe treatment of anorexia nervosa: do different treatments have different outcomes?. Stunkard, AJStellar, EEating and its Disorders. New York: Raven Press; 1984 193207.Google Scholar
American Psychiatric Association Diagnostic and statistical manual of mental disorders. 3rd ed. Washington DC: American Psychiatric Association; 1987[revised]Google Scholar
Ben-Tovim, DI, Esterman, AOutcome in anorexia nervosa. Lancet 2001;358:926CrossRefGoogle Scholar
Ben-Tovim, DI, Walzer, K, Gilchrist, P, Freeman, R, Kalucy, R, Estermann, AOutcome in patients with eating disorders: a 5-year study. Lancet 2001;357:12541257.CrossRefGoogle ScholarPubMed
Beumont, PV, Russell, JD, Touyz, SWTreatment of anorexia nervosa. Lancet 1993;341:16351640.CrossRefGoogle ScholarPubMed
Buchkremer, G, Stricker, K, Holle, R, Kuhs, HThe predictability of relapses in schizophrenic patients. Eur. Arch. Psychiatry Clin. Neurosci. 1991;240:292300.CrossRefGoogle ScholarPubMed
Deter, H-CThe anorexia nervosa symptom score: a multidimensional tool for evaluating the course of anorexia nervosa. Herzog, WDeter, H-CVandereycken, WThe Course of Eating Disorders: Long-term Follow-up Studies of Anorexia and Bulimia Nervosa. Berlin/Heidelberg/New York: Springer; 1992 4052.CrossRefGoogle Scholar
Deter, H-C, Herzog, WAnorexia nervosa in a long-term perspective: results of the Heidelberg–Mannheim study. Psychosom. Med. 1994;56:2027.CrossRefGoogle Scholar
Deter, H-C, Petzold, E, Hengst-Theis, R, Breiden, U, Lanzinger-Rossnagel, GKatamnestische Ergebnisse einer klinisch-psychosomatischen Behandlung von 103 Patienten mit Anorexia nervosa aus internistischer Sicht unter besonderer Berücksichtigung der Mortalität. Inn. Med. 1983;1:312.Google Scholar
Diehm, K, Lentner, CWissenschaftliche tabellen.7. Auflage, 1. Nachdruck. Basel: Documenta Geigy; 1969Google Scholar
Feighner, JP, Robins, E, Guze, SB, Woodruff, RA, Winokur, G, Munoz, RDiagnostic criteria for use in psychiatric research. Arch. Gen. Psychiatry 1972;26:5763.CrossRefGoogle ScholarPubMed
Fichter, MM, Quadflieg, NSix-year course and outcome of anorexia nervosa. Int. J. Eat. Disord. 1999;26:359385.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
Hall, A, Slim, E, Hawker, F, Salmond, CAnorexia nervosa: long-term outcome in 50 female patients. Br. J. Psychiatry 1984;145:407413.CrossRefGoogle ScholarPubMed
Halmi, KA, Eckert, E, Marchi, P, Sampugnaro, V, Apple, R, Cohen, JComorbidity of psychiatric diagnoses in anorexia nervosa. Arch. Gen. Psychiatry 1991;48:712718.CrossRefGoogle ScholarPubMed
Herzog, DB, Keller, MB, Lavori, PWOutcome in anorexia nervosa and bulimia nervosa: a review of the literature. J. Nerv. Ment. Dis. 1988;176:131143.CrossRefGoogle ScholarPubMed
Herzog, W, Rathner, G, Vandereycken, WLong-term course of anorexia nervosa: a review of the literature. Herzog, WDeter, H-CVandereycken, WThe Course of Eating Disorders: Long-term Follow-up Studies of Anorexia and Bulimia Nervosa. Berlin/Heidelberg/New York: Springer; 1992.1529.CrossRefGoogle Scholar
Herzog, W, Minne, H, Deter, H-Cet al.Outcome of bone mineral density in anorexia nervosa patients 11.7 years after first admission. J. Bone Miner. Res. 1993;8:597605.CrossRefGoogle ScholarPubMed
Herzog, W, Deter, H-C, Fiehn, W, Petzold, EMedical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective 12 years follow-up study. Psychol. Med. 1997;27:269279.CrossRefGoogle Scholar
Keel, PK, Dorer, DJ, Eddy, KT, Franko, D, Charatan, DL, Herzog, DBPredictors of mortality in eating disorders. Arch. Gen. Pychiatry 2003;60:179183.CrossRefGoogle ScholarPubMed
Kleining, G, Moore, Hsoziale Selbsteinschätzung (SSE). Kolner Z. Soz. Sozialpsychol. (Aufl) 1968;20:502552.Google Scholar
Köhle, K, Simons, CAnorexia nervosa. Uexküll, TLehrbuch der Psychosomatischen Medizin. Urban & Schwarzenberg: München 1996 582613.Google Scholar
Köpp, W, Wegscheider, KStationäre Behandlung von Essstörungen. Heidelberg: Ansanger; 2000Google Scholar
Löwe, B, Zipfel, S, Buchholz, C, Dupont, Y, Reas, DL, Herzog, WLong-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol. Med. 2001;31:881890.CrossRefGoogle Scholar
Moorhead, DJ, Stashwick, CK, Reinherz, HZ, Diaconia, RM, Streigel-Moore, RM, Paradis, ADChild and adolescent predictors for eating disorders in a community poöulation of young adult women. Int. J. Eat. Disord. 2003;33:19.CrossRefGoogle Scholar
Morgan, HG, Russell, GFMValue of family background and clinical features as predictors of long-term outcome in anorexia nervosa: 4-year follow-up study of 41 patients. Psychol. Med. 1975;5:355371.CrossRefGoogle Scholar
Morgan, HG, Hayward, AEClinical assessment of anorexia nervosa. The Morgan–Russell outcome assessment schedule. Br J Psychiat 1988;152:367371.CrossRefGoogle ScholarPubMed
Patton, GMortality in eating disorders. Psychol. Med. 1988;18:947951.CrossRefGoogle ScholarPubMed
Petzold, EFamilienkonfrontationstherapie bei Anorexia nervosa. Göttingen: Vandenhoeck & Ruprecht; 1979Google Scholar
Pocock, SJClinical trials: a practical approach Chichester: Wiley; 1983Google Scholar
Ratnasuriya, RH, Eisler, I, Szmukler, GI, Russell, GFAnorexia nervosa: outcome and prognostic factors after 20 years. Br. J. Psychiatry 1991; 158:495502.CrossRefGoogle ScholarPubMed
Russell, GFMThe prognosis of eating disorders: a clinican’s approach. Herzog, WDeter, H-CVandereycken, WThe Course of Eating Disorders—Long-Term Follow-up Studies of Anorexia and Bulimia Nervosa Berlin/Heidelberg/New York: Springer; 1992 198213.Google Scholar
Russell, J, Abraham, S, Zipfel, S, Herzog, WOutcome in anorexia nervosa. Lancet 358 2001 926CrossRefGoogle ScholarPubMed
Steinhausen, HC, Rauss-Mason, C, Seidel, RFollow-up studies of anorexia nervosa: a review of four decades of outcome research. Psychol. Med.. 21 1991 447451.CrossRefGoogle ScholarPubMed
Strober, MCourse and outcome predictors in eating disorders presentation on the 4th International Conference of Eating Disorders New York:1990Google Scholar
Strober, M, Freeman, R, Morell, WThe 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. 1997; 22:339360.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Tanaka, H, Kiriike, N, Nagata, T, Riku, KOutcome of severe anorexia nervosa patients receiving inpatient treatment in Japan: an 8-year follow-up study. Psychiatry Clin. Neurosci. 2001; 55:389396.CrossRefGoogle Scholar
Theander, SOutcome and prognosis in anorexia nervosa and bulimia: some results of previous investigation, compared with those of a Swedish long-term study. J Psychiat Res 1985; 19:493508.CrossRefGoogle Scholar
Theander, SChronicity in anorexia nervosa: results from the Swedish long-term study. Herzog, WDeter, H-CVandereycken, WThe Course of Eating Disorders—Long-Term Follow-up Studies of Anorexia Nervosa and Bulimia Nervosa Berlin/Heidelberg/New York: Springer; 1992 214227.Google Scholar
Tolstrup, K, Brinch, M, Isager, T, Nielsen, S, Nystrup, J, Severin, Bet al.Long-term outcome of 151 cases of anorexia nervosa. The Copenhagen anorexia nervosa follow-up study. Acta Psychiatrica Scandinavia 1985; 71:380387.CrossRefGoogle ScholarPubMed
Zipfel, S, Löwe, B, Reas, DL, Deter, H-C, Herzog, WLong-term prognosis in anorexia nervosa: lesons from a 21-year follow-up study. The Lancet 2000; 355:721722.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.