Elke D. Eckert

OBJECTIVE: Anorexia nervosa has been consistently associated with increased mortality, but whether this is true for other types of eating disorders is unclear. The goal of this study was to determine whether anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified are associated with increased all-cause mortality or suicide mortality. METHOD: Using computerized record linkage to the National Death Index, the authors conducted a longitudinal assessment of mortality over 8 to 25 years in 1,885 individuals with anorexia nervosa (N=177), bulimia nervosa (N=906), or eating disorder not otherwise specified (N=802) who presented for treatment at a specialized eating disorders clinic in an academic medical center. RESULTS: Crude mortality rates were 4.0% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorder not otherwise specified. All-cause standardized mortality ratios were significantly elevated for bulimia nervosa and eating disorder not otherwise specified; suicide standardized mortality ratios were elevated for bulimia nervosa and eating disorder not otherwise specified. CONCLUSIONS: Individuals with eating disorder not otherwise specified, which is sometimes viewed as a "less severe" eating disorder, had elevated mortality risks, similar to those found in anorexia nervosa. This study also demonstrated an increased risk of suicide across eating disorder diagnoses.

A series of 34 patients with Bulimia is presented. The patients were young females who usually experienced the onset of eating problems by early adulthood. Most had binge eating episodes on a daily basis, frequently followed by vomiting. Although the majority had never had active anorexia nervosa, all of these patients demonstrated characteristics often described in anorectic patients including a preoccupation with food and an exaggerated fear of becoming obese. Many appeared to be clinically depressed. The association between stealing behavior, chemical abuse and bulimia suggests problems with impulse control in this population.

The authors present data on 275 patients who met DSM-III criteria for bulimia. The mean age of the patients was 24.8 years, and the average duration of illness was approximately 7 years. These patients reported a variety of abnormal eating-related behaviors: binge eating (100%), self-induced vomiting (88.1%), laxative abuse (60.6%), diuretic abuse (33.1%), and chewing and spitting out food (64.5%). Over one-third reported a history of problems with alcohol or other drugs and most indicated substantial social impairment.

Synopsis The clinical course and outcome of anorexia nervosa are presented in a 10-year followup study of 76 severely ill females with anorexia nervosa who met specific diagnostic criteria and had participated in a well-documented hospital treatment study. Information was obtained on 100% of the subjects. A comprehensive assessment was made in 93% of the living subjects in specific categories of weight, eating and weight control behaviours, menstrual function, anorexic attitudes, and psychological, sexual, social and vocational adjustment. Five subjects had died, which gives a crude mortality rate of 6·6%. Standardized mortality rates demonstrated an almost 13-fold increase in mortality in the anorexia nervosa subjects. Only eighteen (23·7%) were fully recovered. Sixty-four per cent developed binge-eating at some time during their illness, 57% at least weekly. Twenty-nine (41%) were still bulimic at follow-up. The high frequency and chronicity of the bulimic symptoms plus the high rate of weight relapse (42% during the first year after hospital treatment) suggest that intensive intervention is needed to help anorexics restore and maintain their weight within a normal range and to decrease abnormal eating and weight control behaviours.