Mortality Rate of Anorexia Nervosa

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					Mortality Rate of Anorexia Nervosa
Is the mortality rate associated with AN greater than average? Is the mortality rate of AN higher than that of other mental illnesses?
By, Jessie Gross

Overview
• Basic facts about AN • Side effects of AN • Factors that contribute to a high mortality rate in AN • Facts about the treatment methods of AN • Argumentative data • Mortality facts about people with AN

Basic Facts
• An estimated 8 million Americans currently suffer from an eating disorder (7 million women & 1 million men) • 1 in 200 women suffer from anorexia • Eating disorders are believed to have the highest mortality rate of any mental illness
•DMH

The Harsh Reality
• 0.5% of girls 15-19 have AN about .25% in women 20-24 • 400 new cases are diagnosed each year • 5,000 patients have AN at any one time • Risk of first degree relative developing the disease is 10x greater • Death from natural causes is 4x greater • Deaths from unnatural causes 11x greater • The risk of successful suicide is 32x greater than average

Side Effects of AN
• -psychiatric morbidity is common; dysthymia, major depression and obsessive-compulsive disorder • Leads to brain atrophy and disorder of myelination, can have a persistent effect on cognition • Cardiac arrhythmias are common case of sudden death in AN • Long term physical morbidity is common and serious • Growth retardation is present in patients who have an early onset • Infertility is common in women who only partially recovered • Osteopenia leading to osteoporosis is a serious complication • More women die as a result of a fractured femur than breast cancer • Renal and hepatic functions are frequently permanently impaired • Neurogenic bowel with rectal prolapse is common, sometimes but not always associated with laxative abuse

National Association of Anorexia Nervosa and Associated Disorders
• 5-10% of anorexics die within 10 years of contracting the disease • 18-20% will be dead after 20 years • Only 30-40% will fully recover • The mortality rate associated with AN is 12x higher than ALL other causes of death for females 15-24 years old • 20% people with AN prematurely die from related complications including suicide and heart problems

Dept. of Psychiatry,

University of British Columbia,
Vancouver, British Columbia, Canada •Cross-sectional study done at St. Paul’s Hospital (19812000) •Out of 954 patients, 326 diagnosed with AN •All diagnosed patients completed a 20 year assessment •SMR = 10.5% (95% confidence interval) •Study confirms high mortality rate within the AN population
•Wiley

University of Psychological Medicine,

Christchurch School of Medicine,
New Zealand
• Meta-analytic study using weighted linear regression used to combine mortality proportions from 42 published studies • Studies used to estimate mortality rate of AN over time • 178 deaths out of 3,006 anorexics = 5.9% • The mortality rate = 0.56% per year and 5.6% per decade • Conclusion: estimated mortality rate for AN is much greater than that reported for female psychiatric patients and the general population
• pubMed

Contributing Factors to a High Mortality Rate
• Only 1 in 10 people with an eating disorder receive treatment • 80% of females who have sought help do not receive the intensity of treatment they need-most are sent home to soon • Treatment in the U.S. ranges from $500-$2,000 per day! Average cost of inpatient treatment is $30,000 per month! • The estimated length off treatment needed is 3-6 months • Health insurance companies do not typically cover the cost of treatment • Outpatient treatment including therapy and medical monitoring averages at $100,000 or more
• DMH

Causes of High Mortality in AN
The most common causes of death in AN are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide

Ways to Decrease AN Mortality
• 1997- 76% of sample studied for 10-15 years after admission met criteria for full recovery> their recovery time ranged from 57-74 months> 10% met partial recovery criteria • 1989- Patients who reached 98% of IBW prior to discharge were less likely to relapse than those who achieved 83% • 2000- Readmissions of patients increased steadily as length of stays became shorter and required weight at discharge became smaller
• Maine

Supporting Evidence
• Compared 14 patients with AN who achieved normal weight (96% IBW) to 8 patients who reached only 76% IBW. Length of stay Menstrual disturbances Re-hospitalization Persistent Anorexic symptoms

96% 116 days 21% 7%
19%

76% 46 days 62% 62%
57%

Conclusion- if patients with AN were provided with the right treatment and allowed enough time to reach a higher BWI, their success rate will be higher and it will be more cost effective in the long-run

The Antagonist Point of View, Mayo Clinic, Canada
• Study of mortality rates of AN over a 60 year period • Findings:people with AN die at the same rate as people without AN • Study recognizes it contradicts all previous clinical studies • Reasoning: Previous studies are generally conducted in hospital settings where individuals with the most advanced cases would me overrepresented
• Carnell

Summary
• 1 in every 200 women currently suffer from AN • Treatment of AN is often too expensive, too short, and ultimately unsuccessful • There are many long lasting side effects of AN, some of which are irreversible, ie; brain atrophy, bone myelination, cardiac arrhythmias, growth retardation, infertility, and osteopenia. • Deaths in AN patients due to natural causes, unnatural causes, and suicides are 4-32 times greater that average.

Questions & Answers
Is the mortality rate associated with AN greater than average? Yes, it is clear that the mortality rate of people with An is significantly greater than average. Is the mortality rate of AN higher than that of other mental illnesses? The facts show that the mortality percentages of AN are higher than the percentages of other mental illnesses.

Work Cited
• • Carnell, Brian. “Death Rate Among Anorexia Nervosa Patients Exaggerated.” 2002. <http://www.skepticism.net/articles/2003/000017.html>. Department of Psychiatry, University of British Columbia. “The Mortality Rate From AN.” 2005. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=Pub Med&list_uids=16134111&dopt=Citation>. Maine, Margo. “Securing Eating Disorders Treatment: Ammunition for Arguments with Third Parties.” National Eatin Disorders Association. 2004. <http://www.nationaleatingdisorders.org/nedaDir/files/documents/handout s/SecrTxAm.pdf>. Thornton, Chris. “The Harsh Reality of Eating Disorders.” Wesley Private Hospital. <http://www.bodycage.com/harsh.html>.

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