Clinical features of anorexia nervosa. A study of a consecutive series of 102 female patients.

Abstract The clinical features, treatment, course and outcome of a consecutive series of 102 anorexia nervosa patients are reported in detail. Data were gathered from systematic retrospective analysis of case records and follow-up assessments conducted after a mean lapse from presentation of 5.9 yr. The patients, all diagnosed according to strict criteria, were found to have a relatively long history of illness and half had failed to respond to previous psychiatric treatment. Over 80% of patients had an onset of illness within 7 yr of menarche, and on the whole the group was premorbidly obese. Over 70% came from professional and managerial class families, and 80% were described as compliant children. They had done well academically but were socially inept before onset of illness. A disturbed premorbid relationship between patient and parents was found in over half of the cases, and this was often related to a disturbed parental relationship. However, no specific anorectic family transactional pattern was found. Weight disorders were common amongst family members. Half of the patients were admitted for intensive inpatient treatment, 30% had outpatient psychotherapy, while 10% had no subsequent treatment following initial consultation. At follow-up nearly 80% had normal or near normal body weight and relatively normal menstruation had recurred in 70%. Nevertheless two-thirds of the patients still showed a highly variable dietary pattern and over 40% still worried intensely about their weight and shape. Other psychiatric symptoms, in particular depression and social phobia, were common but overshadowed by the persistent weight phobia. In general, those who had recovered in terms of weight and menses also had better psychiatric status and psychosocial as well as psychosexual adjustment. The overall length of illness was 4.6 yr in those who had recovered. Two patients had died. Aspects of clinical features, family characteristics and identity of the syndrome are discussed.