Prognosis and duration of disabling effects

Anorexia Nervosa (AN)

About a half of people with Anorexia Nervosa (AN) recover completely, a quarter improve and a quarter develop a chronic eating disorder.

Mortality has been reported as up to 5% over 4 to 5 years, but as high as 10% in the long term. Just over two third of deaths are due to the effects of starvation and one third are by suicide.

Education is disrupted, with attendance at school reduced by more than 50%. Vocational functioning is also impaired, with 21% of people still relying on state benefits 10 -15 years after the onset of the illness. Social isolation is common, social communication skills are poor and social networks are small.

Good prognosis is associated with an early age at onset and a short interval between the onset of symptoms and the beginning of treatment. Poor prognosis is associated with vomiting, bulimia, profound weight loss, long duration of illness, co-morbid psychiatric illness and psychosocial problems.

Bulimia Nervosa (BN)

About 50% of people with Bulimia Nervosa make a full recovery, 30% make a partial recovery and 20% continue to be symptomatic.

Good prognosis is associated with a shorter duration of illness, younger age of onset and higher socio-economic status. Poor prognosis is associated with borderline personality disorder, concurrent substance misuse, low motivation for change and a history of obesity.

An increase in mortality rate has been reported for Bulimia Nervosa (9 times the normal population risk).

In view of the potential for improvement, if the condition has been present for less than 5 years, a 2 year award should be considered. If the condition has been present for more than 5 years, a 5 year award should be considered.

EDNOS (Eating disorder not otherwise specified)

The course and prognosis of EDNOS is similar to that of the disorder it most closely resembles, i.e AN or BN.

In view of the potential for improvement, if the condition has been present for less than 5 years, a 2 year award should be considered. If the condition has been present for more than 5 years, a 5 year award should be considered.

In view of the potential for improvement in each type of eating disorder suggested award duration is -:

Date of Onset - Less than 5 years - 2 year award

Date of Onset - More than 5 years - 5 year award

All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.

Amended June 2008