Long-Term Recovery Following Adolescent Anorexia Nervosa: A Mixed-Methods Follow-Up Study

Background/Objectives: Long-term recovery following adolescent anorexia nervosa (AN) remains incompletely understood because restoration of nutritional status does not necessarily coincide with psychological remission. Comprehensive evaluation of recovery requires consideration of psychological, behavioural, and patient-reported outcomes in addition to anthropometric measures. To evaluate long-term recovery following adolescent anorexia nervosa by integrating clinical outcomes, patient- and caregiver-reported experiences, orthorexic tendencies, and eating-disorder psychopathology, and to identify factors associated with persistent psychological impairment. Methods: This retrospective follow-up study employed a cross-sectional survey design. Families of 100 former patients previously hospitalized for adolescent anorexia nervosa in a child and adolescent psychiatric inpatient unit were invited to participate 5-10 years after discharge. Follow-up questionnaires were returned by 23 former patients and 17 caregivers. Former patients completed the SCOFF questionnaire and questions assessing orthorexic tendencies, whereas caregivers and the patients as well provided information regarding their child's long-term recovery, treatment experiences, current functioning, and selected demographic characteristics. Responses from former patients and caregivers were analysed according to respondent group and the variables available for each group, while information from both groups was used to obtain a comprehensive assessment of long-term recovery. Descriptive and inferential statistical analyses were performed. Results: Mean BMI increased from 13.4 kg/m² during the acute phase of illness to 18.8 kg/m² at follow-up, indicating substantial nutritional improvement. Nevertheless, approximately 60% of former patients screened positive on the SCOFF questionnaire, suggesting persistent eating-disorder symptoms despite nutritional rehabilitation. Orthorexic tendencies were strongly associated with positive SCOFF screening results (Cramér's V = 0.828; p < 0.001). Psychiatric comorbidity and poorer subjective health perception were also associated with less favourable long-term outcomes. Qualitative findings further demonstrated that recovery was perceived as extending beyond symptom reduction to include psychological wellbeing, restoration of autonomy, interpersonal functioning, and social reintegration.