Medically Hospitalized Patients With Eating Disorders and Somatoform Disorders in Pediatrics: What Are Their Similarities and Differences and How Can We Improve Their Care?

OBJECTIVES: The purpose of the current study is to describe the demographic and clinical characteristics and health care use of medically hospitalized patients with eating disorders (ED) and somatoform disorders (SFD) in a pediatric setting and to use the findings to explore opportunities for improved care. METHODS: Retrospective chart reviews of 125 patients with SFD and 125 patients with ED (N = 250) seen at a tertiary pediatric facility over a 12- and 19-month period, respectively. RESULTS: Patients in both groups were predominantly girls, white, came from households with above average incomes, and had academic pressures, internalizing coping styles, and high rates of anxiety disorders. Compared with SFD patients, ED patients had longer medical admissions (P &amp;lt; .001), more depressive disorders (P &amp;lt; .01), higher lifetime rates of suicidal ideation and self-injurious behaviors (P &amp;lt; .05), and were more frequently discharged to intensive psychiatric treatment programs (P &amp;lt; .001). SFD patients were referred later to psychiatry (P &amp;lt; .001), had more emergency department visits (P &amp;lt; .001) and more visits to other hospitals (P &amp;lt; .05) and also had higher rates of learning difficulties (P &amp;lt; .001), bullying (P &amp;lt; .05), and trauma (P &amp;lt; .01) compared with ED patients. CONCLUSIONS: Identifying overlapping features and key differences in the clinical characteristics and health care use of patients with primary psychiatric disorders like ED and SFD, who are frequent users of medical services, is the first step toward developing innovative, integrated hospital-based care approaches and clinical pathways that can reduce service utilization and improve patient outcomes. </jats:sec

Prospective Two-Year Course and Predictors of Outcome in Avoidant/Restrictive Food Intake Disorder

Objective: To evaluate the 2-year course and outcomes of full and subthreshold avoidant/restrictive food intake disorder (ARFID) in youth ages 9-23 at baseline using a prospective longitudinal design to characterize the remission and persistence of ARFID, evaluate diagnostic crossover, and identify predictors of outcome. We hypothesized that greater severity in each ARFID profile – sensory sensitivity, fear of aversive consequences, and lack of interest – would predict greater likelihood of illness persistence, controlling for age, sex, BMI percentile, ARFID treatment status, and baseline diagnosis. // Method: We followed participants (N = 100; ages 9-23 years; 49% female, 91% White) over two years. We used the Pica, ARFID, and Rumination Disorder Interview across three time points (Baseline, Year 1, Year 2) to measure the severity of each ARFID profile and evaluate illness persistence or remission, and the Eating Disorder Assessment for DSM-5 to evaluate diagnostic crossover. // Results: Across the 2-year follow-up period, half the sample persisted with their original diagnosis, and 3% of participants experienced diagnostic shift to anorexia nervosa. Greater severity in the sensory sensitivity and lack of interest profiles was associated with higher likelihood of ARFID persistence at Year 1 only; greater severity in the fear of aversive consequences profile was associated with higher likelihood of ARFID remission at Year 2 only. // Conclusion: Findings underscore the distinctiveness of ARFID from other eating disorders and emphasize its persistence over 2 years. Results also highlight the predictive validity and prognostic value of ARFID profiles (i.e., sensory sensitivity, fear of aversive consequences, lack of interest)