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Stressful life events predict eating disorder relapse following remission: Six‐year prospective outcomes
Author(s) -
Grilo Carlos M.,
Pagano Maria E.,
Stout Robert L.,
Markowitz John C.,
Ansell Emily B.,
Pinto Anthony,
Zanarini Mary C.,
Yen Shirley,
Skodol Andrew E.
Publication year - 2012
Publication title -
international journal of eating disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 138
eISSN - 1098-108X
pISSN - 0276-3478
DOI - 10.1002/eat.20909
Subject(s) - psychology , bulimia nervosa , eating disorders , comorbidity , psychiatry , proportional hazards model , hazard ratio , personality disorders , personality , clinical psychology , medicine , confidence interval , social psychology
Objective: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not‐otherwise‐specified (EDNOS) and test for the effects of stressful life events (SLE) on relapse after remission from these eating disorders. Method: 117 female patients with BN ( N = 35) or EDNOS ( N = 82) were prospectively followed for 72 months using structured interviews performed at baseline, 6‐ and 12‐months, and then yearly thereafter. ED were assessed with the structured clinical interview for DSM‐IV, and monitored over time with the longitudinal interval follow‐up evaluation. Personality disorders were assessed with the diagnostic interview for DSM‐IV‐personality‐disorders, and monitored over time with the follow‐along‐version. The occurrence and specific timing of SLE were assessed with the life events assessment interview. Cox proportional‐hazard‐regression‐analyses tested associations between time‐varying levels of SLE and ED relapse, controlling for comorbid psychiatric disorders, ED duration, and time‐varying personality‐disorder status. Results: ED relapse probability was 43%; BN and EDNOS did not differ in time to relapse. Negative SLE significantly predicted ED relapse; elevated work and social stressors were significant predictors. Psychiatric comorbidity, ED duration, and time‐varying personality‐disorder status were not significant predictors. Discussion: Higher work and social stress represent significant warning signs for triggering relapse for women with remitted BN and EDNOS. © 2011 Wiley Periodicals, Inc. (Int J Eat Disord 2012)