Long-term outcome of bulimia nervosa in Taiwanese

Patients with bulimia nervosa (BN) often experience many associated psychiatric symptoms and behaviors other than disordered eating and body image disturbance. Follow-up studies showed a broad range of remission rates and few prognostic factors were consistently identified. This study examined the outcome of BN in Taiwanese patients using a broad scope of assessment methods.

From January 1985 to August 1999, a total of 68 consecutive patients with BN who visited the Department of Psychiatry at National Taiwan University Hospital were identified by chart review and invited to participate. Forty five patients (66.2%) agreed to participate in the study and were invited back for a follow-up assessment. The follow-up assessments used both semi-structured interview and self-rating questionnaires.

The mean duration of follow-up was 4.7 +/- 2.9 (2 to 15) years. One patient died of gradual weight loss and malnutrition during the follow-up period. Forty four percent of the patients (n = 20) had no signs of eating disorder at follow-up, while 56% of the patients (n = 25) still met the criteria for diagnosis of an eating disorder (anorexia nervosa, BN, and eating disorders not otherwise specified). The rate of crossover from BN to anorexia nervosa was 6.6% (n = 3). The illness persisted for more than 2 years in most of the patients (84.5%). Purging subtype of BN was the only predictor of the presence of an eating disorder diagnosis at follow-up.

This study found a high percentage of Taiwanese patients with BN failed to recover from eating disorders on long-term follow-up. The need for attention to the chronic nature of BN should be emphasized by medical professionals managing these patients.