Original article
Avoidant/Restrictive Food Intake Disorder: Illness and Hospital Course in Patients Hospitalized for Nutritional Insufficiency

https://doi.org/10.1016/j.jadohealth.2015.08.003Get rights and content

Abstract

Purpose

Avoidant/restrictive food intake disorder (ARFID), a recently defined Diagnostic and Statistical Manual of Mental Disorders-5 eating disorder diagnosis, has not been extensively studied in the inpatient population. This study compares hospitalized ARFID and anorexia nervosa (AN) patients, including differences in presentation, treatment response, and 1-year outcomes.

Methods

We conducted a retrospective chart review of ARFID and AN patients hospitalized between 2008 and 2014 for acute medical stabilization at an academic medical center. Data, including characteristics on admission, during hospitalization, and 1 year after discharge, were recorded for each patient and compared between ARFID and AN patients.

Results

On presentation, ARFID patients (n = 41) were younger with fewer traditional eating disorder behaviors and less weight loss, comorbidity, and bradycardia than AN patients (n = 203). During hospitalization, although ARFID and AN patients had similar caloric intake, ARFID patients relied on more enteral nutrition and required longer hospitalizations than AN patients (8 vs. 5 days; p = .0006). One year after discharge, around half of ARFID and AN patients met criteria for remission (62% vs. 46%; p = .18), and less than one-quarter required readmission (21% vs. 24%; p = .65).

Conclusions

The findings from this study reveal several differences in hospitalized eating disorder patients and emphasize the need for further research on ARFID patients, including research on markers of illness severity and optimal approaches to refeeding. Similar remission and readmission rates among ARFID and AN patients highlight both the success and the continued need for improvement in eating disorder treatment regardless of diagnosis.

Section snippets

Patients

Medical records of patients, aged 5–25 years, hospitalized for refeeding between January 2008 and December 2014 at the Cleveland Clinic were reviewed. Patients were included if they were treated using the eating disorder protocol, a protocol designed to stabilize patients with nutritional insufficiency through initiation of refeeding, and met DSM-5 criteria for an eating disorder (n = 342). Patients were excluded if they did not meet DSM-5 criteria for AN or ARFID (n = 74), were hospitalized

Results

A total of 318 eating disorder patients had initial hospitalizations for refeeding during the study period. Of these patients, 41 (13%) who met diagnostic criteria for ARFID and 203 (64%) who met diagnostic criteria for AN were included in the study. The study population was predominantly female (89%; n = 216) and non-Hispanic white (96%; n = 234), with ages that ranged from 9 to 25 years. Table 1 compares patient characteristics at the time of hospitalization. Patients diagnosed with ARFID

Discussion

The present study adds to the literature on ARFID, providing novel information on patients requiring hospitalization for medical instability. ARFID patients made up a small but substantial proportion of hospitalized eating disorder patients and had several significant differences compared with AN patients. On admission, ARFID patients were younger in age, had less weight loss, and exhibited fewer disordered eating behaviors than AN patients. During hospitalization, ARFID patients were less

Funding Sources

This study was not funded.

References (18)

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Conflict of Interest: The authors have no potential conflicts of interest to disclose.

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