Longitudinal comparison of anorexia nervosa subtypes

Int J Eat Disord. 2002 Mar;31(2):191-201. doi: 10.1002/eat.10016.


Objective: To compare patients with restricting anorexia nervosa (ANR) and binge/purge anorexia nervosa (ANBP) on measures of impulsivity, course, and outcome.

Methods: One hundred thirty-six treatment-seeking women with AN followed prospectively for 8-12 years were reclassified at intake as 51 ANRs and 85 ANBPs according to the DSM-IV subtyping classification. Lifetime Axis I and Axis II disorders were assessed using structured interviews; follow-up interviews were conducted at 6-12-month intervals to collect weekly data on eating disorder symptomatology.

Results: Women with ANR and ANBP did not differ on history of substance abuse, kleptomania, suicidality, or borderline personality diagnosis at intake, or on rates of recovery, relapse, or mortality. By 8 years of follow-up, 62% of women with ANR crossed over to ANBP prospectively and only 12% of women with AN never reported regular binge/purge behaviors.

Conclusions: The findings on impulsivity, course, and outcome do not support the current subtyping system. The high crossover rate in our sample from ANR to ANBP suggests that ANR represents a phase in the course of AN rather than a distinct subtype.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anorexia Nervosa / classification*
  • Anorexia Nervosa / diagnosis
  • Anorexia Nervosa / epidemiology
  • Anorexia Nervosa / psychology
  • Boston / epidemiology
  • Bulimia / classification*
  • Bulimia / diagnosis
  • Bulimia / epidemiology
  • Bulimia / psychology
  • Female
  • Humans
  • Impulsive Behavior / psychology
  • Likelihood Functions
  • Logistic Models
  • Manuals as Topic
  • Prospective Studies
  • Recurrence
  • Statistics, Nonparametric
  • Treatment Outcome