Eating Disorders - fieldi

Afterword 179
surprisingly rapidly to treatment. Some patients flounder despite
enormously supportive families; others succeed despite families that
are geographically or emotionally unable to be involved. Patients
with seemingly mild symptoms may have persistent difficulties; others
may be extremely symptomatic and yet make impressive and
complete recoveries.
In 1987 we surveyed the first three hundred patients with anorexia
or bulimia or both who had contacted the Wilkins Center (Mickley
1988). Many had been treated by our staff; others had been referred
to hospitals, had moved to other geographic locations, or had chosen
other treatment or none at all. All were two to five years from their
first visit, and almost half had completed an evaluation.
Fifty percent of surveyed patients were considered to have recovered,
using stringent criteria (within 10 percent of normal weight,
regular menstrual periods, and no binges or purges in more than six
months). Some, however, still experienced excess concern with
weight. Another 15 percent were of normal weight but purged occasionally
(less than once a week). Combining these groups, at two to
five years, more than two-thirds of patients were relatively free of
eating disorder symptoms. Another 20 percent of patients still
purged more than once a week, but significantly less than before
treatment. Less than 15 percent of patients were no better than
when first seen.
In analyzing this outcome study, demographic data, including
age, alcoholism in the patient or family, history of hospitalization,
and duration of illness, had no statistical bearing on outcome. Only
two factors were significant. Patients who did well were more likely
to sign their evaluation questionnaires, whereas those who did
poorly more often submitted them anonymously. More important,
more than 60 percent of patients with the best outcomes had had at least
two years of individual psychotherapy. In contrast, more than 50 percent
of those who failed to improve had participated in consistent treatment
for less than three months.
Though a majority of patients in our 1987 survey recovered, current
outcome may be even more favorable. Many patients in the
study were still in treatment when contacted and continuing to
improve. In addition, treatment in the nineties includes an array of
options that were not available in the early eighties. Antidepressants,