Anorexia Nervosa Often Chronic

Women who have been treated for anorexia nervosa remain at significant risk for relapse up to two years after their weight has been restored and they have been discharged from hospital, says a study from the University of Toronto and Toronto General Hospital.

Dr. Jacqueline Carter, a psychiatry professor at U of T and a staff psychologist in the hospital’s eating disorders program, led the follow-up study of 51 patients, published in the May issue of Psychological Medicine.

It found that within two years of leaving the hospital, 35 per cent of the women had relapsed into anorexia – defined as a drop in body mass index (a measure of body fat based on height and weight) below 17.5 for three consecutive months. The mean time before relapse was 18 months, in contrast to earlier research which had suggested that those who relapsed would do so within a year of finishing treatment.

“Our most important finding is that in a significant proportion of cases, the illness is chronic and debilitating,” says Carter. “We’re pretty good at helping people to become weight-restored in the hospital, but really the challenge now is to figure out how to improve relapse prevention treatments and improve long-term outcomes for people with anorexia nervosa.”

Excessive exercise immediately following discharge from the hospital was the strongest predictor of relapse, but previous suicide attempts, obsessive-compulsive symptoms and an overconcern about weight and shape were also important factors. This knowledge about predictors, and continuing research, will be used to develop treatments to help prevent relapse for a disease that affects one to two per cent of adult women sometime in their lifetimes, says Carter.

The study was funded by the Canadian Institutes of Health Research