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Predictors of Treatment Outcome for Anorexia Nervosa
By Jeanne Rust, Phd

Predictors of poor outcome for anorexia nervosa include longer duration of illness and the presence of vomiting. In more recent studies, researchers found that eating disorder duration did not predict outcome. They also found that the duration of the illness was not related to treatment outcome. However, others found that the outcome of treatment could be determined by the duration of the disorder in anorexia nervosa. Many of these studies, conducted by well-known researchers, are contradictory. In my opinion I do not think that researchers have found the methods with which to predict treatment outcome with any certainty. They are using the obvious etiological factors but there are many things still undiscovered about thesedisorders.

The literature stated that age of onset carried prognostic significance. Several other studies found that early onset of illness is a predictor of positive outcome while other studies have not found this to be true. Researchers found that anorexic patients who purged and had additional social disturbances had a significantly lower chance of recovering. They reported that anorexics who were also bulimic and who met full criteria for anorexia nervosa upon admission had a more severe outcome than those who did not meet full criteria.

Certain laboratory tests have been shown to be excellent predictors of outcome in anorexia nervosa. Researchers found that restrictor-type anorexia and low serum creatinine levels were predictors of earlier recovery. They reported that patients with high creatinine levels did not respond well in treatment. Serum creatinine levels revealed purging behavior in patients who tried to conceal the fact they were purging.

Researchers reported that patients with psychiatric problems and severe core eating disorder psychopathology would do poorly with brief, low-intensity treatment. Others hypothesized that comorbidity would predict a poorer outcome in eating disorders. They also found that anorexic patients with personality disorders had significantly worse outcomes at 1-year follow-up than those patients without personality disorders. They found in their study that percent of ideal body weight type of eating disorders had the strongest predictive value in regards to outcome. The researchers reported that each 10 percent change in percent of ideal body weight corresponded to an 18 percent increase in eating disorder severity: the lower a subjects weight, the less likely she was to recover within the follow-up period.

Researchers found that fewer patients recovered from anorexia nervosa than from bulimia nervosa or a combination of anorexia nervosa and bulimia nervosa. The type of eating disorder was a significant predictor of outcome with anorexics being the least likely to recover. At 1-year follow-up in one particular study, only 10 percent of their subjects had obtained full recovery .

Researchers found that patients with a history of anorexia were more likely to do well in treatment. Their findings do not support those reports that show that a previous history of anorexia is a non-significant predictor of outcome. Others found no differences in outcome in those who had a history of anorexia nervosa and those who had no history of the disorder. They reported that a diagnosis of anorexia nervosa at admission was not associated with outcome status. However, another researcher found that a history of anorexia was a pretreatment indicator of poorer prognosis.

As you can see, outcome studies are extremely difficult to conduct. There are so few comparisons in the literature with many of them contradicting each other.

Jeanne Rust, PhD is the CEO and Founder of Mirasol, a treatment program for women and teens with anorexia, bulimia, obesity, and binge eating disorder. Her treatment philosophy is integrative combining the best of the medical model of treatment with the most effective alternative ones.

Learn more about eating disorders at http://www.mirasol.net

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