Many patients with anorexia nervosa get better, but complete recovery elusive to most

November 20, 2019

Three in four patients with anorexia nervosa -- including many with challenging illness -- make a partial recovery. But just 21 percent make a full recovery, a milestone that is most likely to signal permanent remission.

These results, and more, are drawn from an online survey of 387 parents, of whom 83 percent had children with anorexia nervosa, 6 percent with atypical anorexia nervosa -- a variant occurring in patients who are not underweight -- and the remainder with other eating disorders. The findings are reported in a study led by UC San Francisco and publishing in the International Journal of Eating Disorders on Nov. 19, 2019.

"This study reminds us that we need to work harder to help individuals with anorexia nervosa who are not responding to standard treatment," said first author Erin C. Accurso, PhD, clinical director of the UCSF Eating Disorders Program and assistant professor in the Department of Psychiatry. "Full recovery means that patients can find joy in their daily life, free from the physical and psychological effects caused by restrictive dieting."

Partial recovery, she said, was defined as some improvement, but still symptomatic in at least one area: physical health, eating disorder thoughts and behaviors, social functioning or mood.

Full Recovery Predictive of Permanent Recovery

Among the 21 percent (81 patients) who made a complete recovery, 94 percent had managed to maintain their recovery two years later. "Unfortunately, patients who only achieved partial recovery continued to struggle and were much more susceptible to relapse," Accurso noted.

Previous studies have found that around 50 percent of patients with anorexia nervosa made complete recoveries, but this study had a preponderance of patients with refractory illness. In the current study, approximately half had undergone residential therapy, partial hospitalization or intensive outpatient treatment, and two-thirds received three or more types of psychological treatments. More than 60 percent reportedly received family-based treatment, which is recognized as most effective for adolescent anorexia nervosa.

"Anorexia nervosa is a complex condition with the highest mortality rate of any psychiatric disorder," said Accurso. "We know that families are the most important resource in recovery, which is why family-based treatment is the gold standard for adolescent anorexia nervosa.

"However, treatment doesn't work for everyone. Parents are telling us that recovery needs to be approached more holistically, with treatments that extend beyond eating disorder symptoms to target emotional well-being, cognitive flexibility and establishment of a meaningful life."

The authors also noted that parents are challenging the field's definition of recovery.

"Parents are schooling us on how it should be defined," said Accurso, who is affiliated with the UCSF Weill Institute for Neurosciences. "We found that parents have a much broader view of recovery, which included psychological wellbeing and building a life worth living. Researchers are missing the mark in defining recovery by weight and/or eating disorder symptoms in the absence of these other factors."

Parents reinforced clinicians' observations that physical and behavioral recovery, which includes resuming regular eating habits, precede cognitive recovery, in which patients are no longer plagued by extreme fear of weight gain and body image distortion.

Among the patients -- whose average age was 18, with a five-year history of the disorder -- 90 percent were female, 94 percent were white, and 90 percent lived in the United States, Canada, the United Kingdom or Australia.

In a follow-up study, Accurso and colleagues will look at how weight restoration, including the goal weight set by a patient's clinician, impacts the recovery process.
-end-
Co-Authors: Senior author is Jocelyn Lebow, PhD, of the Department of Psychiatry and Psychology, Mayo Clinic School of Medicine in Rochester. Co-authors are Leslie Sim, PhD, of Mayo Clinic School of Medicine and Lauren Muhlheim, PsyD, of Eating Disorder Therapy LA in Los Angeles. The authors report no conflicts of interest.

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. Learn more at https://www.ucsf.edu, or see our Fact Sheet.

University of California - San Francisco

Related Eating Disorders Articles from Brightsurf:

Virtual Reality health appointments can help patients address eating disorders
Research from the University of Kent, the Research centre on Interactive Media, Smart systems and Emerging technologies -- RISE Ltd and the University of Cyprus has revealed that Virtual Reality (VR) technology can have significant impact on the validity of remote health appointments for those with eating disorders, through a process called Virtual Reality Exposure Therapy (VRET).

Study links eating disorders with body dysmorphia
People with eating disorders are 12 times more likely to be preoccupied with perceived flaws in their physical appearance than those without, according to new research published in the journal Eating and Weight Disorders.

College students access eating disorders therapy via phone app
Studying college women with eating disorders, a team led by researchers at Washington University School of Medicine in St.

Research reveals toll of pandemic on those with eating disorders
The COVID-19 pandemic is having a profound, negative impact on nine out of ten people with experience of eating disorders, a new study from Northumbria University, Newcastle, reveals.

Does posting edited self photos on social media increase risk of eating disorders?
New research published in International Journal Eating Disorders revealed a consistent and direct link between posting edited photos on Instagram and risk factors for eating disorders.

Face up to eating disorders, and seek help
A new study has found young people are leaving it 'too late' to seek help for eating disorders, citing fear of losing control over their eating or weight, denial, and failure to perceive the severity of the illness as reasons not to get professional advice.

Excessive sports in case of eating disorders: Psychological mechanisms decoded
Excessive and obsessive exercise is very harmful to health, particularly for persons suffering from eating disorders.

Helping patients with binge eating disorders: There's an app for that
Study suggests that adaptation of smartphone technology is a scalable option that significantly improves clinical outcomes.

Eating disorders linked to exercise addiction
New research shows that exercise addiction is nearly four times more common amongst people with an eating disorder.

Focus on teenage anxiety may aid early identification of those at risk of eating disorders
Teenage girls who experience clinical levels of anxiety could be at greater risk of eating disorders, according to associations identified in a study completed by researchers at the University of Bristol with UCL.

Read More: Eating Disorders News and Eating Disorders Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.