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Longitudinal comparison of anorexia nervosa subtypes
Kamryn T Eddy1, Pamela K Keel, David J Dorer
1Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Objective:
To compare patients with restricting anorexia nervosa (ANR) and binge/purge anorexia nervosa (ANBP) on measures of impulsivity, course, and outcome.
Methods:
One hundred thirty-six treatment-seeking women with AN followed prospectively for 8-12 years were reclassified at intake as 51 ANRs and 85 ANBPs according to the DSM-IV subtyping classification. Lifetime Axis I and Axis II disorders were assessed using structured interviews; follow-up interviews were conducted at 6-12-month intervals to collect weekly data on eating disorder symptomatology.
Results:
Women with ANR and ANBP did not differ on history of substance abuse, kleptomania, suicidality, or borderline personality diagnosis at intake, or on rates of recovery, relapse, or mortality. By 8 years of follow-up, 62% of women with ANR crossed over to ANBP prospectively and only 12% of women with AN never reported regular binge/purge behaviors.
Conclusions:
The findings on impulsivity, course, and outcome do not support the current subtyping system. The high crossover rate in our sample from ANR to ANBP suggests that ANR represents a phase in the course of AN rather than a distinct subtype.