Full recovery from anorexia nervosa is slow, and women with the disease have close to a nine-fold increased risk of death, according to a new 12-year study of severely ill anorexia patients.

“The long-term course of anorexia nervosa is not very favorable,” Dr. Manfred M. Fichter of the Klinik Roseneck Hospital for Behavioral Medicine in Prien, Germany and colleagues report in the International Journal of Eating Disorders. “Much remains to be done to improve existing treatments and to make them more accessible to those reluctant to seek help.”

Fichter and his team followed 103 women who had been hospitalized for anorexia nervosa at an average age of about 25. The researchers point out that anorexia nervosa patients who are treated during adolescence fare much better than those who undergo treatment as adults, like the women in the current study. Patients in this study had unusually severe disease and some resistance to treatment, and most had attempted treatment previously.

Overall, the study participants fared worse in the 2 years following treatment, then showed gradual improvement over the next 10 years.

At 12 years after hospitalization, almost 30 percent of the study participants still had anorexia nervosa. Just over half had no major eating disorder. Overall outcome was good for 27.5 percent of patients, intermediate for 25.3 percent, and poor for 39.6 percent. Seven patients had died, all from causes related to the disease.

The researchers found that women who fared poorly were more likely to also have sexual problems and impulsivity. They also had suffered from their eating disorder longer before receiving treatment for the first time.

Overall mortality was 8.8 percent, the researchers found, nearly nine times higher than would be expected in a group of healthy women of the same age over the same time period. Other studies have found similar, “alarmingly high” mortality rates for anorexic patients treated during adulthood, they note.

SOURCE: International Journal of Eating Disorders, March 2006.