Prognosis

The prognosis for AN is best when identification and treatment begin early in the illness course, and when full weight restoration is achieved. Recovery-focused treatment is always recommended, and recovery does occur, even among patients who have been ill for an extended period. Longer duration of follow-up and, to a lesser extent, younger age at onset, are associated with better outcomes.[127]​

Follow-up studies suggest that approximately 75% of adolescent patients with AN achieve full recovery, although time to recovery may be 3-5 years.[128] Relapse rates following acute weight restoration are substantial among adult patients, and chronic AN (also labelled 'severe and enduring AN') may develop in a significant minority of presenting patients.[128]

Long-term outcome

Studies of longer-term outcomes in AN suggest that recovery occurs in the majority of individuals who present for treatment during adolescence and young adulthood but sometimes after extended periods of illness. One study that followed individuals for a mean of 22 years after initial presentation found that 62.8% of individuals with AN recovered, compared with 31.4% that had recovered at 9 years following initial presentation.[129]

A different study that followed a sample of adolescents for 10-15 years reported that over 75% of patients recovered completely.[128] A study of 103 patients followed over 12 years showed that 88% of patients were still alive. Of those, 19% still had AN, 9.5% had bulimia nervosa purging type, 19% had eating disorder not otherwise specified, and 52.4% had recovered. In a literature review, poor prognosis in AN was linked to a lower initial weight, poor family relationships, male sex, purging, failure to respond to treatment, and a long duration of symptoms.[130]

Mortality

Mortality associated with AN is high, estimated at 5% per decade of illness.[131] Among psychiatric illnesses, AN has one of the highest premature mortality rates (with a risk of premature death of approximately 5-fold greater than that of peers).[32][33]​ Deaths are due primarily to medical complications or suicide.[34]​[35]​​

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