Anorexia nervosa and bulimic disorder are chronic eating disorders that are increasingly prevalent. Epidemiology studies of anorexia nervosa in a general population indicate that the mortality rate in patients with anorexia nervosa is 5%, and studies have demonstrated persistent psychological morbidity in one-third to one-half of anorectic patients at two year follow-up. Although literature on the course of bulimic disorder is limited, evidence shows that it, like anorexia nervosa, is associated with substantial dysfunction and social maladjustment. A naturalistic longitudinal study is proposed to investigate the course and outcome of anorexia nervosa and bulimic disorder. The study will be conducted in the Eating Disorders Unit (EDU) of the Massachusetts General Hospital. The EDU is a multidisciplinary treatment and research faiclity which evaluates 250 anorectic or bulimic patients a year nd receives 5 to 10 new referrals weekly. This study is designed to elicite information on the patterns of clinical course, including recovery from index episode, chronicity, periods of well-being, relapse, and recurrence. The nosological distinction between anorexia nervosa and bulimic disorder will be validated to determine if further classificaiton is necessary.
Other aims are to identify the clinical predictors of course and outcome within and across the syndromes, and to assess the predictive value of both the current illness and the past history of eating disorders and affective disorders. The sample will be divided into three group with the following distribution: 50 subjects with anorexia nervosa, 125 subjects with bulimic disorder, and 50 subjects with co-existent anorexia nervosa and bulimic disorder. Structured diagnostic interviews and self-report questionnaires will be administered at entry and at six month intervals for a 30 to 54 month period. The proposes design has sufficient duration of follow-up, proper frequency and intensity of assessments and advanced statistical techniques to insure consistency of longitudinal and life-time diagnosis.
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