Course and outcome

Much remains to be learned about the course and outcome of bulimia nervosa. It is clear from epidemiological studies that many people do not present for treatment. The course of their disorder is completely unknown. Those who do present tend to do so after a considerable period of time indicating that among this subgroup the disorder has a tendency to run a protracted course. Conversely, the findings of the treatment studies indicate that the outcome is considerably better than Russell originally suggested, although it must be stressed that even with cognitive-behavioural therapy, the most effective treatment, only about half the patients make a full recovery.

There have been few studies of long-term course or outcome. The studies with longer periods of follow-up have identified proportionately fewer cases at reassessment.(72) At 10-year follow-up, about 10 per cent meet diagnostic criteria for bulimia nervosa and a further 15 per cent have an atypical eating disorder. (73,74> There is no evidence that bulimia nervosa evolves into any other psychiatric disorder, and anorexia nervosa is a very unusual outcome. Body weight barely changes over time and, in contrast with anorexia nervosa, the mortality rate appears not to be raised. The disorder tends to improve during pregnancy but subsequent relapse is common.*7,76) No robust predictors of course or outcome have been identified.

Thus, if one takes a long-term perspective, there seems to be a trend towards recovery. Whether this is an inherent property of bulimia nervosa, whether it is age-related, or whether it reflects the influence of treatment is not known.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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