There is marked variability in the prognosis for patients with anorexia nervosa. About 40% are completely recovered at follow-up and 30% are improved, but 20% remain unimproved or severely impaired. The mortality rate for this disorder is as high as 22% in some studies, with suicide reported in 2-5% of chronic cases.
The presence of nonanorexic psychiatric impairments such as depression, anxiety, and agoraphobia is common at follow-up. Indicators of a favorable prognosis include a good premorbid level of psychosocial adjustment, early age at onset, less extreme weight loss, and less denial of illness at presentation. Unfavorable prognostic factors include poor premorbid level of psychosocial adjustment, low socioeconomic status, extreme weight loss, greater denial of illness, and the presence of bulimia, vomiting, and laxative abuse. These indicators are all relative, since no single feature or set of factors can reliably predict the prognosis for any given individual.
Complete recovery in less than 2 years is unusual. The recovery rate is positively correlated with length of time at follow-up, ie, the more time that passes before follow-up, the greater the likelihood of finding recovery. Thus, clinicians will do well to remember the words of William Gull (1874), who described anorexia nervosa: “As regards prognosis, none of these cases, however exhausted, are really hopeless while life exists.”
Revision date: July 8, 2011
Last revised: by Sebastian Scheller, MD, ScD