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      Prognosis

      Given the complexity of eating disorders, it is difficult to predict the exact outcome. The younger the age at which symptoms begin to appear, the poorer the prognosis if not diagnosed and treated early.  Generally, over a five-year period, nearly one-third of the individuals can expect a complete or near-complete remission, one-third will show significant improvement, while the remaining one-third often fail to improve or their symptoms deteriorate further – sometimes with life-threatening consequences.  

      The complex processes associated with eating disorders cause almost every major body system to be affected, the most dangerous being the imbalance of fluids and electrolytes.  The heart may get progressively weaker and affect the pumping and circulation of blood throughout the body.  Blood potassium levels may lower considerably due to metabolic acidosis.  Depending on the type of eating disorder, the use of laxatives and diuretics, vomiting, and purging often worsens the situation. 

      In anorexic patients, comorbidity with other psychiatric illnesses like mood disorder, anxiety disorder, and substance abuse are poor prognostic factors.  Clinical review has shown that about 40% of patients can recover completely, 36% improve, and the remaining develop a chronic eating disorder like bulimia or binge eating disorder.  Most patients have a history of morbid obesity in childhood or adolescence.  

      In bulimic patients, earlier treatment is the best prognosis, even more than the duration of treatment.  Poor prognostic factors include a history of substance abuse, laxative abuse, suicide attempts, poor psychosocial functioning, and low self-esteem.  The majority of bulimic patients suffer from a relapse due to an over-valued belief of importance of appearance and body weight.  About half of bulimic patients can expect to be recovered in two to ten years after treatment begins.  Nearly 20% will continue into the full form of bulimia while the remaining 30% have remissions or relapse.  There is a strong linkage between weight fluctuation and negative health outcomes.  

      In other eating disorders that resemble anorexia and bulimia, the severity of the associated features determine the prognostic course of the disorder.