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Loulie Gillen


Bulimia nervosa is a disease that predominately affects young females. Since the origination of its medical definition various studies have been implemented to examine the cause of onset and effects of bulimia nervosa. There have also been studies surveying the long-term outcome of bulimia nervosa. These long-term studies have analyzed such relationships as age, employment status, social status and marital status and bulimia nervosa. By using three scientific studies of long-term outcome of bulimia nervosa, this paper will try and evaluate the research obtained and offer critical suggestions to help further studies on this topic.

The first study, "Bulimia nervosa: a 5-year follow-up study," uses a follow up sample of thirty-six patients, which consisted of 72%of the original sample. The original sample was comprised of fifty patients who were consistently referred to the Academic Department of Psychiatry at the Royal Free Hospital. Of the fifty patients, one was male. All of the patients were diagnosed with bulimia nervosa during their initial visit and met DSM-III criteria for bulimia. The ages of the sample ranged from 14 to 40 years with a mean age of 23.5. Also the onset of the disease ranged from 10 to 36 years of age with a mean of 19 years. The follow-up study began no less than five years after their initial visit with an average duration of 5.10 years. The patients were contacted through the mail, and of these fifty patients, 41 were traced, one had died, 5 were unable or refused to participate and 36agreed to participate. The study evaluated the general outcome of each patient, which consisted of three categories: Good outcome, Intermediate outcome and Poor outcome. The poor behavioral outcome group and the intermediate outcome group were combined because the intermediate sample did not contain enough patients for thorough analysis. Patients were assessed on four scales: Eating Attitudes Test (EAT), Hamilton Rating Scale for Depression (HRSD), Hamilton Rating Scale for Anxiety (HRSA) and Social Problem Questionnaire (SPQ). The study considered such characteristics as age, employment status, marital status and number of children, alcohol intake, mental health, weight, menstrual status, social class, social outcome, anxiety and depression ratings and eating attitude rating.

Many of the results obtained from this study agreeably compare with those of other studies. Yet, this study points out the difficulty of comparing such studies. The main complication being that the criteria chosen to categorize outcome groups may differ from study to study. Twenty-five percent of the sample still suffered from bulimia nervosa and fulfilled diagnostic criteria of the disease. The number of members in the good outcome group contained 47.2% of the sample. Firstly, the study provides further evidence supporting the view that symptomatically bulimia nervosa improves with time (Johnson-Sabine, 1992). Secondly, this study contradicts the idea that bulimia nervosa is a variant of affective disorder. Thirdly, the study found a correlation between the good outcome group and fewer social problems. There was no significant association found between alcohol abuse and outcome group. Finally, the study confirmed that sufferers of bulimia nervosa are best managed in out-patient programs due to the unpopularity of in-patient treatment. Overall, the results of this study corroborated with results of other studies.

The second study was an elaboration of the study discussed above. It used the same original sample, but from the original sample used 32 women to examine social outcome and relationship to eating pathology (Johnson-Sabine, 1995). Information about the patientsí behaviors and social factors were obtained through interviews and the Social Problem Questionnaire (SPQ). These patients were categorized into two outcome groups, good outcome and poor outcome. The study resulted in a correlation between social outcome and eating disorder outcome. Patients involved in a satisfactory relationship were associated with good eating disorder outcome, yet being in a stable relationship was not associated with eating disorder outcome. Associations were also made among good eating disorder outcome and higher occupational social class, and having a satisfying social life and job.

The third study reviewed, "Long-term Outcome of Bulimia Nervosa," included 173 women who had participated in one of two previous studies. Of the 222 subjects sought, 177 agreed to participate, but four were eliminated because they never met full DSM-IV criteria for bulimia nervosa, which was a requirement for the study. Participants were contacted through mail in which they were asked to complete questionnaires at home and to participate in a personal interview in person or over the phone. There were no significant differences revealed between type of interview. This study defined eating disorder outcome with both broad and narrow definitions of remission.

The results varied between the narrow and broad definition of remission. According to the narrow definition, 49 women were in partial remission and 72 subjects were in full remission. The broad definition resulted in 40 women being in partial remission and 81 in full remission. The Body Shape Questionnaire scores were strongly associated with eating disorder outcome. Symptomatic women expressed greater body shape concerns than those in remission. The only prognostic factor that proved to be significant was the relationship between the duration of the disorder at presentation and history of substance use problems.

All of the reviewed studies reveal that it is difficult to assess long-term effects of bulimia nervosa since few studies concerning this topic have been implemented. The studies emphasize the difficulty of comparing various studies examining this topic because of the numerous types of criteria for bulimia nervosa. All of them also point out that eating disorder outcome improves with time. The studies also disclose that bulimia nervosa can be a long-term sickness and that there are various factors, which relate to its successful treatment. These findings are useful to further the understanding of bulimia, but I believe it is difficult to make associations and correlations among specific items because bulimia nervosa it such an individualized disease. For example, the second study reviewed confirms a strong association with life satisfaction and good eating disorder outcome, which seems logical. If one is satisfied with her present situation it would be easier to be cured of the disease through support of a relationship and satisfactory social outcome. This study gives a general association. Again, I also find it hard to distinguish treatment programs since each case is individual. Yet, perhaps with more long-term studies in the future bulimia nervosa will be thoroughly understood, and the difficulties I mentioned will be obsolete.



Dayson, D., Johnson-Sabine, E. & Reiss, D.(1992). Bulimia Nervosa: A 5-Year Follow-Up Study. Psychological Medicine, 22(4), 951-959.

Johnson-Sabine, E. & Reiss, D.(1995). Bulimia Nervosa: 5-year Social Outcome and Relationship to Eating Pathology. International Journal of Eating Disorders,18(2),127-133.

Keel, P.K., Mitchell, J.E., Miller, K.B., Davis, T.L. & Crow, S.J. (1999). Long-term Outcome of Bulimia Nervosa. Archives of General Psychiatry, 56(1), 63-69.



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