The American Journal of Psychiatry

Copyright © 2002 American Psychiatric Association.

Volume 159(8) August 2002 pp 1284-1293
The Outcome of Anorexia Nervosa in the 20th Century
[Perspectives: Reviews and Overviews]
Steinhausen, Hans-Christoph M.D., Ph.D.
 Psychological Medicine
© Cambridge University Press 2000
Volume 30(6) November 2000 pp 1249-1262
Prevention research in eating disorders: theory and new
directions
[Review Article]
AUSTIN, S. BRYN 1
Background. Over the past two decades, scores of articles and several
books have been published calling for more attention to the prevention of
eating disorders, but less than two dozen prevention intervention studies
have been conducted to date.
Methods. This paper reports the results of a systematic
review of 20 empirical intervention studies on eating
disorders prevention, discussing the data accumulated
on what has and has not been effective. Beyond a
description of study design and findings, this paper
devotes special attention to the theoretical orientations
of the studies and their implied assumptions about
preventive strategies.
Results. Though there has been a compelling interest
in social, political and economic factors influencing
the incidence of disordered eating, little of this interest
has been carried over into the prevention end of eating
disorders research. Most studies reported thus far have
been designed to target and measure change
principally on the individual level, to the exclusion of
considering leverage points for intervention in the
Methods. This paper reports the results of a systematic review of 20
empirical intervention studies on eating disorders prevention, discussing
the data accumulated on what has and has not been effective. Beyond a
description of study design and findings, this paper devotes special
attention to the theoretical orientations of the studies and their implied
assumptions about preventive strategies.
Results. Though there has been a compelling interest in social, political
and economic factors influencing the incidence of disordered eating,
little of this interest has been carried over into the prevention end of
eating disorders research. Most studies reported thus far have been
designed to target and measure change principally on the individual
level, to the exclusion of considering leverage points for intervention in
the larger social environment.
Conclusions. This paper concludes with a recommendation for new
attention to a model of proactive primary prevention targeted at
environmental change and cross-disciplinary collaboration to achieve a
reduction in the incidence of eating disorders.
Objective: The present review addresses the outcome of anorexia
nervosa and whether it changed over the second half of the 20th
century.

Method: A total of 119 study series covering 5,590 patients

suffering from anorexia nervosa that were published in the
English and German literature were analyzed with regard to
mortality, global outcome, and other psychiatric disorders at
follow-up.
Results: There were large variations in the outcome parameters
across studies. Mortality estimated on the basis of both crude and
standardized rates was significantly high. Among the surviving
patients, less than one-half recovered on average, whereas one-
third improved, and 20% remained chronically ill. The
normalization of the core symptoms, involving weight,
menstruation, and eating behaviors, was slightly better when each
symptom was analyzed in isolation. The presence of other
psychiatric disorders at follow-up was very common. Longer
duration of follow-up and, less strongly, younger age at onset of
illness were associated with better outcome. There was no
convincing evidence that the outcome of anorexia nervosa
improved over the second half of the last century. Several
prognostic features were isolated, but there is conflicting evidence.
Most clearly, vomiting, bulimia, and purgative abuse, chronicity of
illness, and obsessive-compulsive personality symptoms are
unfavorable prognostic features
European Eating Disorders Review
Eur. Eat. Disorders Rev. 10, 233–240 (2002)
Treatment of Anorexia Nervosa: Is ‘Where’ or
‘How’ the Main Issue?
Arthur Crisp*
Department of Psychiatry, St George’s Hospital Medical
School,
London, UK