Death, survival and recovery in anorexia nervosa: A thirty five year study

1. This paper mainly addresses aspects of the fate of patients referred to the Middlesex Hospital (1960-1967) and St George's Hospital services (1967-1995) for anorexia nervosa and comprising the St George's anorexia nervosa database. They were afflicted, usually at presentation or else previously, with the kind of severe anorexia nervosa that used to reach and saturate the resources of the few regional/national secondary/tertiary referral centres that existed in the UK during at that time. Nearly all subsequently were treated within the service. 2. The condition, in severe form, is about as common as schizophrenia. More widely recognized these days, such severe cases probably continue to predominate in the slightly greater number of regional services that now exist. 3. If untreated or ineffectively treated, early death, often in the third or fourth decades of life, ensures a high mortality rate-three or fourfold that of the general population of comparable age. Such early deaths are most often due to suicide or the variety of idiosyncratic complications of the accompanying malnutrition. 4. A proven effective treatment can reduce mortality rates to a level similar to that of the general population. However, the main causes of death remain the same (suicide or malnutrition). 5. When suicide was the registered cause of death in the present series (18 cases), anorexia nervosa or other eating disorder was never mentioned as a risk factor, major or otherwise, though one or the other was probably nearly always present. 6. Anorexia nervosa and any unresolved after-math, still expressing itself as some kind of eating disorder, is an important risk factor for suicide in young adult females. 7. The same risk factor is present for males, but anorexia nervosa is rare in males. 8. Anorexia nervosa, though itself physically, socially and psychologically crippling and with its potentially high early death rate, protects the individual from certain other disorders/diseases that can cause disability and death. 9. Severe anorexia nervosa is compatible with longevity. 10. With the treatment referred to here, recovery from the condition enables robust fecundity, an antithesis of suicide, to be restored. 11. Anorexia nervosa is a crippling condition that is sometimes trivialized in the public's mind. As common as schizophrenia, it receives very much less attention and those suffering with it are provided with much less in the way of health care resources. As a major risk factor for suicide and one that can significantly often respond to treatment, it deserves greater serious public attention and dedicated services. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.