Abstract
Objective:The aim of the study was the descriptive analysis of the two-year course of bulimia nervosa (BN; N=32) and anorexia nervosa (AN; N=23) in adolescents who received intensive inpatient behavioral treatment. Methods:Assessments were made on the basis of expert ratings (Structured Interview for Anorexia and Bulimia Nervosa [SIAB-P], Psychiatric Status Rating Scale for Bulimia/Anorexia Nervosa [PSRSB], Morgan-Russell Outcome Assessment Scale and Munich Diagnostic Check List [MDCL]) and self-ratings (SIAB-S [self-rating], Anorexia Nervosa Inventory for self-rating [ANIS], Eating Disorder Inventory [EDI], SCL-90, and the Parental Bonding Instrument [FBI]). Results:Females with BN maintained their low normal weight. Females with AN maintained some of their weight increase induced during inpatient therapy. The BN group had a higher lifetime comorbidity with affective disorders while AN had a higher comorbidity with substance use disorders. The status at two-year follow-up based on the PSRSB expert rating was as follows: 50% of the BN patients also fulfilled the Diagnostic Statistical Manual, third edition, revised (DSM-III-R) criteria for BN at follow-up while only 3.1% of them fulfilled criteria for AN and 46.9% were below threshold of a diagnosis for AN or BN according to DSM-III-R; of those former BN patients below diagnostic threshold for an eating disorder at follow-up, 26.7% showed “marked symptoms,” 26.7% were classified as “partial remission,” 13.3% had “residual symptoms,” and 33.3% had normalized to their “usual self.” From the patients with AN on admission 30.4% were classified as AN according to DSM-III-R at the two-year follow-up and 21.7% as BN. The remaining 47.8% were below diagnostic threshold of DSM-III-R AN or BN (of those 45.5% with “marked symptoms,” 27.3% with “partial remission,” 9.1% with “residual symptoms,” and 18.2% had normalized to “usual self). Conclusions: At the two-year follow-up almost half of the patients with AN and almost half of those with BN had no major eating disorder (AN, BN). A considerable number of the AN patients developed BN in the two-year interval.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
American Psychiatric Association. (1987).Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) American Psychiatric Association, Washington, DC.
American Psychiatric Association (APA) (1994).Diagnostic and Statistical Manual of Mental Disorders (4th ed.) American Psychiatric Association, Washington, DC.
Bryant-Waugh, R., Knibbs, J., Fosson, A., Kaminski, Z., and Lask, B. (1988). Long-term follow-up of patients with early onset anorexia nervosa.Arch. Dis. Child. 63: 5–9.
Derogatis, L.R., Liberman, R.S., Rickels, K., Uhlenhutz, E.H., and Con, L. (1974). The Hopkins Symptom Checklist (HSCL). A self-report-symptom inventory.Behav. Sci. 19: 1–4.
Deter, H. C., Herzog, W., and Petzold, E. (1992). The Heidelberg-Mannheim study: Long-term follow-up of anorexia n. patients at the University Medical Center-background and preliminary results. In Herzog, W., Deter, H. C., and Vandereycken, W. (eds.),The Course of Eating Disorders. Long-Term Follow-Up Studies of Anorexia and Bulimia Nervosa. Springer, Berlin.
Fichter, M. M. (Ed.) (1990).Verlauf psychischer Erkrankungen in der Bevölkerung. Springer, Heidelberg-New York.
Fichter, M. M., and Keeser, W. (1980).Das Anorexia Inventar zur Selbstbeurteilung (ANIS).Arch. Psychiatr. Nervenkr. 228: 67–89.
Fichter, M. M., Elton, M., Engel, K. et al. (1990). The structured interview for anorexia and bulimia nervosa (SLAB): Development and characteristics of a (semi-)standardized instrument. In Fichter, M. M. (ed.),Bulimia Nervosa: Basic Research, Diagnosis and Therapy. Wiley, Chichester.
Fichter, M. M., Quadflieg, N., and Rief, W. (1992). The German longitudinal bulimia nervosa study I. In Herzog, W., Deter, H. C., and Vandereycken, W. (eds.),The Course of Eating Disorders. Long-Term follow-up studies of anorexia and bulimia nervosa. Springer, Berlin.
Garner, D. M., Olmstead, M. P., and Polivy, J. (1983). Development and validation of a multi-dimensional Eating Disorder Inventory of anorexia nervosa and bulimia.Int. J. Eat. Disord. 2: 14–34.
Greenfeld, D. G., Anyan, W. R., Hobart, M. Quinlan, D. M., and Plantes, M. (1991). Insight into illness and outcome in anorexia nervosa.Int. J. Eat. Disord. 10: 101–109.
Halmi, K. A. (1988). The course and outcome of eating disorders. Paper presented at the 3rd International Conference on Eating Disorders, New York.
Halmi, K. A. (1991, April 17–19). Course of anorexia nervosa: Ten year follow-up. Paper presented at the International Symposium of the International Society for Adolescent Psychiatry with the World Psychiatric Association (WPA)—Section on Eating Disorders, Paris.
Herzog, D. B., Keller, M. B., Lavori, Ph. W., Bradburn, I. S., and Ott, I. L. (1990). Course and outcome of bulimia nervosa. In Fichter, M. M. (Ed.),Bulimia Nervosa: Basic Research, Diagnosis and Therapy. Wiley, Chichester.
Hiller, W., Zaudig, M., and Mombour, W. (1989).Münchner Diagnosen-Checklisten für DSM-III-R. Logomed, Munich.
Hsu, L. K. G., & Sobkiewicz, T. A. (1989). Bulimia nervosa: A four-to six-year follow-up study.Psychol. Med. 19: 1035–1038.
Morgan, H. G., and Russell, G. F. M. (1975). Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa: Four-year follow-up study of 41 patients.Psychol. Med. 5: 355–371.
Parker, G. (1983).Parental Overprotection. A Risk Factor in Psychosocial Development. Grune & Stratton, New York.
Parker, G., Tulping, H., and Brown, L. B. (1979). A parental bonding instrument.Br. J. Med. Psychol. 52: 1–10.
Ratnasuriya, R. H., Eisler, I., Szmukler, G. I., and Russell, G. F. M. (1991). Anorexia nervosa: Outcome and prognostic factors after 20 years.Br. J. Psychiat. 158: 495–502.
Rosenvinge, J. H., and Mouland, S. O. (1990). Outcome and prognosis of anorexia nervosa. A retrospective study of 41 subjects.Br. J. Psychiat. 156, 92–97.
Santonastaso, P., Pantano, M., Panarotto, L., and Silvestri, A. (1991). A follow-up study on anorexia nervosa: Clinical features and diagnostic outcome.Eur. Psychiat. 6: 177–185.
Steinhausen, H. C., and Glanville, K. (1993). Follow-up studies of anorexia nervosa: A review of research findings.Psychol. Med. 13: 239–249.
Steinhausen, H. C., & Seidel, R. (1993). Outcome in adolescent eating disorders.Int. J. Eat. Disord. 14: 487–496.
Steinhausen, H. C., Rauss-Mason, C., and Seidel, R. (1991). Follow-up studies of anorexia nervosa: A review of four decades of outcome research.Psychol. Med. 21: 447–454.
Theander, S. (1985). Outcome and prognosis in anorexia nervosa and bulimia: Some results of previous investigations, compared with those of a Swedish long-term study.J. Psychiat. Res. 19: 493–508.
Tolstrup, K., Brinch, M., Isagen, T. et al. (1985). Long-term outcome of 151 cases of anorexia nervosa.Acta Psychol. Scand. 71: 380–387.
Willi, J., Limacher, B., Helbling, P., and Nussbaum, P. (1989). 10-Jahres-Katamnese der 1973–1975 im Kanton Zürich erstmals hospitalisierten Anorexie-Fälle.Schweizer Medizinische Wochenschrift, 119: 147–155.
von Zerssen, D. (1976).Klinische Selbstbeurteilungs-Skalen (KS) aus dem Münchner Psychiatrischen Informationssystem. Beltz, Weinheim.
Author information
Authors and Affiliations
Additional information
Supported by Grant No. FKZ 0701623-8 of the Bundesministerium für Forschung und Technologie, Germany.
Received M.D. in 1981 from the University of Heidelberg, Germany and his training in psychiatry at UCLA and at the Max Planck Institute of Psychiatry and the University of Munich, Germany. Major research interests are eating disorders, risk factors and course of mental disorders, and psychiatric epidemiology.
Received his degree in psychology (Dipl. Psych) at the University of Munich, Germany. Major research interests are eating disorders.
Rights and permissions
About this article
Cite this article
Fichter, M.M., Quadflieg, N. Course and two-year outcome in anorexic and bulimic adolescents. J Youth Adolescence 25, 545–562 (1996). https://doi.org/10.1007/BF01537548
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01537548