Psychological characteristics and DSM-III-R diagnoses at 6-year follow-up of adolescent anorexia nervosa

C Smith, S S Feldman, A Nasserbakht, H Steiner
Journal of the American Academy of Child and Adolescent Psychiatry 1993, 32 (6): 1237-45

OBJECTIVE: To examine the relationship between psychiatric disorder and psychological characteristics at 6-year follow-up of adolescent-onset anorexia nervosa.

METHOD: Twenty-three subjects were interviewed by telephone using the Structured Clinical Interview for DSM-III-R diagnosis. These subjects and 23 demographically similar controls completed standardized questionnaires that assessed their defense and coping styles, level of depression, defensiveness, and eating disorder psychopathology.

RESULTS: Of the anorexic subjects 35% had no DSM-III-R diagnosis, 43% an eating disorder, (9% anorexia nervosa, 17% bulimia nervosa, 22% eating disorder not otherwise specified), 30% an affective disorder, and 43% an anxiety disorder at follow-up. Factors at presentation associated with good outcome included greater use of mature defenses, less depression, and a lower drive for thinness. Psychological characteristics of anorexic subjects with good outcome resembled those of controls except that the former anorexics expressed greater dissatisfaction with their bodies and reported less use of cognitive avoidance as a coping mechanism. Anorexic subjects with continuing psychiatric problems differed from controls on most of the measures studied.

CONCLUSIONS: Distribution of psychiatric disorders at follow-up is similar for adolescent and adult-onset anorexia nervosa. Self-report measures of some psychological characteristics are useful prognostic indicators. Absence of psychiatric disorder at follow-up is associated with normalization of many psychological characteristics.

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