Defining remission and relapse in bulimia nervosa

Objective: The goals of the current study were to compare the relapse rates obtained when definitions of both remission and relapse were systematically varied and to propose some consensus definitions related to relapse in bulimia nervosa (BN). Method: This was an uncontrolled, prospective follow-up study based on 46 women who met criteria for BN (based on criteria in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders [Washington, DC: American Psychiatric Association]) before treatment and were abstinent or had low frequency symptoms after treatment. Assessments were conducted every 3 months for up to 19 months. Data were analyzed with Kaplan-Meier survival analysis. Results: Relapse rates at 19 months ranged from 21% to 55% depending on the definitions of remission and relapse applied. Discussion: Relapse rates are strongly influenced by definitions of remission and relapse. We propose that partial remission, defined as a maximum of two symptom episodes per month for 2 months, should constitute eligibility for relapse and relapse should be defined as meeting full diagnostic criteria for 3 months.