Stressful life events predict eating disorder relapse following remission: Six-year prospective outcomes

Carlos M. Grilo, Maria E. Pagano, Robert L. Stout, John C. Markowitz, Emily B. Ansell, Anthony Pinto, Mary C. Zanarini, Shirley Yen, Andrew E. Skodol

Research output: Contribution to journalReview articlepeer-review

64 Scopus citations


Objective: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not-otherwise-specified (EDNOS) and test for the effects of stressful life events (SLE) on relapse after remission from these eating disorders. Method: 117 female patients with BN (N = 35) or EDNOS (N = 82) were prospectively followed for 72 months using structured interviews performed at baseline, 6- and 12-months, and then yearly thereafter. ED were assessed with the structured clinical interview for DSM-IV, and monitored over time with the longitudinal interval follow-up evaluation. Personality disorders were assessed with the diagnostic interview for DSM-IV-personality-disorders, and monitored over time with the follow-along-version. The occurrence and specific timing of SLE were assessed with the life events assessment interview. Cox proportional-hazard-regression-analyses tested associations between time-varying levels of SLE and ED relapse, controlling for comorbid psychiatric disorders, ED duration, and time-varying personality-disorder status. Results: ED relapse probability was 43%; BN and EDNOS did not differ in time to relapse. Negative SLE significantly predicted ED relapse; elevated work and social stressors were significant predictors. Psychiatric comorbidity, ED duration, and time-varying personality-disorder status were not significant predictors. Discussion: Higher work and social stress represent significant warning signs for triggering relapse for women with remitted BN and EDNOS.

Original languageEnglish (US)
Pages (from-to)185-192
Number of pages8
JournalInternational Journal of Eating Disorders
Issue number2
StatePublished - Mar 2012
Externally publishedYes


  • bulimia nervosa
  • eating disorder not otherwise specified
  • personality
  • relapse
  • stress
  • work stress

ASJC Scopus subject areas

  • Psychiatry and Mental health


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