Relapse common after anorexia treatment

Many women who are successfully treated for anorexia are in danger of relapsing for at least two years afterward, new research suggests.

In a study of 51 women who'd regained their normal weight after being hospitalized for anorexia nervosa, researchers found that more than one-third had a setback within two years of being discharged.

The most dangerous period appeared to be the 6 to 17 months after hospital discharge - showing, the study authors say, that even women who seem to be doing well a full year after treatment remain at risk of relapse.

Anorexia, which affects an estimated one to two percent of women at some point in their lives, is particularly challenging to treat; people with the disorder see themselves as heavy even when they become dangerously underweight, and harbor an intense fear of gaining weight.

Women in the current study had suffered from the disorder for an average of six years before entering the intensive group therapy program at Toronto General Hospital. More than half had already tried treatment at other institutions.

The findings from the study, published in the journal Psychological Medicine, highlight the need for therapy to prevent the problem resurfacing, according to Dr. Jacqueline Carter, an assistant professor of psychiatry at the University of Toronto and the study's lead author.

Right now, Carter told Reuters Health, long-term therapy to guard against relapse is not the norm. Such treatment, she noted, is expensive and is only beginning to be studied.

"I think the field still has a lot to learn about the effective treatment of anorexia," Carter said.

In their research, she and her colleagues discovered some characteristics that separated the 35 percent of women who relapsed from those who did not, and that could prove useful in designing relapse prevention therapy.

Women who relapsed were more likely to have previously had specialized treatment for an eating disorder or to have attempted suicide. In addition, excessive exercise in the first few months after leaving the hospital was a significant predictor of relapse. For some women, the study authors note, exercise may serve as a way to exert self-control, one of the overriding concerns that marks anorexia.

Another factor linked to relapse was whether a woman remained highly preoccupied with her body weight and shape. While distorted body image is a well-known feature of anorexia, Carter said that not all forms of treatment for anorexia directly address these harmful perceptions.

The new findings, she and her colleagues conclude, "suggest it is essential that treatments for anorexia target cognitive distortions concerning the significance of shape and weight."

SOURCE: Psychological Medicine, May 2004.