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

描述(申请人提供)：项目摘要/摘要神经性厌食症(AN)和神经性暴食症(BN)是与复杂的身体和情感后遗症相关的慢性和严重的精神疾病。关于饮食失调的长期研究数量很少，由于缺乏基于经验的康复定义，对这些疾病后果的全面理解受到了挑战。目前的申请建议对马萨诸塞州总医院厌食症和神经性暴食症纵向研究的幸存参与者进行一次性跟踪调查，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。这项针对246名寻求治疗的妇女的研究，其中包括51名患有AN限制亚型的妇女，85名患有AN-暴食/净化亚型的妇女，以及110名患有BN的妇女。这项研究是此类研究中唯一长期的、前瞻性的、自然主义的研究，使其成为促进我们对饮食失调自然过程的理解的宝贵资源。该队列被频繁地间隔采访，直到2000年，进行了大约10年的随访(中位数=9年，最长=12年)。随访10年，流失率为7%。与该队列保持了年度联系。到目前为止，我们已经确认参与拟议的后续行动，潜在的230名活着的参与者中有155名(67%)，我们继续努力纳入另外44名受试者(只有31名受试者拒绝参加)。该应用程序建议通过检查一系列在症状严重程度和持续时间的阈值上不同的康复定义的预测有效性(将前10年的随访与25年进行比较)，来建立一个基于经验的长期进食障碍恢复的定义。进食障碍纵向间隔后续评估(在研究的初始阶段进行的相同访谈)将用于收集有关进食障碍症状、共病精神障碍和心理社会功能的数据。康复定义的横断面有效性将使用有临床意义的指标进行检查，例如生活质量。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。这项拟议的研究在研究这些问题方面具有得天独厚的优势，因为既有详细的数据集记录了10年来饮食失调的过程，也有很高比例的参与者愿意在25年的随访中接受采访。这项研究的结果将为评估目前的治疗努力创建一个框架，帮助设计未来的治疗研究，向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进食障碍结局的重要临床信息。

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.