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Pamela K. Keel, PhD; James E. Mitchell, MD; Kathryn B. Miller, MA; Traci L. Davis; Scott J. Crow, MD

Arch Gen Psychiatry. 1999;56:63-69.

Background  Since bulimia nervosa's introduction to the psychiatric nomenclature in 1979, data concerning long-term outcome have been largely unavailable.

Methods  Women with the diagnosis of bulimia nervosa between 1981 and 1987 who participated in 1 of 2 studies were located and invited to participate in follow-up assessments.

Results  More than 80% of the women from these studies participated in follow-up assessments and the results represent findings for 173 women. More than 10 years following presentation (mean ±SD length of follow-up, 11.5±1.9 years), 11% of this sample met full criteria for bulimia nervosa, and 0.6% met full criteria for anorexia nervosa. An additional 18.5% met criteria for eating disorder not otherwise specified, and 69.9% of this sample were either in full or in partial remission. For predictive factors, only the duration of the disorder at presentation and history of substance use problems demonstrated prognostic significance. Baseline treatment condition was not associated with remission of disordered eating symptoms by the follow-up assessment.

Conclusions  The findings suggest that the number of women who continue to meet full criteria for bulimia nervosa declines as the duration of follow-up increases; approximately 30%, however, continued to engage in recurrent binge eating or purging behaviors (incidence rate, 0.026 cases per person-years). A history of substance use problems and a longer duration of the disorder at presentation predicted worse outcome.

From the Department of Psychology, Harvard University, Cambridge, Mass (Dr Keel); University of North Dakota and Neuropsychiatric Research Institute, Fargo (Dr Mitchell); and the Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis (Mss Miller and Davis and Dr Crow).

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