Fairburn C G, Norman P A, Welch S L, O'Connor M E, Doll H A, Peveler R C
Department of Psychiatry, University of Oxford Hospital, England.
Arch Gen Psychiatry. 1995 Apr;52(4):304-12. doi: 10.1001/archpsyc.1995.03950160054010.
Little is known about the longer-term outcome of bulimia nervosa and the distal effects of treatment.
Prospective follow-up of subjects from two randomized controlled trials, involving a comparison of cognitive behavior therapy, behavior therapy, and focal interpersonal therapy.
Ninety percent (89/99) underwent reassessment by interview (mean [+/- SD] length of follow-up, 5.8 +/- 2.0 years). Almost half (46%) had a DSM-IV eating disorder; 19%, bulimia nervosa; 3%, anorexia nervosa; and 24%, eating disorder not otherwise specified. There was a low rate of other psychiatric disorders. Premorbid and paternal obesity predicted a poor outcome. While the three treatments did not differ with respect to the proportion of subjects with anorexia nervosa or bulimia nervosa at follow-up, they did differ once all forms of DSM-IV eating disorder were considered together. Those who had received cognitive behavior therapy or focal interpersonal therapy were doing markedly better than those who had received behavior therapy.
The longer-term outcome of bulimia nervosa depends on the nature of the treatment received. Patients who receive a treatment such as behavior therapy, which only has a short-lived effect, tend to do badly, whereas those who receive treatments such as cognitive behavior therapy or focal interpersonal therapy have a better prognosis.
关于神经性贪食症的长期预后以及治疗的远期效果，人们了解甚少。
对两项随机对照试验的受试者进行前瞻性随访，试验涉及认知行为疗法、行为疗法和焦点人际疗法的比较。
90%（89/99）的受试者接受了访谈重新评估（随访的平均[±标准差]时长为5.8±2.0年）。近半数（46%）患有《精神疾病诊断与统计手册》第四版（DSM-IV）中的进食障碍；19%为神经性贪食症；3%为神经性厌食症；24%为未另行规定的进食障碍。其他精神疾病的发病率较低。病前肥胖和父亲肥胖预示着预后不良。虽然三种治疗方法在随访时神经性厌食症或神经性贪食症患者的比例方面没有差异，但将所有形式的DSM-IV进食障碍综合考虑时，它们存在差异。接受认知行为疗法或焦点人际疗法的患者比接受行为疗法的患者情况明显更好。
神经性贪食症的长期预后取决于所接受治疗的性质。接受如行为疗法这种仅有短期效果治疗的患者往往预后较差，而接受如认知行为疗法或焦点人际疗法治疗的患者预后较好。
