Outcomes of Anorexia Nervosa

Information based on outcome studies of anorexia nervosa (AN) plays an important role for patients, next of kin, clinicians, and researchers. Outcome studies can usually provide data on recovery, chronicity, and mortality. During the past 20–30 years, specialized eating disorder (ED) units have been developed in many countries, which increases the expectation of improved treatment outcomes. The aim of this chapter was to describe AN outcome studies during the last two decades and compare the results with data from overviews of studies from the second half of the twentieth century. Outcome studies that only included individuals with adolescent-onset AN indicated that more than 80% no longer fulfilled an ED diagnosis. Mortality rates varied between 0% and 5%. Follow-up studies of childhood-onset AN and studies spanning more than 20 years were rare. A 30-year follow-up was recently completed in a Swedish prospective community-based case-control study of adolescent-onset AN. The outcome was favorable regarding many aspects: there were no deaths and 64% were fully recovered; however, 19% still had an ED and 33% reported having had an ED during the last 12 years. Three studies reported reduced fertility, but two of the studies included only inpatients, which may have biased the results. Two Scandinavian nationwide studies indicated a positive trend regarding premature mortality; the more recent the data, the lower the mortality. In conclusion, AN outcomes in the twenty-first century still imply challenges regarding chronicity, infertility, and mortality. However, there are indications that the outcome of AN is improving, including mortality rates.