Risk and Resilience in Eating Disorders: Longitudinal Research Updates

“Hope you learn a lot, Dr. Attia!”

That was the “so long” I received from a teenager that I treat, at the end of our last session before my departure for this year’s conference of the Eating Disorders Research Society (EDRS) in Taormina, Italy.

Conferences are part of the rhythm of life for an academic psychiatrist. My work specializes in the study and treatment of eating disorders and conferences that focus on this specialty area are opportunities to catch up with colleagues from all over the world. We learn about each other’s work, both formally and informally. The presentations in which the newest study results are shared and the coffee-breaks, when colleagues might ask me for an update on a recently referred patient or studies for which we are currently recruiting, are equally important.

The theme of this year’s EDRS meeting was risk and resilience in eating disorders. Presentations were organized around genetic, biological, behavioral and environmental risks for eating disorders and highlighted available data regarding outcomes following diagnosis.

The presentations offered an impressive assembly of findings from studies that followed individuals with eating disorders who had participated in studies some years before. Dr. Deborah Franko from Harvard University presented data from a study that evaluated individuals with anorexia and bulimia nervosa twice yearly for ten years and then re-evaluated the participants 22 years following the initial presentation. Dr. Franko and her colleagues were able to capture information from an astounding 176 of the original 246 participants at the 22-year assessment point. I was impressed that nearly 63% of the individuals who had presented with anorexia nervosa and 68% of those with bulimia nervosa were fully recovered at this assessment point.

Another researcher, Dr. Anna Keski-Rakhonen, presented data from a community-based sample in Finland. In this study, individuals with eating disorders living in the community who may or may not have ever sought treatment for their conditions were identified. Among this group, 72% of those who met criteria for anorexia nervosa were found to have recovered entirely by 5 years following the initial assessment.

Those of us who care for patients usually focus on the severity of eating disorders, the importance of early identification and intervention, and how to minimize the very real risk of relapse. We know that anorexia nervosa is associated with high rates of medical complication and death, and we emphasize this when we engage our patients in treatments. The fact that sizeable numbers of individuals with this same illness are expected to recover fully is not as commonly known, and my colleagues at EDRS contributed importantly to the part of the story that follows diagnosis, and possibly follows treatment, by several years.

Questions remain about who recovers and who remains affected by illness. Dr. Franko mentioned that 15 of the individuals in her study originally diagnosed with AN reported active symptoms of AN at every assessment point over the 22 years of information. Understanding more about who is at risk for this severe and enduring variety of the illness is essential as we identify who needs treatment and which treatments in the course of having anorexia nervosa.

I returned home to greet my patient with the information that I took away from the EDRS conference. What followed was an interesting discussion about the ongoing process of learning, and the shared sentiment that there are so many more questions that need answering.

We at the Columbia Center for Eating Disorders are hoping to contribute meaningfully to the conversation about long-term outcome in individuals with eating disorders. We are in the midst of a 10-year longitudinal study which involves a brief, annual phone check-in with patients who received treatment for anorexia or bulimia nervosa in our inpatient program. We look forward to speaking with the patients we’ve worked with each year, and we are also looking forward to sharing the story of whatever our findings tell us at a conference in the years to come.

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