An estimated 30 million people in the United States suffer from eating disorders — life-threatening conditions that are notoriously difficult to treat. Earlier studies have suggested that less than half of people with anorexia or bulimia, the most common eating disorders, will recover.
Yet few of these studies have followed patients for longer than 20 years. In a recent Journal of Clinical Psychiatrystudy, researchers did just that — and reached a more hopeful conclusion:
After 22 years, nearly two-thirds of study participants recovered from anorexia or bulimia.
This suggests that even seemingly hopeless cases that don’t appear to improve after 10 years may eventually get better, given more time.
Often plagued by a distorted body image and an intense fear of gaining weight, people with anorexia essentially starve themselves, while bulimia sufferers spiral into a cycle of binge eating and vomiting, or purging. Both disorders can have serious medical consequences, including infertility and heart failure. Anorexia claims more lives than any other mental illness.
The study is very encouraging. Eating disorders are not a lifelong condition. … Most will recover.
Edward Selby, Rutgers University Department of Psychology
“What was important about this work is giving clinicians and patients some idea of what the future may hold,” especially long term, says study co-author Pamela Keel of Florida State University’s department of psychology. To that end, she and her team examined data from 246 women who had enrolled in the study between 1987 and 1991. Among them, 136 had anorexia and 110 had bulimia. During the first decade, researchers interviewed participants every six to 12 months. After that, they interviewed them one last time between 20 and 25 years after the study had begun. The women answered questions about eating disorder symptoms, other mental health issues, treatments they were undergoing, quality of life and interpersonal relationships.
Of the 246 women, 18 died by the time of the 20- to 25-year follow-up. Of the survivors, 176 participated in the 20- to 25-year follow-up interview. (The researchers used a statistical model to predict the data from those who declined to participate in that follow-up.) On average, the women participated in the final follow-up about 22 years after they had enrolled in the study.
Women with anorexia took longer to recover than those with bulimia, but both groups had around the same recovery rates after 22 years. During the first decade, 31.4 percent of women with anorexia recovered, compared to 68.2 percent of those with bulimia. In general, anorexia sufferers are often slower to recover fully, says Kamryn Eddy of Massachusetts General Hospital, who led the study. They often feel more ambivalent about recovery, which, unlike with bulimia, means gaining weight, “something you’re terrified of,” Keel says. Still, after 22 years, 62.8 percent of women with anorexia and 68.2 percent of those with bulimia had recovered.
To be sure, “both are serious psychiatric conditions,” says Edward Selby of Rutgers University’s department of psychology. “Some readers will conclude they would just go away after 22 years, but 22 years is a long time … and some people didn’t recover.” At the same time, we don’t know how engaged participants were in treatment throughout the study period, says Carrie McAdams, an assistant professor of psychiatry at UT Southwestern Medical Center. The researchers also studied a small sample of mostly white women from Massachusetts who had sought treatment, making it hard to generalize the findings. Still, Selby considers the study “methodologically rigorous” and its long-term time line “impressive.” “The study is very encouraging,” he says. “It means that eating disorders are not a lifelong condition. … Most will recover.”
In fact, women who experienced a brief window of recovery from anorexia during the first decade were more likely to fully recover by 22 years. The findings also suggest that treatment for anorexia in particular should focus more on recovery than on palliative care, which seeks to minimize symptoms so patients can enjoy life as much as possible, accepting that these symptoms will never completely disappear, McAdams explains. (The movement for palliative care has typically focused on anorexia.) But giving up hope after 10 years “may shortchange patients” who could get better, given more time, Eddy says. Indeed, about half of the women who hadn’t recovered from anorexia during the first decade had recovered by the long-term follow-up.
Next up, Eddy’s team is trying to uncover the neurobiological mechanisms of eating disorders, including those involved in recovery. Clinicians could then use these mechanisms to assess the effectiveness of different treatments and improve on them. “We need to offer novel treatments to improve recovery rates,” Eddy says. In the meantime, “patients who have been ill for a long time should maintain hope that they will get better. … Recovery is possible.”
