A survey of physician practices on the inpatient medical stabilization of patients with avoidant/restrictive food intake disorder

BACKGROUND: Avoidant/restrictive food intake disorder (ARFID) was added to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition in 2013. ARFID can result in impaired growth and significant nutritional deficiency; individuals with ARFID may be so nutritionally compromised that they require medical stabilization in a hospital. Prior to the new diagnostic criteria, it is unclear how patients now diagnosed with ARFID may have been medically stabilized when hospitalized. Our study aim was to assess the inpatient medical management of adolescents with ARFID. METHODS: United States-based physician members of the Society for Adolescent Health and Medicine’s Eating Disorder Special Interest Group’s listserv or the National Eating Disorders Quality Improvement Collaborative were invited to participate in an anonymous survey regarding their practices of care for hospitalized patients with ARFID. RESULTS: Thirty-seven (44.6%) of 83 physicians completed the survey; 73.0% (n = 27) of respondents medically admitted patients with ARFID. Half of respondents who admitted did not use any protocol for refeeding; 55% of those with a protocol used an anorexia nervosa treatment protocol. Solid food and nasogastric feeds were most commonly used for nutritional rehabilitation. Few typically prescribed medications in the hospital during medical stabilization. CONCLUSIONS: There is considerable variability of practice in the treatment of hospitalized patients with ARFID. An important next step is to test the efficacy of protocols for anorexia nervosa in treating ARFID patients.