While numerous studies have looked at anorexia nervosa (causes, the effectiveness of treatments, the prevalence in certain populations, etc.), very few, if any, have examined the lifetime impact of anorexia nervosa (AN). A recent study published by Cambridge University Press sought to change that by following a group of individuals with adolescent-onset anorexia nervosa over a period of 30 years. The results of the study provide a unique glimpse into the long-term outcomes of anorexia nervosa.
Study of Anorexia Impact Over a Lifetime
The study was initiated in 1985 by Maria Rastam and Christopher Gillberg. Dubbed the “Gothenburg anorexia nervosa study,” the researchers screened 4291 individuals who were all born in 1970 and were attending eighth grade in Gothenburg, Sweden, in 1985 .
Fifty-one individuals with anorexia nervosa were identified, all of whom 1) met the current DSM-III-R and DSM-IV criteria for AN, and 2) were diagnosed with AN by a physician specializing in psychiatry. The AN group was comprised of 48 girls and 3 boys, with the average age at onset of anorexia nervosa being 14.3 years .
In addition to following the group of individuals with anorexia nervosa, the researchers also recruited a school- and gender-matched comparison group of 51 participants who had no history of eating disorders. The comparison group participants consisted of 48 girls and 3 boys, just like the AN group.
The researchers followed up with both the AN group and control group individuals at the average ages of 16, 21, 24, 32, and 44 to assess health-related quality of life, psychiatric disorders, and general outcome.
Results of the Long-Term Study
At the 18-year follow-up, the researchers found that only 12 percent of participants in the AN group had an eating disorder . While they expected to find even lower rates of eating disorders at the 30-year follow-up, they instead discovered a slight increase in eating disorders incidence.
At the 30-year mark, one-third of the Anorexia group met the criteria for eating disorder in the past 12 years, and one in five had experienced eating disorder relapse between the 18-year and 30-year study . These findings suggest that relapses occur even decades after recovery, indicating that clinicians may need to provide better long-term care to some of their anorexia nervosa patients.
Though there was a slight increase in relapse rates and eating disorder incidence at the 30-year follow-up study, the researchers happily discovered that there was no mortality among the AN group and that 64 percent of the group were considered fully recovered . When determining if individuals were fully recovered, the researchers required individuals to be free of all anorexia nervosa and bulimia nervosa symptoms for a minimum of 8 consecutive weeks.
The individuals also had to be “free from all criteria of binge-eating disorder,” and exhibit “the sustained absence of weight deviation, compensatory behaviors, and deviant attitudes regarding weight and shape, including weight phobia,” for at least six months .
While 77 percent of the anorexia nervosa group had received some form of treatment over the course of 30 years (with only 23 percent reporting never receiving treatment), only two individuals in the group were currently in treatment for an eating disorder at the end of the study. According to the researcher’s analysis, there was, surprisingly, no long-term difference between those who had never received treatment and those who had received some form of treatment.
However, they did discover that there was an overall better outcome among those who had developed anorexia at a later age in adolescence versus those who developed anorexia during childhood or early adolescence. In light of this finding, the researchers advise school doctors and nurses, pediatricians, and child psychiatrists to be more vigilant in detecting and treating early-onset anorexia in children and young adolescents.
Finally, the study also revealed that psychiatric morbidity was significantly higher among the anorexia nervosa group than the control group. While anxiety disorders were the most common psychiatric disorder found in both groups, a much higher number of individuals in the AN group had an anxiety disorder compared to those in the control group.
This 30-year study of anorexia impact over a lifetime shows that the majority of people with AN have a positive outcome in the long term, with many fully recovering. However, one in five still had an eating disorder, and many suffered from other psychiatric disorders like an anxiety disorder.
References: Dobrescu, S. R., Dinkler, L., Gillberg, C., Råstam, M., Gillberg, C., & Wentz, E. (2019, May 22). Anorexia nervosa: 30-year outcome. Cambridge Core. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/anorexia-nervosa-30year-outcome/1938E2FAFC6518654451ACD7BE0428E2/core-reader.  ibid.  ibid.  ibid.  ibid.  ibid.
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published November 23, 2020, on EatingDisorderHope.com
Reviewed & Approved on November 23, 2020, by Jacquelyn Ekern MS, LPC