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Anorexia Nervosa Is More Common and Often Transient, According to Nationwide Study
In the first nationwide outcome study of anorexia nervosa conducted to date, collaborating scientists at the Mailman School and the University of Helsinki, Finland report that while anorexia nervosa can be a devastating disorder and carries high mortality rates, its outcome is generally good with up to 70% of women with anorexia recovering before age 30.
The study comprised nearly 3,000 female twins born in Finland in 1975-79. Those with anorexia nervosa were compared to their healthy co-twins and to healthy women from the general population.
According to the findings, 2.2% of Finnish young women suffered from this severe psychiatric disorder. “When milder forms of self-starvation and obsessive anxiety about weight and shape were included, up to 5% of women had anorexic symptoms during their lifetime,” says Anna Keski-Rahkonen, MD, PhD, MPH, an epidemiologist and psychiatrist at the University of Helsinki, Finland, who completed this study while on a fellowship at the Department of Epidemiology at the Mailman School of Public Health.
“Although Finland has an excellent taxpayer-funded healthcare system that covers everyone, only half of women with anorexia nervosa were recognized by healthcare professionals. Even fewer received any type of treatment for their symptoms.”
Symptoms of anorexia usually started between ages 10 and 25, with the peak of illness onset reported between ages 15 and 19. “Our data suggest that the incidence of anorexia nervosa has been substantially underestimated, because the illness often goes undetected,” states Hans Wijbrand Hoek, MD PhD, adjunct professor of Epidemiology. “The findings suggest that more research on the patterns of help-seeking behavior in women with this disorder is warranted,” says co-author Ezra Susser, MD, DrPH, chair of the Department of Epidemiology at the Mailman School and also at the New York State Psychiatric Institute.
Recovery from anorexia was usually slow and gradual. By age 30, however, up to 70% of women with anorexia had recovered from their illness. Results indicate that within five years from weight restoration, women with anorexia nervosa were virtually indistinguishable from their healthy co-twins in terms of psychological symptoms and self-esteem. However, learning to deal with body shape and weight related concerns usually took much longer, an average of 5-10 years. “Despite the fact that more than two-thirds of the women with anorexia nervosa achieved clinical recovery within five years, the burden of illness was considerable, and in almost two-thirds of the cases the illness duration was greater than two years; in half, it was greater than three years,” noted Dr. Susser.
The findings also suggest that women in the acute starvation phase of anorexia were less apt to date, live in long-term relationships, and marry than their healthy co-twins and other healthy women. However, women who had recovered from anorexia nervosa were just as likely to date, have sexual relationships, marry, and have children compared to healthy women. Women recovering from anorexia were also as likely as healthy women to continue their studies and find steady employment.
The study is reported in detail in American Journal of Psychiatry (August 1, 2007 issue), available online at http://ajp.psychiatryonline.org/.
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