Six-year course of bulimia nervosa.

OBJECTIVE: Because little is known about the longer-term course of bulimia nervosa, the 2- and 6-year course and outcome of 196 consecutively treated females with bulimia nervosa-purging type (BN-P) was assessed.

METHOD: One hundred ninety-six females with BN-P were assessed longitudinally at four points of time: at the beginning of therapy, at the end of therapy, at 2-year follow-up, and at 6-year follow-up. Self-rating scales as well as expert ratings from interview data were used. Eating disorder specific and general psychopathology was assessed.

RESULTS: The general pattern of results over time showed substantial improvement during therapy, a slight (in most cases nonsignificant) decline during the first 2 years after treatment, and further improvement and stabilization from 3 to 6 years posttreatment. At 6-year follow-up, 20.9% had BN-P, 0.5% BN-nonpurging type (BN-NP), 1.1% had shifted from BN to binge-eating disorder, 3.7% had anorexia nervosa, 1.6% were classified as eating disorder not otherwise specified (ED-NOS), and 2 patients had died; obesity with a body mass index (BMI) of > 30 was seen in 6.0%; the majority (71.1%) showed no major DSM-IV eating disorder.

CONCLUSIONS: Based on a composite global outcome score at 6 years follow-up, 59.9% achieved a good outcome, 29.4% an intermediate outcome, 9.6% a poor outcome, and 2 (1.1%) persons were deceased. Course and outcome were generally more favorable than in anorexia nervosa.