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Table 3 Rates of relapse identified by the literature searcha

From: What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa

Authors Definition Rate Sample size Follow up rate Study quality
Rates of Relapse
 Isager et al., 1985 [33] Loss of ≥15% of weight acquired during course of treatment (if resulting in weight ≤50 kg) any point in time within a 1 year period 26% AN 151 Not reported at 4–22 years (mean follow up: 12.5 years) Good
 Norring and Sohlberg, 1993 [34] “Ill” defined as having an eating disorder or dead 25% AN 48 62% at 6 years Good
 Eckert et al., 1995 [29] Loss of ≥15% of average body weight (based on Metropolitan Height-Weight Chart, 1959), after achieving normal body weight 42% AN 76 100% at 10 years Good
 Herzog et al., 1999 [32] Relapse full criteria of symptoms or PSR score of 5 or 6 for 8 weeks following a state of recovery 40% AN 136 93% at 7.5 years Good
 Kordy et al., 2002 [10] Change from partial or full remission to full syndrome according to DSM-IV 9% AN who were in full remission/recovery;
35% AN who were in partial remission
233 67% at 2.5 years Good
 Carter et al., 2004 [15] BMI below 17.5 for 3 consecutive months or at least one episode of binge eating/purging behavior per week for 3 consecutive months following a state of recovery 35% AN 51 100% at 0.5 years
(mean follow up: 1.3 ± 0.4 years)
Good
 Carter et al., 2012 [7] BMI below 17.5 for 3 consecutive months or at least one episode of binge eating/purging behavior per week for 3 consecutive months following a state of recovery 41% AN overall;
70% AN–BP, 30% AN–R
100 Not reported at 1 year Good
 Walsh et al., 2006 [14] BMI below 16.5 for 2 consecutive weeks, or severe medical complications, or risk of suicide, or development of another psychiatric disorder requiring treatment 27% of the placebo group and 29% of the fluoxetine group 89
(44 placebo group; 49 fluoxetine group)
43% at 1 year Good
 Keel et al., 2005 [17] Full criteria symptoms/PSR score of 5 or 6 36% AN group 136 93% at 9 years Good
 Helverskov et al., 2010 [16] Full criteria symptoms/PSR score of 5 or 6 19% AN: full or partial relapse 58 50% at 2.5 years Good
 Martin, 1985 [28] “Excellent”: > 90% of their ideal weight, regular menstrual patterns, and eating and social patterns were normal.
“Good”: some but not incapacitating difficulty in one of these areas only
9% of AN adolescents 25 100% at 5 years Fair
 Strober et al., 1997 [4] Weight falls below 85% of total body weight/recurrence of psychological symptoms 29.5% AN post-discharge relapse;
9.8% AN post-partial-recovery relapse
95 87% at 0.5 years Final follow up at 15 years Good
 Fichter and Quadflieg, 1999 [21] Outcome “poor” defined using Morgan-Russell criteria 20.8% AN 103 98% at 6 years Good
 Lowe et al., 2001 [22] Outcome “poor” defined using Morgan-Russell criteria and PSR score of 5 or 6 26% AN 63 90% at 21 years Good
 Eisler et al., 2007 [20] Outcome “poor” defined using Morgan-Russell criteria 34.2% AN adolescents 38 95% at 5 years Good
 Clausen, 2008 [18] PSR score ≥ 3 8.6% 51 69% at 2.5 years Good
 Bodell and Mayer, 2011 [24] Poor outcome BMI less than 18 (using Modified Morgan Russell criteria) 52% of AN group poor outcome 21 86% at one year Fair
  1. a N = 1474 patients included across all studies. Reported follow up rates varied tremendously, from 43 to 100% across 0.5 to 21 years. However, the average follow up rate was relatively high at 82.2%