Factors associated with recovery from anorexia nervosa: A population-based study

Authors

  • Anna Keski-Rahkonen MD, PhD, MPH,

    Corresponding author
    1. Department of Public Health, University of Helsinki, Helsinki, Finland
    2. Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
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  • Anu Raevuori MD, PhD,

    1. Department of Public Health, University of Helsinki, Helsinki, Finland
    2. Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
    3. Institute of Clinical Medicine, Child Psychiatry, University of Turku, Turku, Finland
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  • Cynthia M. Bulik PhD,

    1. Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina
    2. Department of Nutrition, University of North Carolina at Chapel Hill, North Carolina
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  • Hans W. Hoek MD, PhD,

    1. Parnassia Psychiatric Institute, The Hague, The Netherlands
    2. Department of Psychiatry, Groningen University, Groningen, The Netherlands
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  • Aila Rissanen MD, PhD,

    1. Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
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  • Jaakko Kaprio MD, PhD

    1. Department of Public Health, University of Helsinki, Helsinki, Finland
    2. Department of Mental Health and Alcohol Research, National Public Health Institute for Health and Welfare, Helsinki, Finland
    3. Institute for Molecular Medicine FIMM, Helsinki, Helsinki, Finland
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ABSTRACT

Background

 To examine factors associated with the outcome of anorexia nervosa among women from the general population.

Method

 Women (N = 2,881) from the 1975–1979 birth cohorts of Finnish twins were screened for lifetime DSM-IV anorexia nervosa (N = 55 cases) using questionnaires and the SCID interview. Potential factors associated with the likelihood of recovery were addressed in the same assessment. Recovery was defined as restoration of weight, menstruation, and the absence of bingeing and purging for at least one year prior to assessment. Using two-tailed t tests and Pearson's chi-square tests, we contrasted recovered (N = 39) and unrecovered (N = 16) women. We then used logistic regression adjusted for duration of illness and Cox proportional hazard models to account for the variable lengths of illness on prognostic factors.

Results

 Unrecovered women were more likely to suffer from depressive symptoms prior to eating disorder onset (18.8% vs. 2.6%, p = 0.04), remain unemployed (18.8% vs. 2.6%, p = 0.04), report dissatisfaction with their current partner/spouse (p = 0.02), and report high perfectionism (p = 0.05) than were recovered women. When duration of illness was accounted for in the analyses, premorbid depression was the sole factor significantly associated with decreased likelihood of recovery (hazard ratio 0.17, 95% confidence interval: 0.03–0.89).

Discussion

Predicting the course of anorexia remains fraught with difficulty, but premorbid depressive symptoms are associated with poor outcome of anorexia nervosa in the general population. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:117–123)

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