OUTCOME OF TREATMENTStudies of mortality rates in anorexia nervosa indicate that the rate of mortality increases the longer the patient has the disorder. One study showed a mortality rate of 5% at five years, 6.5% at ten years, 16% at twenty years and 18% at thirty-three years. The deaths were found to be secondary to anorexia nervosa and not due to other causes (Herzog, 1992). Outcome studies of bulimic patients have found the course to be chronic with periods of remission and relapse (Garfinkel and Kennedy, 1992). A study by Swift et al reported on a group of bulimic women two years after discharge from a treatment program. They found that 27% were asymptomatic, 40% had an intermediate outcome and the remaining 33% had a poor outcome with bingeing or purging on a daily basis (Garfinkel and Kennedy, 1992). The difficult in determining outcomes of treatment for anorexia nervosa and bulimia exists in the overlap of symptomatology during the course of the disorders. Switching behaviors is common, with a patient restricting intake for a period of time, then engaging in binge-purge behavior and then returning to a restrictive model once again. A study done by Herzog which followed the course of anorexia nervosa patients, bulimic patients and a mixed symptom anorexic-bulimic group for five years found considerable cross-over among the groups (Garfinkel and Kennedy, 1992). He found that the patients who started out in the mixed group had the poorest recovery rate (Garfinkel and Kennedy). A more positive outcome was found by Brownell (1986) in a study of bulimic patients. It shows changes in the binge-purge frequency of fifteen bulimics from six months prior to treatment to the one year follow-up date. Seven patients showed complete abstinence in the follow-up study, while the remainder showed reductions in binge-purge activity ranging from 63% to 94%. Overall, a 91% reduction in binge-purge frequency was noted (Brownell, 1986). Another study shows the medical and psychosocial outcome of fifty anorexic patients following family therapy. In 86% of the cases, treatment was effective. It appears most effective with younger patients who receive treatment within the first year of the onset of their behavior, and whose families become involved in therapy (Minuchin, 1978). Next: CONCLUSION |