Longitudinal comparison of anorexia nervosa subtypes

Abstract

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. © 2002 by Wiley Periodicals, Inc. Int J Eat Disord 31: 191–201, 2002; DOI. 10.1002/eat.10016