As with most mental illnesses, the earlier the onset, detection, and treatment, the better the prognosis. Eating disorders can have potentially irreversible effects on the physical and emotional growth of adolescents. There is evidence suggesting improved outcome with early treatment, and therefore the threshold for intervention should be lower than with adults. The prognosis for individuals who have engaged in maladaptive eating patterns for years is guarded. Behaviors may remain constant, or the patient may improve briefly and return to the eating disorder during stressful times. Psychological immaturity persists in about 50 percent of the patients, with difficulties in social adjustment, and one-third continue to have problems with eating. Chronicity increases the risk of morbidity.
Despite advances in the understanding of anorexia and bulimia nervosa, eating disorders are still associated with significant long-term rates of morbidity and mortality. Mortality figures range from 2 to 5 percent to a high of 18 percent. Abnormally low albumin levels and low body weight (<60 percent ideal body weight) best predict a lethal course. High creatinine and uric acid levels predict chronicity in anorexics. 7 Death may result from suicide, starvation, metabolic catastrophe, infection, and cardiac insufficiency. Agents used to induce weight loss may lead to fatal complications.
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