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

J Adolesc Health. 2015 Dec;57(6):673-8. doi: 10.1016/j.jadohealth.2015.08.003. Epub 2015 Oct 1.


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.

Keywords: Anorexia nervosa; Avoidant/restrictive food intake disorder; DSM-5; Eating disorder; Inpatient; Outcomes; Refeeding.

MeSH terms

  • Academic Medical Centers
  • Adolescent
  • Anorexia Nervosa / diagnosis
  • Child
  • Child, Preschool
  • Feeding Behavior*
  • Feeding and Eating Disorders* / diagnosis
  • Feeding and Eating Disorders* / therapy
  • Female
  • Hospitalization*
  • Humans
  • Male
  • Medical Audit
  • Retrospective Studies
  • Young Adult