Long-term Social and Health Outcome of Bulimic Women

On the roller-coaster of bulimia nervosa, most patients reach the high point of full recovery, but as many as 30% also eventually hit the low point of relapse. Also, there have been conflicting opinions about how well bulimic women do socially and how healthy they are after recovery. Some researchers have reported that bulimic patients have no differences in work and social/leisure life 2 to 5 years after recovery (Psychosom Med 1987; 49:45), while others have found significantly worse function across all domains of social life one year after recovery (Am J Psychiatry 1984;141:444).

Dr. B. Jger and colleagues at Hanover Medical School, Hanover, Germany, and Bonn Medical School, Bonn, Germany, have reported moderately good outcomes among 80 women with bulimia nervosa followed for 7 to 9 years (Acta Psychiatr Scand 2004;110:138). The original treatment group included 83 patients, 46 of whom were treated as outpatients and 37 treated as inpatients. Eighty of the women were interviewed by telephone and returned completed questionnaires, including the Freiburg Personality Inventory, the Eating Attitudes Test, and five scales of the Eating Disorders Inventory.

Most now have stable relationships

At the end of the 9-year study, the researchers found that more than 60% of the women were married (29.9%) or living in a stable partnership (32.5%), 56.4% shared an apartment with their partner, 34% were living with one (16.7%) or more (16.7%) children, and 32.5% lived alone. However, many more women of comparable age in the general population were married (61.4%) and the cumulative birth rate up to age 32 was much higher among women in the general population than among women in the study (1,036 vs. 333).

General physical health

The general physical health of the women was moderately good. One patient was a chronically ill psychiatric inpatient and another was methadone- and heroin-dependent. However, in spite of their general overall good health, nearly 30% of the women were treated in a general medical hospital during the year after they had recovered. This compares to 10.7% of women in the general population who were treated in a hospital during the same period.

One-fifth still binged daily

As for health issues related to bulimia nervosa, one-fifth of the women reported binge eating up to twice a day, and 8.8% reported an even higher frequency of binges. The frequency of self-induced vomiting was very similar to that of binge-eating; thus, according to the authors, after 9 years 28.9% of the women still suffered from DSM-III-R bulimia.

Over time, the course of symptoms and related dimensions differed between the women treated as inpatients and outpatients. In both groups, there was a very steep fall in the number of binge-eating episodes in the first follow-up period (from 11.4 to 3.2 binges per week in the inpatients and from 10.6 to 5.1 binges per week among the outpatients).When the two groups were compared at the 8-year point, the inpatients had greater overall improvement in symptoms.

The number of “normal meals per day” and the number of restrictions of intake are important markers of bulimic behavior, indicating the ability of the patient to eat in a normal manner and to desist from the urge to be thin. Steady improvement was seen in both groupsthe number of “normal meals” per week increased from 1.9 to 3.4 at the 8-year assessment for women treated as inpatients and from 2.1 to 3.4 per week for the outpatients.

Finally, the authors note that their results underscore the comparatively good prognosis of patients with bulimia nervosa after treatment, with acceptable social adaptation and little serious deterioration. Dr. Jger also reported that, over time, non-symptom-focused treatment can produce good results among patients with bulimia nervosa. During the study, none of the treatments had provided systematic information either about healthy eating or meal planning or about behavioral or cognitive interventions to the disturbed eating patterns.