Steinhausen Hans-Christoph
Department of Child and Adolescent Psychiatry, University of Zurich, Neumünsterallee 9, Postfach, CH-8032 Zurich, Switzerland.
Child Adolesc Psychiatr Clin N Am. 2009 Jan;18(1):225-42. doi: 10.1016/j.chc.2008.07.013.
Both Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are marked by a serious course and outcome in many of the afflicted individuals. In AN, there are an almost 18-fold increase in mortality including a high suicide rate, chronic courses in approximately 20 per cent of the cases, and more than half of the patients showing either a complete or a partial eating disorder in combination with another psychiatric disorder or another psychiatric disorder without an eating disorder. Mitigating factors of the outcome include onset of the disorder during adolescence and longer duration of follow-up. Vomiting, bulimia and purgative abuse, chronicity, and obsessive-compulsive features represent unfavourable prognostic factors in various studies. The longer-term outcome of BN is only slightly better result as compared to AN; however, the rate of mortality is low. Diagnostic crossover from bulimia nervosa to other eating disorders is a rather rare phenomenon, whereas the high rates of partial eating disorders may explain a large proportion of chronic courses. Social adjustment and the quality of personal relationship normalize in the majority of the affected patients. At present, the study of prognostic factors in bulimia nervosa does not allow any definite conclusions.
神经性厌食症（AN）和神经性贪食症（BN）在许多患者中都具有严重的病程和后果。在神经性厌食症中，死亡率几乎增加了18倍，包括高自杀率，约20%的病例病程呈慢性，超过一半的患者表现出完全或部分饮食失调，同时伴有另一种精神障碍或无饮食失调的另一种精神障碍。影响预后的因素包括疾病在青春期发病以及随访时间较长。呕吐、贪食和滥用泻药、慢性病程以及强迫特征在各种研究中均为不良预后因素。与神经性厌食症相比，神经性贪食症的长期预后仅略好；然而，死亡率较低。从神经性贪食症诊断转变为其他饮食失调是一种相当罕见的现象，而部分饮食失调的高发生率可能解释了很大一部分慢性病程。大多数受影响患者的社会适应和人际关系质量会恢复正常。目前，对神经性贪食症预后因素的研究尚无明确结论。
