Eating disorders can come back later in life
Two out of three people who had anorexia in adolescence were completely healthy, but some still struggled with eating disorders when they were middle aged, according to a study that has followed 47 Swedes over 30 years.
Eating disorders can be difficult to treat, as anyone who has struggled with this problem can attest. But a new study suggests that the disorder can continue to plague some people well into middle age.
The Swedish researchers behind the study followed 47 young people with anorexia for 30 years. Although the overall outcomes for participants were good — there was no mortality in the group, and 64 per cent had a full recovery from their eating disorder symptoms — one in five was still found to have a chronic eating disorder.
“Thirty years of follow-up is fantastic,” says Inger Halvorsen, a specialist in child and adolescent psychiatry who studies eating disorders at Oslo University Hospital. She has also previously treated patients with eating disorders.
Halvorsen believes the study provides very important knowledge about anorexia that starts in adolescence.
Halvorsen herself and colleagues have studied young people with eating disorders nine years on average after receiving treatment at a hospital in Buskerud. This is the longest follow-up of young people with anorexia in Norway, Halvorsen says.
The Swedish study is unique in that it is based on a whole class of high school pupils from Gothenburg in 1985.
The students answered a questionnaire and underwent a health check. The researchers found that 24 had anorexia, but four declined to participate in the final follow-up interview 30 years later.
They also selected 27 young people with eating disorders from the local community, which eventually resulted in a total of 47 participants, one male and the rest female. They were compared to the same number who did not have eating disorders.
In spite of the length of the study, the actual number of participants is quite low, the researchers point out.
Age of onset matters
The youths were around 16 years old when the study began. The disease began when they were on average just over 14 years old.
The researchers examined the participants five times until they were middle-aged. This allowed them to follow the development of each individual's illness.
Typically, researchers study eating disorders in patients who are being treated. Sometimes some people die from the disease in these studies.
However, the Swedish study reported no deaths. But the proportion of healthy individuals after 30 years was about the same as in studies of patients after 20-22 years from other countries.
One important distinction is how researchers define what as a healthy outcome.
In a Swedish study from 1985, as many as 76 percent were described as healthy after 33 years. But during the course of the study, 18 per cent had died.
Two out of three were healthy
The researchers behind the new study expected more to become healthy over the years, because they recruited participants from outside the health care system, and thus the participants may not have been as sick as those already being treated.
On the other hand, every fourth participant in the new study never received treatment at all, although they might have had an equally severe form of anorexia as those who were treated.
Nevertheless, the study found that two out of three participants were healthy, which is good, says Elisabet Wentz. Wentz is a professor at the University of Gothenburg and was one of the researchers behind the study.
“When the survey began in 1985, there were no special units for eating disorders in Sweden. The first began in the 1990s. This is one of the reasons why many did not received help. But it is also because many people with anorexia do not want help or to gain weight,” Wentz wrote in an e-mail.
Some developed anorexia again
In fact, there were no differences in outcome between people who got treatment and those who did not. But because the researchers weren’t looking at treatment per se, they can’t explain this outcome.
Treatments have likely improved over the years, Halvorsen says. And those who were not seriously underweight may have received help from family or others instead.
Halvorsen also thinks that the results are good news, especially because no one died of the disease.
In addition, the few participants who had anorexia at the 18 year check-up had no eating disorder at the 30-year follow-up.
"One can thus recover from anorexia even if one has had this serious illness both in adolescence and during a large percentage of adulthood," she wrote in an e-mail.
However, the study did show that other participants developed anorexia again.
It can take a long time to recover from anorexia, and there is a risk of relapse.
The Swedish study shows how recovery does not necessarily mean that you are free from the disease for the rest of your life.
After five years, the majority of the study participants did not have anorexia. But some had developed other eating disorders, such as bulimia, instead.
Others became completely healthy, but later relapsed into anorexia — even after being healthy for many years.
On average, participants struggled for ten years with an eating disorder, on and off.
The Swedish researchers were surprised that in their study, there were actually more people who had anorexia at the 30-year follow-up than 18 years after the study started.
This result may simply reflect the number of relapses at the exact time the researchers made their follow-up evaluation, Wentz believes.
“We saw that over the last twelve years, every third person at one time or another met the eating disorder criteria,” she said.