When anorexia patients need hospitalization

What is anorexia?

Eating disorders are mental health conditions that impact behaviors and attitudes toward food, eating, and body image. Anorexia nervosa commonly develops during adolescence, but can affect people of any gender or age ^[1].

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines criteria for a diagnosis of anorexia that include ^[2]:

• Severely restricting dietary intake, leading to excessive weight loss and significantly low body weight
• Intense fear of weight gain
• Lack of insight into the severity of disordered eating behaviors and distorted view of own body image

Anorexia can be further defined as a restrictive type, in which dietary intake is consistently restricted to prevent weight gain, and a binge-purge type, in which individuals engage in binge eating episodes followed by purging behaviors such as self-induced vomiting.

At what point do people with anorexia require hospitalization?

Although it is possible to overcome anorexia without professional help, the best chance of recovery involves intervention from specialized professionals. Early intervention further increases the possibility of recovery ^[3].

Many individuals with anorexia receive professional treatment through outpatient care services, allowing them to remain at home while treating the condition. However, this is not always possible, and some people find that they are unable to properly engage with treatment in this way, causing a worsening in their condition and thus requiring hospitalization ^[1][4].

Although it may vary between individual cases, people with anorexia are typically admitted to hospital for treatment when one or more of the following criteria are met ^[1][3]:

• Body weight is severely lower than is normal for the height, age, and gender of the individual. This is typically considered to be the case at below 75% of the expected body weight for the individual.
• Vital signs, such as pulse, temperature, and blood pressure, are severely low.
• The individual has severe physical concerns that may be life-threatening.
• The individual is under the age of 18 and does not have appropriate support at home or access to necessary resources to improve their health.
• Professionals have deemed the individual to be at significant risk of suicide.

People with anorexia can receive inpatient treatment voluntarily by deciding themselves that they need hospitalization, or involuntarily when a professional has deemed it a medical emergency and hospitalizes the individual in their best interest ^[5].

Complications of anorexia

Prolonged or untreated anorexia can result in several physical health complications, which can become increasingly severe or even fatal.

Complications of anorexia can include ^[1][6]:

• Rapid and severe weight loss
• Hormonal abnormalities and fertility issues
• Amenorrhea (missed or irregular menstrual periods)
• Heart problems, such as abnormal heart rhythms, low blood pressure, and sudden cardiac arrest
• Weak and brittle bones
• Decline in brain health and cognitive function
• Weakened immune system
• Gastrointestinal issues, such as constipation and stomach pain
• Kidney failure
• Reduced blood cell count

As such, anorexia often requires specialist professional treatment. Specialist treatment can improve a sufferers physical and mental wellbeing and prevent a worsening of physical health complications, many of which can lead to death if not managed effectively.

What does inpatient anorexia treatment involve?

Treatment for anorexia nervosa, both as an inpatient and an outpatient, requires a multidisciplinary approach. While in a hospital, individuals with anorexia will receive input into their treatment plan from several medical and mental health professionals, including a psychiatrist, a medical physician, eating disorder therapists, and a registered dietician ^[4].

Upon hospitalization, individuals will first be treated for any severe or life-threatening physical conditions that have occurred, in order to stabilize their physical health ^[1].

At this time, they will also undergo the refeeding process, to increase body weight and nutritional intake. This will likely require therapeutic intervention and nutritional counseling to help manage behaviors and attitudes toward food and eating. Management of these symptoms allows for the refeeding process to commence with necessary support in place ^[3][4].

If required, nasogastric (NG) tube feeding may be implemented while in the hospital. Tube feeds can provide the individual with the necessary nutrition and fluid even when the severity of their condition does not allow them to engage in the refeeding process voluntarily. Tube feeds can also reduce the risk of refeeding syndrome through gradual supplementation of nutrition and vitamins ^[4][7].

During treatment, the individual will also receive specialized therapy. In therapy they will explore their thoughts and feelings related to their body image as well as any emotions that arise during their treatment process. They will also discuss and explore any underlying causes of the condition ^[3].

Often, the individual and loved ones involved in their medical care will receive psychoeducation on the condition, symptoms, and recovery process. This can help to provide all involved with support and understanding of the treatment process, which can also be utilized upon the individual’s discharge from the hospital once their health and weight is stabilized ^[3][4].