Magazine article Clinical Psychiatry News
Eating Disorder Relapse Risk Linked to Self-Esteem, Motivation. (Impulsivity, Ego Syntonicity Influence Risk)
BERLIN -- Self-esteem, motivation, and impulsivity are key predictive factors in the outcome of eating disorder treatment, including the possibility of relapse, Dr. Katherine Halmi said at the Seventh World Congress of Biological Psychiatry.
Ego syntonicity also is strongly linked to relapse risk. "The highest rates occur in those who regard the illness an integral part of their personality," said Dr. Halmi of Cornell Medical Center in White Plains, N.Y.
The course of eating disorders tends to be problematic: 25% of patients with anorexia nervosa are expected to recover, 25% remain chronically ill, and 50% achieve partial improvement. Forty percent of those who recover will relapse. Ten-year mortality is 6.7%; 30-year mortality, 18%-20%. And, recovery and relapse rates with bulimia are not much better, she said.
A study that investigated prognostic factors followed 29 patients treated in an inpatient eating disorders unit. Seven patients, who were older than participants, but no different in eating disorder scores, dropped out of the program.
Among the 22 who completed the program, severe relapses (a return to DSM-IV criteria for eating disorders) and partial relapses (significant eating problems) over 5 years were more common in binging and purging anorectics than in restrictors.
Those who relapsed later had scored higher, at the conclusion of treatment, on scales that measured the time spent on, distress with, and lack of control over eating preoccupation and rituals. They scored lower in motivation (insight into and resistance to preoccupation and rituals), and had the highest ratings in ego syntonicity of their disorder.
Altogether, the strength of preoccupation, rituals, and motivation, and ego syntonicity predicted more than half the variance in relapse, Dr. …