Fichter Manfred M, Quadflieg Norbert
Department of Psychiatry, University of Munich, Prien, Germany.
Psychol Med. 2004 Nov;34(8):1395-406. doi: 10.1017/s0033291704002673.
Since little is known about the long-term course and outcome of bulimia nervosa, the authors designed a 12-year prospective longitudinal study with five cross-sectional assessments based on a large sample of consecutively treated females with bulimia nervosa (purging type) (BN-P).
One hundred and ninety-six females with BN-P were assessed (1) at the beginning of treatment, (2) at the end of treatment, (3) at 2-year follow-up, (4) at 6-year follow-up, and (5) at 12-year follow-up. In self-ratings as well as expert ratings based on interviews we assessed specific eating-disorder and general psychopathology.
The general pattern of results over time showed substantial improvement during treatment, slight (in most cases non-significant) decline during the first two years after the end of treatment, and further improvement and stabilization until 12-year follow-up. At that point the majority of patients (70.1 %) showed no major DSM-IV eating disorder, 13.2% had eating disorders not otherwise specified, 10.1 % had BN-P and 2% had died. Very few had undergone transition to anorexia nervosa or binge-eating disorders. Logistic regression analyses showed that psychiatric co-morbidity was the best and most stable predictor for eating-disorder outcome at 2, 6 and 12 years.
Course and outcome of BN-P was generally more favourable than for anorexia nervosa.
由于对神经性贪食症的长期病程和结局了解甚少，作者基于大量连续接受治疗的神经性贪食症（清除型）（BN-P）女性样本，设计了一项为期12年的前瞻性纵向研究，并进行了五次横断面评估。
对196名BN-P女性进行了评估，（1）在治疗开始时，（2）在治疗结束时，（3）在2年随访时，（4）在6年随访时，以及（5）在12年随访时。在自评以及基于访谈的专家评定中，我们评估了特定的饮食失调和一般精神病理学情况。
随着时间推移的总体结果模式显示，治疗期间有显著改善，治疗结束后的头两年有轻微（大多数情况下无显著意义）下降，直到12年随访时进一步改善并趋于稳定。到那时，大多数患者（70.1%）未出现主要的DSM-IV饮食失调，13.2%患有未另行规定的饮食失调，10.1%患有BN-P，2%已死亡。很少有人转变为神经性厌食症或暴饮暴食症。逻辑回归分析表明，精神共病是2年、6年和12年饮食失调结局的最佳且最稳定的预测因素。
BN-P的病程和结局总体上比神经性厌食症更有利。
