Ellen Astrachan-Fletcher, PhD, CEDS
Franko, D. L., Tabri, N., Keshaviah, A., Murray, H. B., Herzog, D. B., Thomas, J. J., . . . Eddy, K. T. (2017). Predictors of long-term recovery in anorexia nervosa and bulimia nervosa: data from a 22-year longitudinal study. Journal of Psychiatric Research, 96, 183-188.
https://doi.org/10.1016/j.jpsychires.2017.10.008
Recovery from eating disorders is possible but predictors of long term recovery have not been well understood. If we could more clearly understand these predictors, important components of treatment might be developed to address issues to foster greater numbers of those in long term recovery.
Participants in the 22-year long longitudinal study were recruited from 1987-1991 from outpatient eating disorders services in the Boston area. Of the 228 surviving participants, 176 (100 dx with AN and 76 dx with Bulimia) were re-interviewed 20-25 years after the initial recruitment. The Longitudinal Interval Follow-up Evaluation was used to assess ED recovery. The strongest predictor of having a diagnosis of AN restricting type at the 22 year follow up was having a comorbid diagnosis of major depression at initial assessment. The second notably significant result of this longitudinal study is that having a higher BMI at initial interview predicted lower chances of being diagnosed with AN binge-purge type relative to being recovered, 22 years later. Finally, the results of this study showed that the only predictor that increased the chances of being diagnosed with Bulimia at the 22-year assessment was more weeks of active diagnosable bulimic symptoms during the study.
This information from a 22-year longitudinal study can be used to potentially help us focus treatment to address the factors that were found to be predictive of long term recovery. First, understanding that co morbid major depression can make it much more difficult to benefit from treatment and recover from anorexia, can help us to focus on developing treatments that simultaneously address the depression and the anorexic symptoms, such as Radically Open DBT which is a transdiagnostic treatment that addresses issues like perfectionism, inflexibility, and closed mindedness that is common in depression as well as in anorexia. In addition, the results regarding the higher BMI highlight that clinicians might need to encourage higher BMI’s in moving towards long term recovery. The authors do note a number of limitations such as lack of information about anxiety disorders and other psychiatric and medical comorbidities that require us to view the results as being tentative.