A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention

Anorexia nervosa (AN) is a serious psychiatric disorder with a high rate of relapse. The goal of this study was to identify predictors of relapse in adult AN using a prospective, longitudinal design. Participants were 100 AN patients who had successfully completed specialized inpatient/day treatment, were weight-restored to a body mass index (BMI) of at least 20 for a minimum of 2 weeks, and reported less than one binge-purge (BP) episode over the previous 28 days at the end of treatment. Predictor variables included baseline demographic and clinical features, behavioral and psychological changes during treatment, residual psychopathology at post-treatment, and motivation to recover. Results indicated that 41% of participants relapsed during the 1-year follow-up period. The highest risk period for relapse was between 4 and 9 months post-treatment. Predictors of relapse included: the BP subtype of AN, severity of checking behaviors at pre-treatment, decrease in motivation to recover during treatment, and lower motivation to recover at post-treatment. These findings suggest that individuals with the BP subtype of AN are particularly susceptible to relapse. Increasing and maintaining motivation to recover during acute treatment may have an important impact on long-term outcome.