Women who have been treated for anorexia nervosa remain at significant risk for relapse up to two years after their weight has been restored and they have been discharged from treatment programs, according to a study from the University of Toronto and Toronto General Hospital. “My clinical experience indicated that a significant number of individuals who responded well to intensive treatment for anorexia nervosa ended up relapsing within a year or so of discharge. I thought it was important to examine the incidence of relapse to see if we could identify factors that differentiate people who recover from those who relapse,” explained Jacqueline C. Carter, PhD, an Assistant Professor in the Department of Psychiatry, University of Toronto, and a Staff Psychologist in Toronto General Hospital’s Inpatient Eating Disorders Program. She led the follow-up study of 51 female patients, the results of which were published in the May Psychological Medicine.

The participants (mean age, 26.9) were consecutive first-admission patients who met DSM-IV criteria for anorexia and were weight restored following inpatient treatment (average duration, 14 weeks). Participants were followed up a median of 15 months postdischarge from inpatient treatment. Within two years of leaving the hospital, 35% of the women had relapsed into anorexia—defined as a drop in body mass index below 17.5 for three consecutive months. The mean time before relapse was 18 months, in contrast to earlier research that had suggested that those who relapsed would do so within a year of completing treatment.

“Our most important finding is that in a significant proportion of cases, the illness is chronic and debilitating,” said Dr. Carter. “We’re pretty good at helping people to become weight restored in the hospital, but really the challenge now is to figure out how to improve relapse prevention treatments and improve long-term outcomes for people with anorexia nervosa.”

Excessive exercise immediately following discharge from the hospital was the strongest predictor of relapse, but previous suicide attempts, obsessive-compulsive symptoms, and an overconcern about weight and shape were also important factors.

With regard to the timing of relapse, the investigators noted, the highest risk period for relapse appeared to be from six to 17 months after discharge and the mean survival time was 18 months. This indicates that some participants relapsed after remaining well for the first year. The team also noted that some variables—such as anorexia subtype, marital or employment status, duration of illness, living situation, age at onset of the eating disorder, duration of illness, age and body mass index at admission—showed no significant effect on survival probability.

“Treatment of anorexia nervosa is a long-term process. There are no quick-fix solutions. It is important to continue to provide support and counseling for at least a year after people are discharged from intensive hospital treatment programs,” Dr. Carter noted.

—Heidi W. Moore

Suggested Reading
Carter JC, Blackmore E, Sutandar-Pinnock K, Woodside DB. Relapse in anorexia nervosa: a survival analysis. Psych Med. 2004;34:1-9.

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