Defining Recovery for Anorexia and Bulimia Nervosa: A 25-Year Outcome Study

描述（由申请人提供）：项目摘要/摘要神经性厌食症（AN）和神经性贪食症（BN）是慢性和严重的精神疾病与复杂的身体和情绪后遗症。对饮食失调的长期研究数量很少，对这些疾病结果的全面了解受到缺乏基于医学的恢复定义的挑战。目前的申请建议对马萨诸塞州总医院厌食症和神经性贪食症纵向研究的幸存参与者进行一次性随访调查，该研究是在NIMH于1987年开始为该项目提供初始资金25年后进行的。这项研究涉及246名寻求治疗的女性，其中包括51名AN限制亚型女性，85名AN狂欢/清除亚型女性和110名BN女性，是此类研究中唯一的长期，前瞻性，自然主义研究，使其成为促进我们理解饮食失调自然过程的宝贵资源。该队列在2000年之前接受了约10年随访（中位数= 9年，最长= 12年）的频繁访谈。10年随访时的脱落率为7%。每年都与该群体保持联系。迄今为止，我们已确认230名潜在存活受试者中的155名（67%）参与了拟定的随访，我们将继续努力纳入另外44名受试者（仅31名受试者拒绝参与）。本申请提出通过检查一系列恢复定义的预测有效性（将随访的前10年与第25年进行比较）来建立长期进食障碍恢复的基于临床的定义，这些定义在症状严重程度和持续时间的阈值上不同。进食障碍纵向间隔随访评价（与研究初始阶段相同的访谈）将用于收集进食障碍精神病学、共病精神疾病和心理社会功能的数据。将使用有临床意义的指标（如生活质量）检查恢复定义的横断面有效性。最后，这项研究将记录饮食失调的长期结果，包括死亡率，以及25年结果的人口统计学和临床预测因素。这项拟议的研究是独特的定位，以检查这些问题，由于提供了一个详细的数据集，记录了饮食失调的过程超过10年的后续行动，以及高比例的参与者愿意接受采访，在25年的后续行动。这项研究的结果将为评估目前的治疗工作建立一个框架，帮助设计未来的治疗研究，为进行结果研究的研究人员提供信息，并为临床医生，研究人员和患者提供有关饮食失调结果的重要临床信息。

DESCRIPTION (provided by applicant): Project Summary/Abstract Anorexia nervosa (AN) and bulimia nervosa (BN) are chronic and severe psychiatric illnesses associated with complex physical and emotional sequelae. Long-term studies of eating disorders are few in number and comprehensive understanding of the outcome of these illnesses has been challenged by a lack of an empirically-based definition of recovery. The current application proposes a one-time follow-up investigation of the surviving participants of the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa 25 years after initial funding for the project by NIMH began in 1987. This study of 246 treatment-seeking women, which included 51 women with AN-restricting subtype, 85 with AN-binge/purge subtype, and 110 with BN, is the only long-term, prospective, naturalistic study of its kind, making it an invaluable resource for promoting our understanding of the natural course of eating disorders. The cohort was interviewed at frequent intervals until 2000 for approximately 10 years of follow-up (median = 9 years, maximum = 12 years). The attrition rate at 10 years of follow-up was 7%. Annual contact has been maintained with the cohort. To date, we have confirmed participation in the proposed follow-up with 155 (67%) of our potentially 230 living participants and we continue our efforts to include an additional 44 subjects (only 31 subjects declined participation). This application proposes to establish an empirically-based definition of long-term eating disorder recovery by examining the predictive validity (comparing the first 10 years of follow-up to year 25) of a series of definitions of recovery that differ on thresholds of symptom severity and duration. The Eating Disorder Longitudinal Interval Follow-up Evaluation (the same interview administered in the initial phase of the study) will be used to gather data on eating disorder symptomatology, comorbid psychiatric disorders, and psychosocial functioning. Cross-sectional validity of recovery definitions will be examined using clinically meaningful indices such as quality of life. Finally, this study will document long-term outcome of eating disorders, including mortality rates, as well as the demographic and clinical predictors of 25-year outcome. The proposed study is uniquely positioned to examine these questions due to the availability of both a detailed dataset documenting the course of eating disorders over 10 years of follow-up as well as a high percentage of participants willing to be interviewed at the 25 year follow-up. Findings from this study will create a framework for the evaluation of current treatment efforts, assist in the design of future treatment studies, inform researchers conducting outcome studies, and provide clinicians, researchers, and patients with important clinical information about the outcome of eating disorders.