Inpatient hospital course and self-reported symptomatology in underweight adults with ARFID compared to age- and sex-matched controls with anorexia nervosa

Irina A Vanzhula; Erin Wang; Mary K Martinelli; Colleen Schreyer; Angela S Guarda

doi:10.1186/s40337-023-00912-x

Inpatient hospital course and self-reported symptomatology in underweight adults with ARFID compared to age- and sex-matched controls with anorexia nervosa

J Eat Disord. 2023 Nov 20;11(1):206. doi: 10.1186/s40337-023-00912-x.

Authors

Irina A Vanzhula¹, Erin Wang², Mary K Martinelli², Colleen Schreyer², Angela S Guarda²

Affiliations

¹ Johns Hopkins University School of Medicine, Meyer 101, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. ivanzhu1@jhu.edu.
² Johns Hopkins University School of Medicine, Meyer 101, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.

Abstract

Objective: Avoidant restrictive food intake disorder (ARFID) has similar prevalence to anorexia nervosa (AN) in adults, but research in this population is lacking. Although inpatient or residential treatment involving nutritional rehabilitation is increasingly recommended for malnourished individuals with ARFID, best practices remain poorly defined. Existing studies on self-reported symptomatology and treatment course and outcome are primarily in child and adolescent cohorts and demonstrate inconsistent findings. This study aimed to compare hospital course and self-reported symptomatology of underweight adult inpatients with ARFID and sex- and age-matched patients with AN.

Method: Underweight adult patients with ARFID or AN admitted to a specialized, hospital-based behavioral treatment program completed measures of body dissatisfaction, drive for thinness, bulimic symptoms, anxiety, depression, and personality traits. Demographic and treatment course data were abstracted from electronic medical records. Patients with ARFID (n = 69) were matched to those with AN (n = 69) based on sex and age.

Results: Adults with ARFID were closer to target weight at admission, but gained weight at a slower rate, were discharged at lower BMI, and were less likely to reach target weight by discharge than adults with AN. Patients with ARFID reported less weight and shape-related eating disorder, state anxiety, and depression symptoms and lower neuroticism.

Discussion: Adults with ARFID progress through treatment more slowly and achieve less favorable weight outcomes by hospital discharge than patients with AN, but long-term outcomes are unclear. Describing clinical presentations and course of illness of adult ARFID may help inform treatment protocols.

Keywords: ARFID; Anorexia nervosa; Inpatient treatment; Weight restoration.

Plain language summary

This study examined hospital course and symptomatology in underweight adults with avoidant/restrictive food intake disorder (ARFID) compared to adults with anorexia nervosa (AN). Both groups were admitted at similar BMI, however compared to patients with AN, those with ARFID gained weight slower and were half as likely to reach target weight by discharge. Adults with ARFID were equally likely, however, to be rated as clinically improved at discharge. Patients with ARFID also reported less symptoms of anxiety, depression or neuroticism than did those with AN, and less weight and shape-related eating disorder symptoms at admission. The reason for slower weight restoration in adults with ARFID may reflect the need for more individualized protocols adapted to meet the unique, often heterogeneous needs of these individuals. Longer-term post-discharge outcomes for adults with ARFID remain unclear and require investigation.