Mortality and its predictors in severe bulimia nervosa patients.

BACKGROUND: The risk of mortality remains unclear for bulimia nervosa (BN) patients, especially the most severe. The aims of this study were to improve knowledge on BN and mortality. METHODS: With initial evaluation at admission, 258 BN (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) consecutive inpatients were included (1988-2004). Vital status was established from the French national register. Standardized Mortality Ratio (SMR) calculation and bivariate Cox analysis were performed for the hypothesised predictors of mortality. RESULTS: Mean follow-up duration was 10.5 years. Ten deaths were recorded, and the crude mortality ratio was 3.9%; SMR = 5.52 [CI95 (2.64-10.15)]. The majority of deaths were from suicide [6/10, SMR = 30.9 (5.7-68.7)]. The mean age at time of death was 29.6 years. Predictive factors were previous suicide attempt and low minimum BMI. CONCLUSIONS: Severe BN patients are at higher risk of death (mainly suicide) especially if previous suicide attempt or previous low BMI. More studies are needed to confirm these results.

Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors.

Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.

Outcomes of empirical eating disorder phenotypes in a clinical female sample: results from a latent class analysis.

BACKGROUND/AIMS: To empirically classify phenotypes of eating disorders (ED) using latent class analysis (LCA), and to validate this classification based on clinical outcomes. METHODS: LCA was applied to 968 inpatients. The resultant classes were validated by clinical outcomes including mortality. RESULTS: A 5-class solution showed the best fit. The symptoms of latent class 1 (LC1; 26% of the sample) resembled anorexia nervosa (AN), bingeing-purging (AN-B/P) subtype; those of LC2 (23%) resembled bulimia nervosa; those of LC3 (11%) were close to AN-B/P without weight and body concerns; those of LC4 resembled restrictive anorexia nervosa (RAN) without weight and body concerns, and those of LC5 RAN. A history of hospitalization for ED was significantly more frequent for LC3 and LC4. The lowest BMI at admission were presented in LC4. LC1 showed the highest level of psychological disturbances and LC4 the lowest. LC3 and LC4 differed from LC1 and LC5 by higher percentages of treatment dropout (64.9 vs. 57.2 and 55.7 vs. 47.5%, respectively; overall p = 0.001). Survival rates tended to be different between the LC (p = 0.09). CONCLUSIONS: Subgroups of AN patients with low weight and body concerns seem more severe at hospitalization and more difficult to manage, with a higher rate of treatment dropout than the 'typical' AN patients.

Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample.

Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).

Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders.

OBJECTIVE: The objective of the present study was to identify factors associated with suicidal behaviors among patients with eating disorders. METHOD: A large database including sociodemographic and clinical characteristics of 1,009 consecutive patients hospitalized for an eating disorder in Paris, France, was examined. Data gathered upon admission to hospital were analyzed to identify factors associated with a history of suicide attempt or current suicidal ideation, among the whole sample as well as among each subtype of eating disorder. RESULTS: Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use. CONCLUSION: Suicide risk should be monitored carefully among patients with eating disorders, paying particular attention to combinations of risk factors.