Outcome in bulimia nervosa

Am J Psychiatry. 1997 Mar;154(3):313-21. doi: 10.1176/ajp.154.3.313.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Age of Onset
  • Anorexia Nervosa / diagnosis
  • Anorexia Nervosa / epidemiology
  • Anorexia Nervosa / mortality
  • Bulimia / diagnosis*
  • Bulimia / epidemiology
  • Bulimia / mortality
  • Cause of Death
  • Comorbidity
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Outcome Assessment, Health Care
  • Prognosis
  • Recurrence
  • Severity of Illness Index
  • Treatment Outcome