Joel Yager, MD

Risk for death was elevated with lifetime anorexia nervosa, longer illness duration, low body-mass index, and concurrent alcohol and substance abuse.

Although premature mortality is known to be frequent among patients with anorexia nervosa (AN) and bulimia nervosa (BN), little has been discovered about specific predictors of timing and other factors associated with risk for death. These investigators interviewed 246 patients with AN, BN, or both every 6 to 12 months for a median of 9 years; mortality was ascertained for a median of 20 years overall. Researchers determined standardized mortality ratios (SMRs; an age-adjusted ratio of observed-to-expected death rates in a population cohort).

SMR was significantly elevated with lifetime AN but not lifetime BN (SMRs: AN, 4.37; BN, 2.33). Risk for death was highest in patients with lifetime AN within the first 10 years of follow-up (SMR, 7.7). SMR increased with duration of illness (e.g., AN lasting >15–30 years: SMR, 6.6). In addition to illness duration, significant predictors of premature mortality included low body-mass index at last visit, poor social adjustment, and persistent alcohol abuse. All but 3 of the 16 recorded deaths occurred in patients between ages 35 and 48, and only 2 occurred in women with BN without AN; 4 deaths were directly attributed to suicide (SMR, 25.2), 2 were directly attributed to alcohol or other substance intoxication or abuse, and the remainder were attributed to various medical causes.

Citation(s):

Franko DL et al. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Am J Psychiatry 2013 Jun 17; [e-pub ahead of print].