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Semin Reprod Med 2022; 40(01/02): 079-086
DOI: 10.1055/s-0042-1742326
Review Article

The Reproductive Impact of Eating Disorders in Adolescents

Kelly A. Curran
1   Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
,
Paulette D. Pitt
2   Department of Education and Psychology, East Central University, Ada, Oklahoma
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Abstract

Eating disorders are common, chronic illnesses that frequently arise during adolescence. Because of the impact on nutrition, individuals with eating disorders have significant health consequences, including effects on reproductive health. Adolescent women with eating disorders frequently have menstrual irregularities, though the causes of these abnormalities are complex and vary depending on the type of eating disorder. Teens with eating disorders may have changes in current and future fertility, and eating disorders during pregnancy can have medical and psychologic impacts for both mother and child. Though not well researched, eating disorders in men can affect reproductive health and potentially impact fertility. Lastly, eating disorders in adolescents can have significantly deleterious, irreversible effects on bone health.

Keywords

eating disorders - reproductive health - amenorrhea - adolescents


Publication History

Article published online:
24 January 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013
    CrossrefGoogle Scholar
  • 2 Lindvall Dahlgren C, Wisting L. Transitioning from DSM-IV to DSM-5: a systematic review of eating disorder prevalence assessment. Int J Eat Disord 2016; 49 (11) 975-997
    CrossrefPubMedGoogle Scholar
  • 3 Bulik CM, Sullivan PF, Tozzi F, Furberg H, Lichtenstein P, Pedersen NL. Prevalence, heritability, and prospective risk factors for anorexia nervosa. Arch Gen Psychiatry 2006; 63 (03) 305-312
    CrossrefPubMedGoogle Scholar
  • 4 Keski-Rahkonen A, Hoek HW, Susser ES. et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 2007; 164 (08) 1259-1265
    CrossrefPubMedGoogle Scholar
  • 5 Wade TD, Bergin JL, Tiggemann M, Bulik CM, Fairburn CG. Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort. Aust N Z J Psychiatry 2006; 40 (02) 121-128
    CrossrefPubMedGoogle Scholar
  • 6 Norris ML, Robinson A, Obeid N, Harrison M, Spettigue W, Henderson K. Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord 2014; 47 (05) 495-499
    CrossrefPubMedGoogle Scholar
  • 7 Fisher MM, Rosen DS, Ornstein RM. et al. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. J Adolesc Health 2014; 55 (01) 49-52
    CrossrefPubMedGoogle Scholar
  • 8 Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord 2014; 2 (01) 21
    CrossrefPubMedGoogle Scholar
  • 9 Strandjord SE, Sieke EH, Richmond M, Rome ES. Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency. J Adolesc Health 2015; 57 (06) 673-678
    CrossrefPubMedGoogle Scholar
  • 10 Mountjoy M, Sundgot-Borgen J, Burke L. et al. The IOC consensus statement: beyond the Female Athlete Triad–Relative Energy Deficiency in Sport (RED-S). Br J Sports Med 2014; 48 (07) 491-497
    CrossrefPubMedGoogle Scholar
  • 11 Mountjoy M, Sundgot-Borgen J, Burke L. et al. International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update. Int J Sport Nutr Exerc Metab 2018; 28 (04) 316-331
    CrossrefPubMedGoogle Scholar
  • 12 Vyver E, Steinegger C, Katzman DK. Eating disorders and menstrual dysfunction in adolescents. Ann N Y Acad Sci 2008; 1135: 253-264
    CrossrefPubMedGoogle Scholar
  • 13 Warren MP. Endocrine manifestations of eating disorders. J Clin Endocrinol Metab 2011; 96 (02) 333-343
    CrossrefPubMedGoogle Scholar
  • 14 Poyastro Pinheiro A, Thornton LM, Plotonicov KH. et al. Patterns of menstrual disturbance in eating disorders. Int J Eat Disord 2007; 40 (05) 424-434
    CrossrefPubMedGoogle Scholar
  • 15 Frisch RE, Gotz-Welbergen AV, McArthur JW. et al. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. JAMA 1981; 246 (14) 1559-1563
    CrossrefPubMedGoogle Scholar
  • 16 Warren MP. The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 1980; 51 (05) 1150-1157
    CrossrefPubMedGoogle Scholar
  • 17 Keery H, LeMay-Russell S, Barnes TL. et al. Attributes of children and adolescents with avoidant/restrictive food intake disorder. J Eat Disord 2019; 7: 31
    CrossrefPubMedGoogle Scholar
  • 18 Aulinas A, Marengi DA, Galbiati F. et al. Medical comorbidities and endocrine dysfunction in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls. Int J Eat Disord 2020; 53 (04) 631-636
    CrossrefPubMedGoogle Scholar
  • 19 Harshman SG, Wons O, Rogers MS. et al. A diet high in processed foods, total carbohydrates and added sugars, and low in vegetables and protein is characteristic of youth with avoidant/restrictive food intake disorder. Nutrients 2019; 11 (09) 11
    CrossrefPubMedGoogle Scholar
  • 20 Gendall KA, Bulik CM, Joyce PR, McIntosh VV, Carter FA. Menstrual cycle irregularity in bulimia nervosa. Associated factors and changes with treatment. J Psychosom Res 2000; 49 (06) 409-415
    CrossrefPubMedGoogle Scholar
  • 21 Algars M, Huang L, Von Holle AF. et al. Binge eating and menstrual dysfunction. J Psychosom Res 2014; 76 (01) 19-22
    CrossrefPubMedGoogle Scholar
  • 22 Morgan JF, McCluskey SE, Brunton JN, Hubert Lacey J. Polycystic ovarian morphology and bulimia nervosa: a 9-year follow-up study. Fertil Steril 2002; 77 (05) 928-931
    CrossrefPubMedGoogle Scholar
  • 23 Michelmore KF, Balen AH, Dunger DB. Polycystic ovaries and eating disorders: Are they related?. Hum Reprod 2001; 16 (04) 765-769
    CrossrefPubMedGoogle Scholar
  • 24 Naessén S, Carlström K, Garoff L, Glant R, Hirschberg AL. Polycystic ovary syndrome in bulimic women–an evaluation based on the new diagnostic criteria. Gynecol Endocrinol 2006; 22 (07) 388-394
    CrossrefPubMedGoogle Scholar
  • 25 Austin SB, Ziyadeh NJ, Vohra S. et al. Irregular menses linked to vomiting in a nonclinical sample: findings from the National Eating Disorders Screening Program in high schools. J Adolesc Health 2008; 42 (05) 450-457
    CrossrefPubMedGoogle Scholar
  • 26 Sawyer SM, Whitelaw M, Le Grange D, Yeo M, Hughes EK. Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics 2016; 137 (04) 137
    CrossrefPubMedGoogle Scholar
  • 27 Diaz A, Laufer MR, Breech LL. American Academy of Pediatrics Committee on Adolescence, American College of Obstetricians and Gynecologists Committee on Adolescent Health Care. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics 2006; 118 (05) 2245-2250
    CrossrefPubMedGoogle Scholar
  • 28 Bachrach LK, Guido D, Katzman D, Litt IF, Marcus R. Decreased bone density in adolescent girls with anorexia nervosa. Pediatrics 1990; 86 (03) 440-447
    CrossrefPubMedGoogle Scholar
  • 29 Golden NH, Jacobson MS, Schebendach J, Solanto MV, Hertz SM, Shenker IR. Resumption of menses in anorexia nervosa. Arch Pediatr Adolesc Med 1997; 151 (01) 16-21
    CrossrefPubMedGoogle Scholar
  • 30 Faust JP, Goldschmidt AB, Anderson KE. et al. Resumption of menses in anorexia nervosa during a course of family-based treatment. J Eat Disord 2013; 1: 12
    CrossrefPubMedGoogle Scholar
  • 31 Dempfle A, Herpertz-Dahlmann B, Timmesfeld N. et al. Predictors of the resumption of menses in adolescent anorexia nervosa. BMC Psychiatry 2013; 13: 308
    CrossrefPubMedGoogle Scholar
  • 32 Seetharaman S, Golden NH, Halpern-Felsher B, Peebles R, Payne A, Carlson JL. Effect of a prior history of overweight on return of menses in adolescents with eating disorders. J Adolesc Health 2017; 60 (04) 469-471
    CrossrefPubMedGoogle Scholar
  • 33 Rastogi R, Sieke EH, Nahra A, Sabik J, Rome ES. Return of menses in previously overweight patients with eating disorders. J Pediatr Adolesc Gynecol 2020; 33 (02) 133-138
    CrossrefPubMedGoogle Scholar
  • 34 Misra M, Klibanski A. Endocrine consequences of anorexia nervosa. Lancet Diabetes Endocrinol 2014; 2 (07) 581-592
    CrossrefPubMedGoogle Scholar
  • 35 Kohmura H, Miyake A, Aono T, Tanizawa O. Recovery of reproductive function in patients with anorexia nervosa: a 10-year follow-up study. Eur J Obstet Gynecol Reprod Biol 1986; 22 (5-6): 293-296
    CrossrefPubMedGoogle Scholar
  • 36 Wassenaar E, Friedman J, Mehler PS. Medical complications of binge eating disorder. Psychiatr Clin North Am 2019; 42 (02) 275-286
    CrossrefPubMedGoogle Scholar
  • 37 Harrison ME, Balasubramanaiam B, Robinson A, Norris ML. Adolescent pregnancy and eating disorders: a minireview and case report. Eat Weight Disord 2018; 23 (03) 389-393
    CrossrefPubMedGoogle Scholar
  • 38 Foster JE, Jenkins ME. A schoolgirl with onset of anorexia nervosa during a concealed pregnancy. Br J Psychiatry 1987; 150: 551-553
    CrossrefPubMedGoogle Scholar
  • 39 Tabler J, Utz RL, Smith KR, Hanson HA, Geist C. Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. Int J Eat Disord 2018; 51 (02) 102-111
    CrossrefPubMedGoogle Scholar
  • 40 Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Reproductive health outcomes in eating disorders. Int J Eat Disord 2013; 46 (08) 826-833
    CrossrefPubMedGoogle Scholar
  • 41 Lindeman R, Hakko H, Riipinen P. et al. Reproductive health outcomes among eating disordered females: a register-based follow-up study among former adolescent psychiatric inpatients. J Psychosom Obstet Gynaecol 2020; DOI: 10.1080/0167482x.2020.1759544.
    CrossrefPubMedGoogle Scholar
  • 42 Easter A, Treasure J, Micali N. Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon Longitudinal Study of Parents and Children. BJOG 2011; 118 (12) 1491-1498
    CrossrefPubMedGoogle Scholar
  • 43 Chaer R, Nakouzi N, Itani L. et al. Fertility and reproduction after recovery from anorexia nervosa: a systematic review and meta-analysis of long-term follow-up studies. Diseases 2020; 8 (04) 8
    CrossrefPubMedGoogle Scholar
  • 44 Bulik CM, Hoffman ER, Von Holle A, Torgersen L, Stoltenberg C, Reichborn-Kjennerud T. Unplanned pregnancy in women with anorexia nervosa. Obstet Gynecol 2010; 116 (05) 1136-1140
    CrossrefPubMedGoogle Scholar
  • 45 Bulik CM, Sullivan PF, Fear JL, Pickering A, Dawn A, McCullin M. Fertility and reproduction in women with anorexia nervosa: a controlled study. J Clin Psychiatry 1999; 60 (02) 130-135 , quiz 135–137
    CrossrefPubMedGoogle Scholar
  • 46 Siega-Riz AM, Von Holle A, Haugen M. et al. Gestational weight gain of women with eating disorders in the Norwegian pregnancy cohort. Int J Eat Disord 2011; 44 (05) 428-434
    CrossrefPubMedGoogle Scholar
  • 47 Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Pregnancy, obstetric, and perinatal health outcomes in eating disorders. Am J Obstet Gynecol 2014; 211 (04) 392.e1-392.e8
    CrossrefPubMedGoogle Scholar
  • 48 Dörsam AF, Preißl H, Micali N, Lörcher SB, Zipfel S, Giel KE. The impact of maternal eating disorders on dietary intake and eating patterns during pregnancy: a systematic review. Nutrients 2019; 11 (04) 11
    CrossrefPubMedGoogle Scholar
  • 49 Easter A, Bye A, Taborelli E. et al. Recognising the symptoms: how common are eating disorders in pregnancy?. Eur Eat Disord Rev 2013; 21 (04) 340-344
    CrossrefPubMedGoogle Scholar
  • 50 Newton MS, Chizawsky LL. Treating vulnerable populations: the case of eating disorders during pregnancy. J Psychosom Obstet Gynaecol 2006; 27 (01) 5-7
    CrossrefPubMedGoogle Scholar
  • 51 Bulik CM, Von Holle A, Hamer R. et al. Patterns of remission, continuation and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa). Psychol Med 2007; 37 (08) 1109-1118
    CrossrefPubMedGoogle Scholar
  • 52 Micali N, Treasure J. Biological effects of a maternal ED on pregnancy and foetal development: a review. Eur Eat Disord Rev 2009; 17 (06) 448-454
    CrossrefPubMedGoogle Scholar
  • 53 Crow SJ, Agras WS, Crosby R, Halmi K, Mitchell JE. Eating disorder symptoms in pregnancy: a prospective study. Int J Eat Disord 2008; 41 (03) 277-279
    CrossrefPubMedGoogle Scholar
  • 54 Blais MA, Becker AE, Burwell RA. et al. Pregnancy: outcome and impact on symptomatology in a cohort of eating-disordered women. Int J Eat Disord 2000; 27 (02) 140-149
    CrossrefPubMedGoogle Scholar
  • 55 Micali N, Treasure J, Simonoff E. Eating disorders symptoms in pregnancy: a longitudinal study of women with recent and past eating disorders and obesity. J Psychosom Res 2007; 63 (03) 297-303
    CrossrefPubMedGoogle Scholar
  • 56 Crow SJ, Keel PK, Thuras P, Mitchell JE. Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa. Int J Eat Disord 2004; 36 (02) 220-223
    CrossrefPubMedGoogle Scholar
  • 57 Lacey JH, Smith G. Bulimia nervosa. The impact of pregnancy on mother and baby. Br J Psychiatry 1987; 150: 777-781
    CrossrefPubMedGoogle Scholar
  • 58 Morgan JF. Eating disorders and reproduction. Aust N Z J Obstet Gynaecol 1999; 39 (02) 167-173
    CrossrefPubMedGoogle Scholar
  • 59 Lemberg R, Phillips J. The impact of pregnancy on anorexia nervosa and bulimia. Int J Eat Disord 1989; 8: 285-295
    CrossrefPubMedGoogle Scholar
  • 60 Soares RM, Nunes MA, Schmidt MI. et al. Inappropriate eating behaviors during pregnancy: prevalence and associated factors among pregnant women attending primary care in southern Brazil. Int J Eat Disord 2009; 42 (05) 387-393
    CrossrefPubMedGoogle Scholar
  • 61 Siega-Riz AM, Haugen M, Meltzer HM. et al. Nutrient and food group intakes of women with and without bulimia nervosa and binge eating disorder during pregnancy. Am J Clin Nutr 2008; 87 (05) 1346-1355
    CrossrefPubMedGoogle Scholar
  • 62 Micali N, Northstone K, Emmett P, Naumann U, Treasure JL. Nutritional intake and dietary patterns in pregnancy: a longitudinal study of women with lifetime eating disorders. Br J Nutr 2012; 108 (11) 2093-2099
    CrossrefPubMedGoogle Scholar
  • 63 Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, Marcks B. The reciprocal effects of eating disorders and the postpartum period: a review of the literature and recommendations for clinical care. J Womens Health (Larchmt) 2008; 17 (02) 227-239
    CrossrefPubMedGoogle Scholar
  • 64 Walker LO. Weight-related distress in the early months after childbirth. West J Nurs Res 1998; 20 (01) 30-44
    CrossrefPubMedGoogle Scholar
  • 65 Stein A, Fairburn CG. Eating habits and attitudes in the postpartum period. Psychosom Med 1996; 58 (04) 321-325
    CrossrefPubMedGoogle Scholar
  • 66 Franko DL, Blais MA, Becker AE. et al. Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry 2001; 158 (09) 1461-1466
    CrossrefPubMedGoogle Scholar
  • 67 Hudson JI, Hiripi E, Pope Jr HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61 (03) 348-358
    CrossrefPubMedGoogle Scholar
  • 68 Narla A, Kaiser K, Tannock LR. Extremely low testosterone due to relative energy deficiency in sport: a case report. AACE Clin Case Rep 2018; 5 (02) e129-e131
    CrossrefPubMedGoogle Scholar
  • 69 Coelho JS, Lee T, Karnabi P. et al. Eating disorders in biological males: clinical presentation and consideration of sex differences in a pediatric sample. J Eat Disord 2018; 6: 40
    CrossrefPubMedGoogle Scholar
  • 70 Skolnick A, Schulman RC, Galindo RJ, Mechanick JI. The endocrinopathies of male anorexia nervosa: case series. AACE Clin Case Rep 2016; 2 (04) e351-e357
    CrossrefPubMedGoogle Scholar
  • 71 Wheeler MJ, Crisp AH, Hsu LK, Chen CN. Reproductive hormone changes during weight gain in male anorectics. Clin Endocrinol (Oxf) 1983; 18 (04) 423-429
    CrossrefPubMedGoogle Scholar
  • 72 Brinch M, Isager T, Tolstrup K. Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women. Acta Psychiatr Scand 1988; 77 (05) 611-617
    CrossrefPubMedGoogle Scholar
  • 73 Lindblad F, Lindberg L, Hjern A. Anorexia nervosa in young men: a cohort study. Int J Eat Disord 2006; 39 (08) 662-666
    CrossrefPubMedGoogle Scholar
  • 74 Loud KJ, Gordon CM. Adolescent bone health. Arch Pediatr Adolesc Med 2006; 160 (10) 1026-1032
    CrossrefPubMedGoogle Scholar
  • 75 Norris ML, Apsimon M, Harrison M. et al. An examination of medical and psychological morbidity in adolescent males with eating disorders. Eat Disord 2012; 20 (05) 405-415
    CrossrefPubMedGoogle Scholar
  • 76 Misra M, Aggarwal A, Miller KK. et al. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics 2004; 114 (06) 1574-1583
    CrossrefPubMedGoogle Scholar
  • 77 Misra M, Katzman DK, Cord J. et al. Bone metabolism in adolescent boys with anorexia nervosa. J Clin Endocrinol Metab 2008; 93 (08) 3029-3036
    CrossrefPubMedGoogle Scholar
  • 78 Schorr M, Drabkin A, Rothman MS. et al. Bone mineral density and estimated hip strength in men with anorexia nervosa, atypical anorexia nervosa and avoidant/restrictive food intake disorder. Clin Endocrinol (Oxf) 2019; 90 (06) 789-797
    CrossrefPubMedGoogle Scholar
  • 79 Lucas AR, Melton III LJ, Crowson CS, O'Fallon WM. Long-term fracture risk among women with anorexia nervosa: a population-based cohort study. Mayo Clin Proc 1999; 74 (10) 972-977
    CrossrefPubMedGoogle Scholar
  • 80 Nagata JM, Golden NH, Peebles R. et al. Assessment of sex differences in bone deficits among adolescents with anorexia nervosa. Int J Eat Disord 2017; 50 (04) 352-358
    CrossrefPubMedGoogle Scholar
  • 81 Nagata JM, Carlson JL, Golden NH, Long J, Murray SB, Peebles R. Comparisons of bone density and body composition among adolescents with anorexia nervosa and atypical anorexia nervosa. Int J Eat Disord 2019; 52 (05) 591-596
    CrossrefPubMedGoogle Scholar
  • 82 Alberts Z, Fewtrell M, Nicholls DE, Biassoni L, Easty M, Hudson LD. Bone mineral density in anorexia nervosa versus avoidant restrictive food intake disorder. Bone 2020; 134: 115307
    CrossrefPubMedGoogle Scholar
  • 83 Misra M, Prabhakaran R, Miller KK. et al. Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. J Clin Endocrinol Metab 2008; 93 (04) 1231-1237
    CrossrefPubMedGoogle Scholar
  • 84 Gordon CM, Grace E, Emans SJ. et al. Effects of oral dehydroepiandrosterone on bone density in young women with anorexia nervosa: a randomized trial. J Clin Endocrinol Metab 2002; 87 (11) 4935-4941
    CrossrefPubMedGoogle Scholar
  • 85 Strokosch GR, Friedman AJ, Wu SC, Kamin M. Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in adolescent females with anorexia nervosa: a double-blind, placebo-controlled study. J Adolesc Health 2006; 39 (06) 819-827
    CrossrefPubMedGoogle Scholar
  • 86 Miller KK, Meenaghan E, Lawson EA. et al. Effects of risedronate and low-dose transdermal testosterone on bone mineral density in women with anorexia nervosa: a randomized, placebo-controlled study. J Clin Endocrinol Metab 2011; 96 (07) 2081-2088
    CrossrefPubMedGoogle Scholar
  • 87 Misra M, Katzman D, Miller KK. et al. Physiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa. J Bone Miner Res 2011; 26 (10) 2430-2438
    CrossrefPubMedGoogle Scholar
  • 88 Gordon CM, Ackerman KE, Berga SL. et al. Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017; 102 (05) 1413-1439
    CrossrefPubMedGoogle Scholar
  • 89 Golden NH, Iglesias EA, Jacobson MS. et al. Alendronate for the treatment of osteopenia in anorexia nervosa: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 2005; 90 (06) 3179-3185
    CrossrefPubMedGoogle Scholar
  • 90 Herpertz-Dahlmann B, Müller B, Herpertz S, Heussen N, Hebebrand J, Remschmidt H. Prospective 10-year follow-up in adolescent anorexia nervosa–course, outcome, psychiatric comorbidity, and psychosocial adaptation. J Child Psychol Psychiatry 2001; 42 (05) 603-612
    CrossrefPubMedGoogle Scholar
  • 91 Strober M, Freeman R, Morrell W. The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study. Int J Eat Disord 1997; 22 (04) 339-360
    CrossrefPubMedGoogle Scholar