CPG for Eating Disorders

11. Prognosis of Eating DisordersKey Questions:11.1. What is the prognosis of eating disorders?11.2. Are there prognostic factors for eating disorders?11.1. What is the prognosis of eating disorders?Anorexia nervosaThere are contradictory data on the prognosis of AN despite its long historical trajectory,motivated by several factors: follow-up studies with great temporal variability, different resultsdepending on when these studies are performed, lack of randomised intervention studies withsufficient outcome assessment, etc.Acknowledging the previous limitations, results derived from the review of the mainstudies and SRSE of AN prognosis indicate that: mean gross mortality rate is 5% with a highstandard deviation (5.7) and a 0 to 22 interval 388, 389 . Gross mortality rates are generally superior tothose of the general population and increase significantly with the duration of follow-up. Incontrast to this data, it seems that the overall outcome in survivors improves with duration offollow-up (with the resulting therapeutic implications).50% of AN cases resolve in complete remission 390-392 . Partial remission is observed in 20%-30% of AN cases 388, 391 . Between 10% and 20% of cases result in chronicity 389, 391, 393 .Bulimia nervosaThe natural course of BN at 5 years in patients who live in a community is as follows: eachyear, 33% result in remission and 33% in relapse. This information indicates a relatively poorprognosis for non-treated individuals 74 .In 6-year follow-up studies of treated individuals, 60% were determined to have goodprognosis, 30% were considered partially recovered and 10% were determined to have poorprognosis 394 .Risk factors of diagnosis modification (AN to BN or vice versa)There is a lack of prospective studies focused on the evolution of AN based on the survivalanalysis model. However, the following risk factors for diagnosis modification from AN to BNor from BN to AN are: low self-sufficiency or autonomy, high paternal criticism, alcohol185CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS