Follow-up Studies on Anorexia Nervosa : Family background and personality characteristics as predictors of poor long-term outcome(The Mid-term and Long-term Treatment of Eating Disorders)

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  • 神経性食思不振症の予後調査 : 遷延化予測因子としての家族背景と性格特徴(摂食障害の中・長期経過第30回日本心身医学会総会)
  • 神経性食思不振症の予後調査--遷延化予測因子としての家族背景と性格特徴
  • シンケイセイ ショクシ フシンショウ ノ ヨゴ チョウサ センエンカ ヨソク

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Seventy nine females with anorexia nervosa (AN) were followed up by postal questionnaire 2-12 years after their first consultation at Kyoto National Hospital. Their outcome was assessed using the global clinial score of Garfinkel et al. Scores of 0 to 3 were defined as "improved", 4 to 13 as "intermediate" and greater than 14 as "unimproved". The outcome showed improved in 31 (39.2%), intermediate in 29 (36.7%) and unimproved in 19 (24.1%). Sixteen of the unimproved, whose duration of illness was over 5 years were defined as having chronic AN. These patients had poor psycho-social adjustment as well as long lasting low body weight, amenorrhoea, and other physical conditions such as hypokalemia, elevated hepatic enzymes, parotid enlargement, arteriomesenteric duodenal occlusion and alopecia, and poor eating behavior. The factors that were significantly correlated with poor outcome were older age at first consultation, longer delay from onset to consultation, lower minimum body weight and bulimic behavior. Of the family background that we investigated, alcohol abuse and social mal-adjustment in the patients' fathers were significantly correlated with poor outcome. The personality characteristics of AN were examined using the Rorschach test in 13 patients with chronic AN and 15 improved patients. The Rorschach variables in chronic AN were found to have a greater number of responses scored "F-" than in the improved group The patients were classified into five groups according to their levels of ego-strength, which were determined by both form levels and how much they employed their primitive defenses. Ten of the 13 with chronic AN were categorized as belonging to group IV (suspected serious neuroses) or group V (suspected borderline personalities). On the other hand, 13 in the improved group were categorized as belonging to group I (suspected mild neuroses), group II or group III (suspected moderate neuroses). It is suggested that the borderline personalities and family background of AN should always be taken into account when deciding the method of treatment, as well as when assessing the final outcome of the patients. And counselling of the patients' mothers is also recommended as part of the treatment.

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