Previous research has indicated a high rate of mortality and illness for patients with anorexia nervosa. A recent Swedish study, however, found positive long-term outcomes for adolescent anorexics.
Dr. Frank Lindblad and colleagues at the Karolinska Institute, Stockholm, Sweden examined data on all 529,369 Swedish females born between 1968 and 1977, including 748 ex-hospital inpatients with anorexia.
When the patients were followed up between nine and 14 years after admission, their mortality rate was 1.2 percent, 40 percent lower than that for women in the general population.
Of the ex-patients, 8.7 percent had “persistent psychiatric health problems demanding hospital care,” and 21.4 percent were “dependent on society for their main income.” These rates were 5.8 and 2.6 times higher, respectively, than those in the general population.
In the November issue of the British Journal of Psychiatry, the researchers reported that a more than 180-day hospital stay and psychiatric conditions besides anorexia were linked to a greater risk of persistent psychiatric problems and the need for state support.
This study raises hopes for the future of hospitalized anorexics, as the death rate was exceptionally low. But further long-term studies including non-hospitalized patients are needed to confirm the results.
Italian researchers recently analyzed the latest scientific literature to estimate the long-term anorexia mortality rate. The team, from the University of Naples Federico II, brought together the findings from ten studies published since 1988, totalling 2,240 patients.
Of these patients, 123 died, producing an overall mortality rate of 5.25 percent. The most common causes of death were complications such as cardiac arrest and electrolyte imbalance. The death rate directly attributable to anorexia was 3.07 percent, other causes 0.98 percent, and suicide 1.20 percent. After correcting for unrelated deaths, mortality rate was 4.27 percent.
In their own eight-year study of 147 female anorexics, the Italian researchers found a lower mortality rate of 2.72 percent, or 1.82 percent after removing unrelated deaths. Writing in the European Journal of Clinical Nutrition, they interpreted their findings “as a consequence of an integrated, clinical-nutritional and psychiatric approach,” but added that, the mortality rate is drastically high for young women in industrialized countries.
Between 0.5 and 3.7 percent of women will suffer from anorexia nervosa at some point in their lifetime according to the U.S. Eating Disorders Coalition. The most commonly used criteria for diagnosing anorexia in the U.S. are:
- Refusal to maintain a normal body weight for age and height, with a weight of less than 85 percent of that expected
- Intense fear of gaining weight
- Disturbance in the way that body weight or shape is viewed, with excess concern for body weight, or denial of the seriousness of current body weight
- Amenorrhea (absence of periods)
The American Psychiatric Association makes a distinction between two forms of anorexia.
The binge-eating or purging type engages in self-induced vomiting, overexercise or the misuse of laxatives, diuretics, or enemas. The restricting type does not regularly engage in binge-eating or purging behavior.
The consequences of anorexia can include heart muscle shrinkage, slow and irregular heartbeat and heart failure, kidney stones and kidney failure, excessive body hair on the face, arms and legs, muscle wasting and osteoporosis. But in recent times medical treatment of starvation has improved, and certain treatments have been successful in helping patients recover. The Eating Disorders Coalition states that day hospital treatment can work, and that antidepressants may help.
Hjern, A., Lindberg, L. and Lindblad, F. Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9- to 14-year follow-up. British Journal of Psychiatry, Vol. 189, November 2006, pp. 428-32.
Signorini, A. et al. Long-term mortality in anorexia nervosa: a report after an 8-year follow-up and a review of the most recent literature. European Journal of Clinical Nutrition, published online 2 August, 2006.
Eating Disorders Coalition
Russell J. Management of anorexia nervosa revisited. British Medical Journal, Vol. 328, 1 May 2004, pp. 1076.