The Childhood and Youth Psychiatry and Psychology Department at Hospital Clínic carried out a study to assess the results of anorexia treatment 20 years after onset, in patients who developed the disease during adolescence. The study aimed to assess the percentage of patients who had recovered from anorexia nervosa, and whether they currently presented an eating disorder, or another type of psychiatric disorder. They also tried to find out which factors contributed to a better prognosis.
The patients examined were exclusively women, as the prevalence of anorexia nervosa is much higher in women than men. 61% of the patients treated between 1987 and 1993 (and who could be located) were willing to participate in the study, giving a total of 62 patients. Of the original group, one had died due to malnutrition, and another two could not participate in the study due to serious illness.
The average age of onset of anorexia was 13 years, and the period of time between the onset of the disease and the start of treatment was between one month and three years. The majority of patients presented a serious case of anorexia nervosa, with average weight loss of 12kg. 66% required at least one hospital admission during treatment. 32% had made at least one suicide attempt, and 68% had received psychopharmacological treatment. Half of them also presented one or two psychiatric disorders in addition to anorexia at the time of initial evaluation.
The average duration of treatment was two and a half years. Half of patients were discharged due to having made a full recovery, 34% were admitted to an adult unit and 18% abandoned treatment.
Patients’ development after 20 years was as follows: 26% of patients evaluated continued to present an eating disorder, in particular anorexia and bulimia nervosa. 8% had partially recovered, as they still feared weight gain or had a distorted body image. Finally, 66% had fully recovered from anorexia nervosa. Of the fully recovered patients, 3 out of 4 did not present any other psychiatric disorder. Meanwhile, the majority of the group who did not recover presented one or more psychiatric disorders.
The conclusion of the study, after comparing the results with a control group of women without anorexia, and after conducting several statistical analyses, was that the duration of the disorder before receiving treatment has a great impact on patients’ recovery. In other words, the sooner treatment is initiated, the greater the probability of recovery.
This study, which only includes patients whose anorexia nervosa began in adolescence, found that mortality rates were lower compared to other studies that also included patients who developed the disease in adulthood. In this case, only 2% of patients died as a result of the disease, while in studies that included adult women, rates were between 15 and 18%.
Anorexia nervosa is a serious mental illness, with a high rate of mortality, and tends to be associated with other mental and physical illnesses. Few studies have explored the result of treatment of anorexia nervosa in the long-term, in other words, more than 15 years after treatment is initiated. Furthermore, the few studies that do exist have obtained mixed results.
This study shows that the age of onset of the disorder is a decisive factor in recovery, and shows that adolescent patients tend to fare better. One possible explanation is that adolescents come to treatment due to their parents, and not on their own initiative. This means that they have the opportunity to receive the psychological, psychiatric and nutritional care necessary to recover from anorexia nervosa – care that they perhaps would not have sought out in adulthood, reducing the chances of a full recovery.
Author: Inés Hilker, Childhood and Youth Psychiatry and Psychology Department at Hospital Clínic de Barcelona
