Relapse in anorexia and bulimia nervosa - A 2.5-year follow-up study

Anorexia nervosa (AN) and bulimia nervosa (BN) not infrequently take a chronic course during which remission is followed by relapse, sometimes repeatedly. For AN as well as BN, substantial interindividual differences have been observed in long-term course and relapse rates. Attempts to identify consistent predictors of relapse have not been very successful so far in both disorders. This paper presents the results of the German Project TR-EAT, which served as the blueprint for the European collaboration COST Action B6. In Project TR-EAT, the symptomatic status of eating-disordered patients (AN, N= 233, BN, N= 422) was tracked after inpatient treatment over a 2.5-year follow-up period using the LIFE interview. The distribution of time to relapse for both disorders and possible predictors for relapse are investigated by means of discrete time survival analysis. Fifty-eight per cent of the patients with AN and 74% of those with BN achieved partial remission before end of treatment, and thus were at risk for relapse. The relapse rates within 2.5 years were 32.6% for AN and 37.4% for BN. For both eating disorders, the highest risk of relapse was within the first 6 or 7 months after achieving partial remission, but the distribution of time to relapse differed between both. Desired weight, duration of illness, EDI scores, specialization of clinic and additional treatment during follow-up were identified as predictors for AN. For BN, symptomatic status before relapse, motivation for treatment and additional treatment during followup showed predictive value. Implications for care provision are discussed. Copyright (c) 2005 John Wiley & Sons, Ltd and Eating Disorders Association.