Increased Mortality in Bulimia Nervosa and Other Eating Disorders

Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Ave., Minneapolis, MN 55454, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 10/2009; 166(12):1342-6. DOI: 10.1176/appi.ajp.2009.09020247
Source: PubMed


Anorexia nervosa has been consistently associated with increased mortality, but whether this is true for other types of eating disorders is unclear. The goal of this study was to determine whether anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified are associated with increased all-cause mortality or suicide mortality.
Using computerized record linkage to the National Death Index, the authors conducted a longitudinal assessment of mortality over 8 to 25 years in 1,885 individuals with anorexia nervosa (N=177), bulimia nervosa (N=906), or eating disorder not otherwise specified (N=802) who presented for treatment at a specialized eating disorders clinic in an academic medical center.
Crude mortality rates were 4.0% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorder not otherwise specified. All-cause standardized mortality ratios were significantly elevated for bulimia nervosa and eating disorder not otherwise specified; suicide standardized mortality ratios were elevated for bulimia nervosa and eating disorder not otherwise specified.
Individuals with eating disorder not otherwise specified, which is sometimes viewed as a "less severe" eating disorder, had elevated mortality risks, similar to those found in anorexia nervosa. This study also demonstrated an increased risk of suicide across eating disorder diagnoses.

Full-text preview

Available from:
  • Source
    • "Papadopoulos et al. (2009) "
    [Show abstract] [Hide abstract]
    ABSTRACT: There has been a debate on the extent of the mortality in anorexia nervosa (AN), given different figures in the available studies investigating this topic. In an early meta-analysis investigating the mortality in AN entitled ‘Mortality in anorexia nervosa’, Patrick Sullivan (1995. Mortality in anorexia nervosa. American Journal of Psychiatry, 152(7), 1073–1074) pointed out that the true nature of the mortality rate over time associated with AN was masked by factors such as methodological limitations in the literature and the fact that normally only the crude mortality was reported, making the data difficult to interpret, and suggested the use of standardised mortality ratios as a means of adjusting the mortality rate for the number of expected deaths during the follow-up period. Sullivan's (1995. Mortality in Anorexia-Nervosa. American Journal of Psychiatry, 152(7), 1073–1074) paper has become the ninth most cited article in the field and 1 out of 34 citation classics, defined as an article with more than 400 citations. We look back at this seminal article to consider its relevance today and beyond it to see what we have learned since then about mortality in AN.
    Full-text · Article · May 2015
    • "(p. 1074) The crude mortality rate of the EDs is similar across all three diagnoses: 4.0% for AN, 3.9% for BN, and 5.2% for ED-NOS (Crow et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study the author reviews the current empirical research regarding Enhanced Cognitive Behavioral Therapy (CBT-E) in the treatment of the full range of eating disorders (EDs): anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. All peer-reviewed outcome studies identified through electronic bibliographic databases and manual searches of article reference lists are reviewed. A total of six studies (n = 6) were found. The author reports the results of these studies consisting of open-trials of CBT-E applied to different ED diagnoses, comparing two forms of CBT-E (focused and broad) to waitlist, and comparing CBT-E plus Motivation Focused Therapy. There is evidence to support the use of CBT-E for the treatment of EDs; however, this evidence is tentative as CBT-E is still in its early phases of empirical testing. No trials found CBT-E to be ineffective. Although these research designs are not randomized control trials, these results are promising for ED research. There are few efficacious treatments for EDs, especially for those with "chronic" EDs and adults with anorexia nervosa. CBT-E is one of the first interventions that focuses on particular symptomatic behaviors of EDs manifested in individual clients rather than treating ED diagnoses generically.
    No preview · Article · Jan 2015
  • Source
    • "Suicide accounts for about half of the deaths, whereas cardiac arrest is the main cause of mortality in the remainder (Birmingham, Su, Hlynsky, Goldner, & Gao, 2005). Mortality rates in BN are understudied, but some reports suggest rates approximating those of AN (Crow et al., 2009). Other significant medical problems common in adolescents with eating disorders include growth retardation, pubertal delay or interruption, and peak bone mass reduction (Modan-Moses et al., 2003; Olmos et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.
    Preview · Article · Jan 2015 · Journal of Clinical Child & Adolescent Psychology
Show more