Psychological Medicine

Original Articles

Ten-year follow-up of anorexia nervosa: clinical course and outcome

E. D. Eckerta1 c1, K. A. Halmia1, P. Marchia1, W. Grovea1 and R. Crosbya1

a1 Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry, Cornell University Medical College, New York Hospital—Westchester Division, the Department of Psychology, New York University, New York, USA


The clinical course and outcome of anorexia nervosa are presented in a 10-year followup study of 76 severely ill females with anorexia nervosa who met specific diagnostic criteria and had participated in a well-documented hospital treatment study. Information was obtained on 100% of the subjects. A comprehensive assessment was made in 93% of the living subjects in specific categories of weight, eating and weight control behaviours, menstrual function, anorexic attitudes, and psychological, sexual, social and vocational adjustment. Five subjects had died, which gives a crude mortality rate of 6·6%. Standardized mortality rates demonstrated an almost 13-fold increase in mortality in the anorexia nervosa subjects. Only eighteen (23·7%) were fully recovered. Sixty-four per cent developed binge-eating at some time during their illness, 57% at least weekly. Twenty-nine (41%) were still bulimic at follow-up. The high frequency and chronicity of the bulimic symptoms plus the high rate of weight relapse (42% during the first year after hospital treatment) suggest that intensive intervention is needed to help anorexics restore and maintain their weight within a normal range and to decrease abnormal eating and weight control behaviours.


c1 Address for correspondence: Dr Elke D. Eckert, Box 393 Mayo Building, University of Minnesota Hospitals, Minneapolis, Minnesota 55455, USA.