Psychological Medicine

Relapse in anorexia nervosa: a survival analysis

a1 Department of Psychiatry, Toronto General Hospital and the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Article author query
carter j   [PubMed][Google Scholar] 
blackmore e   [PubMed][Google Scholar] 
sutandar-pinnock k   [PubMed][Google Scholar] 
woodside d   [PubMed][Google Scholar] 


Background. Knowledge about factors that predict relapse in anorexia nervosa (AN) is needed for the development of effective relapse prevention treatments and may also advance understanding of the psychopathology of AN. The aim of the present study was to examine the rate, timing and prediction of relapse in AN following weight restoration in a specialized in-patient treatment programme.

Method. Fifty-one consecutive first-admission AN patients who were weight-restored following in-patient treatment participated in the study. Follow-up assessments were conducted a median of 15 months post-discharge. Relapse of AN was defined as a body mass index <17·5 for 3 consecutive months. Data were analysed using Kaplan–Meier survival analysis and Cox regression.

Results. The overall rate of relapse was 35% and the mean survival time was 18 months. The highest risk period was from 6 to 17 months after discharge. Several significant predictors of relapse were identified: a history of suicide attempt; previous specialized treatment for an eating disorder; severity of obsessive–compulsive symptoms at presentation; excessive exercise immediately after discharge; and residual concern about shape and weight at discharge.

Conclusions. There continues to be a significant risk of relapse among AN patients who remain well for the first year post-discharge. Several variables were shown to be associated with an elevated risk of relapse. These findings have implications for the development of initial treatments and relapse prevention strategies for AN.

c1 Dr Jacqueline C. Carter, Department of Psychiatry, Toronto General Hospital, 200 Elizabeth Street, Eaton Wing North 8-231, Toronto, Ontario M5G 2C4, Canada. (Email: