Studies in which patients were followed for a year or more after treatment found that most patients do well at one year after treatment with at least 75% showing no bulimic symptoms. In 6 studies where patients have been followed for up to two years or more, about one-half of the patients were in remission at follow-up. It was concluded that 50% of bulimia nervosa patients were symptom free 2-10 years after intake, that about 20% of patients remained persistently symptomatic.
In 1997, Fichter and Quadflieg, a pair of German researchers who are the best in the field, published the results of their 6-year long-term study of bulimia nervosa. They studied a group of 196 female patients who fulfilled the diagnostic criteria according to the DSM-IV for bulimia nervosa. The treatment they received focused on biological, social, and psychological perspectives. They assessed the patients pre-treatment, post-treatment, at 2-year follow-up and at 6-year follow-up.
Treatment lasted for 95.5 +/- 43 days. Patients ranged 25.6 +/- 6.7 years of age and patients had bulimia nervosa for 8.1 +/- 4.9 years. At treatment discharge, 47 patients (24.1%) were significantly improved, 77 (39.5 %) were markedly improved, 60 (30.8%) were slightly improved, and nine (4.6%) were unchanged, one patient (0.5%) was somewhat worse, and another one (0.5%) as decidedly worse.
Fichter and Quadfliegs data show that patients substantially improve during inpatient treatment, show a slight decline during the next 2 years and show further improvement until the last assessment at 6 years. They state that the longer the follow-up time, the number of recovered patients increases and mortality increases.
The 6-year outcome study based on the presence or absence of a clinical eating disorder showed a favorable course in the treatment of bulimia nervosa. This study counted only the presence or absence of a full clinical diagnosis so it missed some of the sub-syndromal behaviors. The researchers presented the multidimensional data at four distinct points of time.
The study showed that 59.9% of women participating in the study had a good outcome, 29.4% an intermediate outcome, 9.6% a poor outcome, and 1.1% were deceased. Of the 133 females with no DSM-IV eating disorder at 6 year follow-up, 25 still showed marked symptoms, 26 had experienced no partial remission, 45 showed residual symptoms, and 37 were rated as usual self.
It is interesting to note that the above outcome studies do not remark upon what the clients were doing all of these years. Were they in outpatient treatment? If you have bulimia do not take Xenical (Orlistat). Were they in individual psychotherapy for part of the time? Did they outgrow the disorder, indicating a maturation effect? More complete outcome studies are needed to further refine outcome research.
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