The prognosis of anorexia nervosa is largely unknown, as its course is difficult to predict. What is known is that it is often chronic and associated with a variety of medical complications. A fact that may be surprising to some is that anorexia has the highest death rate of any psychiatric illness (Neumarker, 1997).

In a long-term follow-up study of patients 21 years after first hospitalization for anorexia, researchers found that 50.6% had achieved a full recovery, 10.4% still met full diagnostic criteria for anorexia, and 15.6% had died from causes related to anorexia (Zipfel, Lwe, Reas, Deter, & Herzog, 2000). Walter Kaye (2004), an expert in the field of eating disorders, reports that about 50% recover, 20-30% are chronically ill, and over 10% die. Finally, a meta-analysis published in 1997 indicates that the aggregate estimated mortality rate for people with anorexia is 5.9%, which is substantially greater than that reported for female psychiatric inpatients and for the general population (Neumarker, 1997). Thus, anorexia has the highest death rate of any psychiatric illness.

The longer a patient is sick, the less likely they are to recover: Michael Strober and his colleagues found that among patients still unrecovered after 5 years, 67% had recovered by the time 10 years rolled around. By contrast, of those who remained ill through 10 years, only 14% had recovered when reassesed at year 15 (Strober, Freeman, & Morrell, 1997).

Anorexia is associated with numerous medical complications, which is unsurprising because starvation can cause major organs to shut down. A heart attack is one of the most common causes of death in those suffering with an eating disorder. Osteoporosis is another danger of anorexia. Low calcium intake is only part of the problem. Even in those who take in adequate calcium through food or supplements, amenorrhea prevents the body from absorbing it fully. Other medical complications include anemia, gastrointestinal problems, kidney dysfunction, and changes in brain structure. Since depression accompanies anorexia, suicide is also a risk factor. Approximately 25% of all anorexics attempt suicide, and about 50% of anorexic deaths result from suicide.

References

Kaye, W. H. (2004, May). Does dieting help people with anorexia nervosa fit into their genes? Recognition, understanding, and intervention. Presentation at San Diego Children's Hospital Child & Adolescent Psychiatry Grand Rounds.

Neumarker, K. (1997). Mortality and sudden death in anorexia nervosa. International Journal of Eating Disorders, 21, 205-212.

Strober, M., Freeman, R., & Morrell, W. (1997). The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study. International Journal of Eating Disorders, 22, 339-360.

Zipfel, S., Lwe, B., Reas, D. L., Deter, H., & Herzog, W. (2000). Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study. The Lancet, 355, 721-722.

Learn more about this author, Betty Gorham.
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