Recovery is judged by return to normal weight, return of menstruation, and improved psychological and psychosexual adjustment. After 5 years, about half these patients have recovered fully, and a quarter have improved to some degree. Some cease to be anorexic and go on to develop bulimic features. There is an increased risk of death from suicide, malnutrition, or physical complications. Poor prognostic features are a long history, older age of onset, abnormal pre-morbid personality, poor family relationships, and extreme weight loss.
A 16-year-old schoolgirl, intelligent but lacking in self-confidence, started to diet after a young man said that her tummy was too fat. The girl was working hard for exams at the time, and her parents were having some marital problems. While eating less and less, she became more and more interested in food and spent much time reading recipe books, and baking cakes for the rest of the family. She slept very little, and would get up early to run for an hour before school. Her weight dropped from 8 to 5 stone within about 3 months, and eventually her mother insisted on taking her to the doctor because her periods had stopped. The girl refused to talk about her condition or accept any medical treatment; however, she agreed to eat a little more within strictly controlled limits, taking an extra half-pint of milk and two slices of bread each day.
Her weight gradually increased again over the next few months but it was 6 years before menstruation resumed. She achieved a professional qualification, and held a responsible job throughout her 20s despite drinking half a bottle of vodka in private every night. The drinking decreased in her early 30s after she married an older man; they had no children. Now aged 50, she has continued to maintain her weight at 47 kg precisely and becomes very anxious if prevented, by circumstances such as going on holiday, from weighing herself twice a day.
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