Symposia
Eating Disorders
Irina Vanzhula, Ph.D.
Johns Hopkins School of Medicine
Baltimore, Maryland
Colleen Schreyer, PhD
Assistant Professor
Johns Hopkins School of Medicine
Baltimore, Maryland
Angela Guarda, MD
Associate Professor
Johns Hopkins School of Medicine
Baltimore, Maryland
Background: ARFID is associated with low weight and/or nutritional deficiency and impairment in psychosocial functioning. Some patients with severe malnutrition require hospitalization to assist with weight restoration and nutritional rehabilitation. Hospital-based studies of children and adolescents with ARFID report higher rates of medical and psychological comorbidities, higher admission BMI, but slower rates of weight restoration and longer length of stay compared to those with anorexia nervosa (AN). However, very little is known about hospitalized adults with ARFID. The current study compared self-reported personality and symptom characteristics and clinical hospital course of adults with ARFID and AN treated in the same meal-based inpatient behavioral program for eating disorders.
Methods: Adult patients with ARFID (n = 80) were matched to patients with AN (n = 80) based on age and sex to minimize confounds. Patients (age range 18 – 75; 85% female, 15% male) completed self-report questionnaires at admission, and clinical data was extracted from the chart.
Results: Patients with ARFID reported significantly lower neuroticism, state and trait anxiety (ps = .009 -.034), drive for thinness, bulimic symptoms, and body dissatisfaction (ps < .001), and lower perceived coercion surrounding hospital admission (p = .003) than patients with AN. Patients with ARFID had higher openness to experience (p = .002), higher admission BMI (p = .002), and higher desired BMI (p < .001) than patients with AN. There were no differences in other personality traits or depression (ps > .081). Regarding course of treatment, underweight patients with ARFID gained weight more slowly (p < .001), were less likely to achieve goal weight range at discharge (OR = 3.23, p < .001) or to attend partial hospital (OR = 5.19, p < .001) than those with AN. However, the groups did not differ in length of stay (p = .161). Out of all ARFID patients who did not achieve goal weight range by discharge, 63% left the program for reasons other than clinical improvement, such as patient request, transfer to medical unit, financial, non-compliance).
Conclusions: Overall, despite lower self-reported psychopathology at admission, adults with ARFID demonstrated slower rates of weight restoration and were less likely to achieve goal weight prior to discharge compared to those with AN. Further studies are needed to characterize potential reasons for these group differences (e.g., greater gastrointestinal complaints, disgust, or anxiety about consequences of eating) and to establish best practices for inpatient treatment of ARFID.