***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The aim of this study was to assess prospect ively the long-term outcome in a representative sample of teenage-onset anorexia nervosa ( AN ) in respect of psychiatric disorders and overall outcome . Fifty-one AN cases , recruited by community screening , with a mean age of onset of 14 years , was contrasted with 51 matched comparison cases at a mean age of 24 years ( 10 years after AN onset ) . All 102 cases had been examined at ages 16 and 21 years . At 24 years all prob and s were interviewed regarding psychiatric disorders ( SCID-I ) and overall outcome ( Morgan-Russell assessment schedule , the GAF ) . There were no deaths at 10-year follow-up . One in four in the AN group had a persisting eating disorder ( ED ) , including three who still had anorexia nervosa . Lifetime diagnoses of affective disorders and obsessive-compulsive disorder were over-represented in the AN group . Outcome according to Morgan-Russell was poor in 27 % , intermediate in 29 % , and good in 43 % . According to the GAF , half the AN group had a poor psychosocial functioning . These were subjects with either a persisting ED or lifelong problems with social interaction or obsessive-compulsive behaviour . Ten-year outcome of teenage-onset AN is favourable in the majority of cases ; most individuals have recovered from their ED and have no other axis I disorder . However , half the AN group reported poor psychosocial outcome , in most cases explained by a persisting ED or chronic obsessive-compulsive behaviour/social interaction problems BACKGROUND Obstetrical complications , based on parental recall , have been reported to be associated with development of anorexia nervosa . We used prospect ively collected data about pregnancy and perinatal factors to examine the subsequent development of anorexia nervosa . METHODS This population -based , case-control study was nested in cohorts defined by all liveborn girls in Sweden from 1973 to 1984 . From the Swedish Inpatient Register , 781 girls had been discharged from any hospital in Sweden with a main diagnosis of anorexia nervosa at the age of 10 to 21 years . For each case , 5 controls were r and omly selected , individually matched by year and hospital of birth ( n = 3905 ) . Conditional logistic regression was used to calculate odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) for potential risk factors . RESULTS Increased risk of anorexia nervosa was found for girls with a cephalhematoma ( OR , 2.4 ; 95 % CI , 1.4 - 4.1 ) and for very preterm birth ( < or = 32 completed gestational weeks ) ( OR , 3.2 ; 95 % CI , 1.6 - 6.2 ) . In very preterm births , girls who were small for gestational age faced higher risks ( OR , 5.7 ; 95 % CI , 1.1 - 28.7 ) than girls with higher birth weight for gestational age ( OR , 2.7 ; 95 % CI , 1.2 - 5.8 ) . CONCLUSIONS Our results show that perinatal factors , possibly reflecting brain damage , had independent associations with anorexia nervosa . These risk factors may uncover the mechanisms underlying the development of the disorder , even if only a fraction of cases of anorexia nervosa may be attributable to perinatal factors OBJECTIVE DSM-IV subtypes anorexia nervosa by the presence or absence of bulimic symptoms . Assessing whether bulimic symptoms are related to the probability of recovery can provide justification for subtyping of anorexia . METHOD Two hundred twenty-five treatment-seeking women with anorexia and /or bulimia nervosa were interviewed every 3 months for up to 4 years . Survival methods were used for analyses . RESULTS Less than half of the entire cohort recovered ; however , the great majority of the women became less symptomatic over time . Contrary to findings from previous studies , bulimic anorexics had a higher rate of recovery than restricting anorexics . CONCLUSION Differences in course provide some support for the subtyping of anorexia nervosa . Additional prospect i ve studies are needed before subtyping can be warranted OBJECTIVE Although there have been many studies of the outcome of anorexia nervosa , method ological weaknesses limit their interpretation . The authors used a case-control design to try to improve knowledge about the outcome of anorexia nervosa . METHOD All new female patients referred to an eating disorders service between Jan. 1 , 1981 , and Dec. 31 , 1984 , who had probable or definite anorexia nervosa were eligible for inclusion . Of these women , 86.4 % ( N = 70 ) were located and agreed to participate . The comparison group ( N = 98 ) was a r and om community sample .  All subjects were interviewed with a structured diagnostic instrument . RESULTS A minority of the patients ( 10 % ) continued to meet the criteria for anorexia nervosa a mean of 12 years after initial referral . Even among those who no longer met these criteria , relatively low body weight and cognitive features characteristic of anorexia nervosa ( perfectionism and cognitive restraint ) persisted . The rates of lifetime comorbid major depression , alcohol dependence , and a number of anxiety disorders were very high . CONCLUSIONS In the managed care/brief treatment era , therapeutic approaches with an excessive focus on weight gain that neglect the detection and treatment of associated psychological features and comorbidity may be inappropriate . Anorexia nervosa is a serious psychiatric disorder with substantial morbidity BACKGROUND Little is known about the longer-term outcome of bulimia nervosa and the distal effects of treatment . METHODS Prospect i ve follow-up of subjects from two r and omized controlled trials , involving a comparison of cognitive behavior therapy , behavior therapy , and focal interpersonal therapy . RESULTS Ninety percent ( 89/99 ) underwent re assessment by interview ( mean [ + /- SD ] length of follow-up , 5.8 + /- 2.0 years ) . Almost half ( 46 % ) had a DSM-IV eating disorder ; 19 % , bulimia nervosa ; 3 % , anorexia nervosa ; and 24 % , eating disorder not otherwise specified . There was a low rate of other psychiatric disorders . Premorbid and paternal obesity predicted a poor outcome . While the three treatments did not differ with respect to the proportion of subjects with anorexia nervosa or bulimia nervosa at follow-up , they did differ once all forms of DSM-IV eating disorder were considered together . Those who had received cognitive behavior therapy or focal interpersonal therapy were doing markedly better than those who had received behavior therapy . CONCLUSIONS The longer-term outcome of bulimia nervosa depends on the nature of the treatment received . Patients who receive a treatment such as behavior therapy , which only has a short-lived effect , tend to do badly , whereas those who receive treatments such as cognitive behavior therapy or focal interpersonal therapy have a better prognosis OBJECTIVE Body dissatisfaction and depression have consistently demonstrated a positive association in women . This study sought to determine the independence of this association from bulimic symptomatology among women diagnosed with bulimia nervosa . METHOD Participants were 101 women who completed a controlled treatment study of bulimia nervosa and participated in follow-up assessment s 10 years later . RESULTS Findings indicated that baseline levels of depression were independent of and superior to bulimic symptoms in prospect ively predicting body dissatisfaction at follow-up assessment . DISCUSSION Findings suggest that depression may be a better prognostic indicator of body dissatisfaction than bulimic symptoms in women diagnosed with bulimia nervosa . A model in which depression represents a contributing factor for the maintenance of body dissatisfaction is discussed OBJECTIVE The purpose of this study was to assess the course and outcome of anorexia nervosa and bulimia nervosa at 1 year in a large cohort of women with eating disorders . METHOD A prospect i ve , naturalistic , longitudinal design was used to map the course of 225 women with anorexia nervosa , bulimia nervosa , and mixed anorexia and bulimia nervosa .  Structured interviews were conducted quarterly . Follow-up data are presented in terms of patterns of recovery , clinical features predictive of time to recovery , and the role of comorbid disorders as fixed predictors . RESULTS The recovery rate of bulimics was significantly better than that of anorexic or mixed subjects , yet nearly half the anorexic and mixed subjects no longer met full DSM-III-R criteria for at least 8 consecutive weeks during the first year of follow-up . Percent ideal body weight and type of eating disorder were significantly associated with outcome . CONCLUSIONS Our findings suggest that the diagnosis of anorexia nervosa has severe implication The results of a 12-year follow-up study of occurrence and timing of first recovery in 69 hospitalized patients with severe anorexia nervosa ( AN ) are presented . For the first time discrete-time survival analysis methods were used to determine the likelihood of recovery in AN patients . Furthermore , predictors gleaned from pretreatment-posttreatment studies of long-term outcome in AN could be evaluated as to their effect on a change in the time course structure of the likelihood of first recovery . Results show that AN condition did not improve until after 6 years after the first inpatient treatment in 50 % of patients . However , a restricter-type AN and low serum creatinine levels were predictors for earlier recovery . One specific effect was that AN patients who show purging behavior in combination with additional social disturbances have a lower chance of recovering . The use of discrete-time survival analysis methodology in further prospect i ve studies will contribute to the development of more tailored treatment of AN , which also takes the individual phase of illness and specific aspects of the symptomatology into account 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 prospect ively 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 prospect ively 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 BACKGROUND Owing to the lack of controlled trials of treatment setting in adolescent anorexia nervosa , the benefits and costs of in-patient treatment are not established . AIMS To clarify the relationship between a range of presenting features , treatment received and medium- to long-term outcome in adolescent anorexia nervosa . METHOD A range of presenting variables were rated for 75 cases of DSM-III-R anorexia nervosa at presentation to an adolescent service , including the Morgan-Russell Global Assessment Score . Cases were followed up at 2 - 7 years and outcome rated according to reliable methods . Setting of treatment received was also recorded . RESULTS Two out of 75 cases had died by the time of follow-up . Adequate data for 72 enabled an outcome category to be assigned . The 21 who had received inpatient treatment had a significantly worse outcome than the 51 never admitted to hospital . Multivariate analysis suggests admission to be the major predictor of poor outcome . CONCLUSIONS The benefits and costs of admission to hospital require further investigation , ideally in a r and omised-controlled trial . The negative consequences of in-patient treatment are neglected in research BACKGROUND Anorexia nervosa , but not bulimia nervosa , has one of the highest mortality rates among psychiatric disorders . However , potential predictors of mortality , such as comorbid psychiatric illnesses , remain unclear . We sought to determine mortality ratios and predictors of fatal outcome in women diagnosed as having anorexia or bulimia nervosa . METHODS Women ( N = 246 ) diagnosed as having either DSM-IV anorexia nervosa ( n = 136 ) or bulimia nervosa ( n = 110 ) between January 1 , 1987 , and December 31 , 1991 , participated in a prospect i ve longitudinal study . Vital status was determined by ongoing contact and a National Death Index search as of December 1998 ( overall ascertainment , 99.8 % ) and telephone contact as of October 2000 ( ascertainment , 95.0 % ) . RESULTS Eleven women died . St and ardized mortality ratios were elevated for all causes of mortality ( 11.6 ; 95 % confidence interval , 5.5 - 21.3 ) and suicide ( 56.9 ; 95 % confidence interval , 15.3 - 145.7 ) in anorexia nervosa but not for death ( 1.3 ; 95 % confidence interval , 0.0 - 7.2 ) in bulimia nervosa . Predictors of mortality in anorexia nervosa included severity of alcohol use disorder during follow-up ( P<.001 ) . Hospitalization for an affective disorder before baseline assessment seemed to 
    Output:
    
RESULTS At followup , individuals with AN were more likely than comparisons to be depressed , have Asperger 's syndrome and autism spectrum disorders , and suffer from anxiety disorders including obsessive-compulsive disorders .
Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced .
The only consistent factor across studies relating to worse BN outcomes was depression .
A substantial proportion of individuals continue to suffer from eating disorders over time but BN was not associated with increased mortality risk .
Data were insufficient to draw conclusions concerning factors associated with BED outcomes .
The strength of the bodies of literature was moderate for factors associated with AN and BN outcomes and weak for BED