Given time, most women with anorexia or bulimia will recover

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A study from Massachusetts General Hospital (MGH) investigators finds that, contrary to what is often believed, around two thirds of women with anorexia nervosa or bulimia nervosa will eventually recover from their eating disorders. Recovery from bulimia tends to happen more quickly, but while less than a third of participants with anorexia were determined to have recovered an average of nine years after entering the study, almost 63 percent were recovered an average of 22 years later.

“These findings challenge the notion that eating disorders are a life sentence,” says Kamryn Eddy, PhD, of the MGH Eating Disorders Clinical and Research Program, corresponding author of a report published online in the Journal of Clinical Psychiatry.

“While the road to recovery is often long and winding, most people will ultimately get better. I’ve had patients say to me, ‘Food and my body are only parts of who I am now; neither defines me anymore,’ or ‘My life became more full, and there just wasn’t room on my plate anymore for the eating disorder.’ ”

While previous studies have suggested that fewer than half of adults with eating disorders will recover, the authors note that few studies have analyzed outcomes from as long as 20 years or more. Participants entered this observational study at MGH between 1987 and 1991, and those in this study’s analysis were followed for 20 years or more. Of 246 original participants, 136 met criteria for anorexia and 110 for bulimia at the outset of the study. Over the first decade, participants were interviewed every 6 to 12 months. For the second phase of the study, participants were contacted for follow-up between 20 and 25 years after study outset.

The evaluation at the end of the first decade – reflecting an average of about 9 years for each participant – revealed that 31.4 percent of those with anorexia had recovered, while 68.2 percent of those with bulimia had recovered. The final evaluation, which included 176 participants contacted an average of 22 years after joining the study, found that 62.8 percent of those with anorexia and 68.2 percent of those with bulimia had recovered. In both groups, some of those determined to have recovered at the first evaluation had relapsed by the second, but more of those not recovered at the first evaluation had recovered by the second evaluation.

“We set the bar for recovery as being a year without symptoms, and we found that most of those who do recover will stay recovered over time,” says Eddy. “Still a small subset of patients in both groups did relapse, and we need to work harder to identify predictors of relapse to promote enduring recovery.”

With an overall of goal determining the brain, hormonal and behavioral mechanisms involved in persistent illness and recovery, Eddy and her colleagues will be studying over several years the neurobiological basis of eating disorders in recently diagnosed adolescents. What they learn should offer important clues about new treatment targets for these prevalent, potentially life-threatening illnesses.

“With my patients, I try to emphasize how serious these illnesses are to help mobilize them for treatment,” she says. “Our current data argue both that early symptom change increases the chance for long-term recovery, which can motivate new patients to engage in treatment, and that improvements continue even over the long term, which can encourage patients who have been ill longer to keep working towards recovery.” Eddy is an associate professor of Psychology in the Harvard Medical School Department of Psychiatry.

The co-authors of the Journal of Clinical Psychiatry paper are Nassim Tabri, PhD, Jennifer J. Thomas, PhD, Helen B. Murray, Aparna Keshaviah, MS, Elizabeth Hastings, Katherine Edkins, Meera Krishna and Debra L. Franko.

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