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Am J Psychiatry 1997; 154:313-321
Copyright © 1997 by American Psychiatric Association
Outcome in bulimia nervosa
PK Keel and JE Mitchell
Department of Psychology, University of Minnesota, Minneapolis 55455, USA.
OBJECTIVE: The authors sought to synthesize existing data on outcome for
individuals diagnosed with bulimia nervosa in order to better understand
long-term outcome and prognostic factors. METHOD: They reviewed 88 studies
that conducted follow-up assessments with bulimic subjects at least 6
months after presentation. Findings are summarized for the areas of
mortality, recovery, relapse, crossover, and prognostic variables. RESULTS:
The crude mortality rate due to all causes of death for subjects with
bulimia nervosa in these studies was 0.3% (seven deaths among 2,194
subjects); however, ascertainment rates and follow-up periods were small
and likely to produce underestimation. Five to 10 years following
presentation, approximately 50% of women initially diagnosed with bulimia
nervosa had fully recovered from their disorder, while nearly 20% continued
to meet full criteria for bulimia nervosa. Approximately 30% of women
experienced relapse into bulimic symptoms, and risk of relapse appeared to
decline 4 years after presentation. Few prognostic factors have been
consistently identified, but personality traits, such as impulsivity, may
contribute to poorer outcome. In addition, participation in a treatment
outcome study was associated with improved outcome for follow-up periods
less than 5 years. CONCLUSIONS: Treatment interventions may speed eventual
recovery but do not appear to alter outcome more than 5 years following
presentation. Long-term outcome for women diagnosed with bulimia nervosa
remains unclear. However, this disorder may be chronic for at least a
subset of women.
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