Eating Disorders - fieldi

180 Afterword
now widely used and of proven benefit in the treatment of eating disorders
(Walsh 1991), were only beginning to be recognized as helping
bulimia when these early patients were treated. The study ended
before fluoxetine (Prozac) was even marketed in the United States.
Although fluoxetine alone has been of enormous value and has been
approved by the Food and Drug Administration specifically for the
treatment of bulimia, an array of new medications of potential benefit
has become available and these are widely used. Progress has
been made in other treatment techniques and combinations as well.
It is hoped that these strides will promote recovery in an ever greater
majority of those with anorexia and bulimia.
More recent data actually confirm and expand the findings of our
1987 study. In terms of prognosis, other studies also note that few
factors consistently predict outcome (Herzog et al. 1991; Sohlberg,
Norring, and Rosmark 1992). However, earlier age at onset tends to
improve prognosis in both anorexia and bulimia. Healthy parental
relationships may correlate with better outcome in anorexia,
whereas good friendships may be associated with more favorable
results in bulimia (Herzog, Nussbaum, and Marmor 1996).
Much subsequent research has analyzed outcome. Both anorexia
and bulimia can be fatal illnesses, from either medical complications
or suicide. Mortality in anorexia accrues at a rate of about 0.5 percent
for each year of illness; that is, 5 percent of patients die after a decade
of anorexia and 10 percent after two decades. The death rate in
bulimia is less clear but probably lower. A 1997 review of eighty-eight
outcome studies found that five to ten years after presentation, 50 percent
of patients with bulimia had recovered from their eating disorder
(although 30 percent had relapsed during the course of their illness),
and up to 20 percent had chronic symptoms (Keel and Mitchell 1997).
Some of the psychiatric difficulties seen during the acute illness may
be secondary to the eating disorder and remit (Dancyger et al. 1997).
However, even with complete eating disorder recovery, patients may
experience other psychological difficulties, such as depression or anxiety
disorders. Many studies have documented the need for intensive
and long-term treatment, especially for anorexia (Herzog, Nussbaum,
and Marmor 1996; Foppiani et al. 1998). It is impressive that the benefits
of intensive psychological treatment can still be demonstrated
five years after its completion (Eisler et al. 1997).