LONGITUDINAL STUDY OF ANOREXIA NERVOSA AND BULIMIA NERVOSA

Longitudinal Study of Anorexia Nervosa and Bulimia Nervosa1

Eating Disorders Unit, Massachusetts General Hospital

David B. Herzog, M.D., David J. Dorer, Ph.D., Pamela K. Keel, Ph.D., Debra L. Franko Ph.D.

Longitudinal Study of Anorexia and Bulimia Nervosa, Eating Disorders Unit, Child Psychiatry Service, MGH

This thirteen-year project is the only prospective, naturalistic study, of a large, successfully maintained cohort of eating disordered women. A cohort of 246 women seeking treatment for anorexia or bulimia nervosa between 1987-1991 have been followed prospectively for a median of 9 years and interviewed semi-annually. Data from the longitudinal study includes prospective weekly information covering eating disorder symptomatology, comorbid psychopathology, and treatment participation, and prospective monthly information on psychosocial functioning.

Secondary Analyses of Substance Use Disorders in the Longitudinal Sample

Currently we are seeking funding to conduct a series of secondary analyses on the extensive data set collected through the Longitudinal Study. We have proposed to further examine the role of substance use disorders in women with eating disorders by describing predictors of prospective onset of substance abuse, comparing eating disordered women with and without substance use disorders, and describing patterns of onset and offset of eating disorder and substance use disorder when the conditions are comorbid.

Offspring Project

We have recently submitted a proposal to study the children of the participants in our Longitudinal Study. The overall aim of this research project is to describe the risk and protective factors in the offspring of women with eating disorders. The cross-sectional pilot study proposed will examine female children ages 6-16 to identify the extent to which children of women with eating disorders differ from children of mothers without psychiatric disorders with regard to both risk and resiliency.

Cognitive Functioning Study Eating Disorders Unit, Child Psychiatry Service and Neuroscience Group, MGH

We are currently conducting a pilot study of cognitive functioning in women with anorexia and bulimia in comparison to non-psychiatric controls. We are evaluating verbal and nonverbal memory using measures of organizational strategy as potential mediators of memory capacity. We plan to submit a more comprehensive grant in order to further examine cognitive functioning in addition to looking at neuroimaging in eating disordered women. This study is being performed in collaboration with the Cary Savage, Ph.D. and Scott Rauch, Ph.D. of the Cognitive Neuroscience Group.

Osteoporosis/ Osteopenia in Anorexia Nervosa Eating Disorders Unit, Child Psychiatry Service and

Neuroendocrine Unit, MGH

We are also currently collaborating with the Neuroendocrine Unit (Anne Klibanski M.D., Steven Grinspoon M.D., Karen Miller, M.D., Madhu Misra, M.D.) on several studies. We are assessing the prevalence of osteoporosis and osteopenia in eating disordered women, determining the efficacy of IGF-I, Insulin-like Growth Factor, and Actonel on bone formation in women with anorexia nervosa, and we are determining the role of growth hormone in bone loss in adolescents with anorexia nervosa.

Key words. anorexia nervosa, bulimia nervosa, course, outcome, comorbidity.

Grant Support. Rubenstein Foundation; Eli Lilly.

Project Sites. Eating Disorders Unit, Massachusetts General Hospital; Neuroendocrine Unit, MGH

Project Director. David B. Herzog, Director, Eating Disorders Unit, 725 WACC, Massachusetts General Hospital, 15 Parkman St., Boston, MA 02114. Contact Person. Valerie Charat, Project Coordinator.

(617) 726-9068. Fax: (617) 726-1595.

Representative Publications.

Grinspoon S, Thomas E, Pitts S, Gross E, Mickley D, Miller K, Herzog D, Klibanski A. Prevalence and predictive factors for

regional osteopenia in women with anorexia nervosa. Annals of Internal Medicine. 2000 133:790-4.

Grinspoon S, Thomas L, Miller K, Pitts S, Herzog D, Klibanski A. Regional fat redistribution and the effects of estrogen during

spontaneous weight gain in women with anorexia nervosa. Am J Clin Nutr. 2001; 73:865-9.

Franko DL, Blais MA, Becker AE, Selwyn S, Greenwood DN, Flores AT, Ekeblad ER, Eddy KT, Herzog DB. Pregnancy

complications and neonatal outcome in eating disordered women. Am J Psychiatry. 2001; 158: 1461-1466.

Eddy KT, Keel PK, Dorer DJ, Delinsky SS, Franko DL, Herzog DB. A longitudinal comparison of anorexia nervosa subtypes. Intl J

Eat Dis. In press.

Keel PK, Dorer DJ, Eddy KT, Selwyn SE, Franko DL, Blais MA, Keller MB, Herzog DB. Predictors of treatment utilization in

women with anorexia and bulimia nervosa. Am J Psychiatry. In press Jan, 2002.