A study of patients who died of eating disorders

There have been some reports on the assessment of mortality rate in eating disorders. The reports in Western countries and Japan have shown the mortality rate of 1-10%, and studies on many cases revealed the rate was approximately 4%. Of the outpatients who visited our department for the past 23-years, 724 had eating disorders. In this paper, the prognosis, the number of patients who died, and the situation of their death were investigated in these 724 patients. Data were collected from outpatient charts, registers, data bases and questionnaires given to attending physicians in our department. Data were collected from 434 of the 724 patients, and their list was made. We directly asked the attending physician for a summary of each individual patient and the items described later. Death was confirmed in 9 of the 434 patients. All of them were women, and the age at death ranged from 17 to 48 years (mean, 28 years). The age at the onset ranged from 14 to 21 years (mean, 17 years). Four patients had anorexia nervosa (AN) alone, and 5 had AN and bulimia nervosa (BN). The body weight at the time of death was 17-66 kg (mean, 35kg). Hepatopathy has been confirmed in 6, edema in 4, hypokalemia in 5, and hypoglycemic attack in 4. The cause of death was weakness (debility) in 3, suicide by leaping from a high place in 2, heart failure following attempted suicide by taking medicine in 1, sudden death in 2, and cancer in one patient. As psychosocial factors, a desire for emaciation (fear of obesity) was observed in all the patients, and an attempted suicide, personality disorder, child mother binding (symbiosis), obsessive character and hysteric tendency were observed in 4, 4, 6, 5 and 3 patients, respectively. The following points were reconsidered from the standpoint of the attending physician: 1. Three patients (Cases 1, 3 and 9) with AN, who died from weakness. No therapeutic relationship was established or multivation for the treatment was lacking. These points were reflected upon commonly in these three patients. In Case 9, her mother's load was increased because her father worked away from their home. Her mother showed a strong negative transference to the attending physician. This has been considered a therapeutic problem. 2. Two patients (Case 5 and 8) with AN + BN commited suicide by leaping from a high place. Management of their unstable mental condition was not adequate. No evaluation was made nor countermeasure taken for chronic depression. Prediction of and response to attempted suicide were not adequate. 3. A patient (Case 6) with AN+BN and a patient (Case 7) with AN died suddenly. No precise evaluation was made regarding her physical condition.