Anorexia Nervosa in the Acute Hospitalization Setting

Inpatient treatment for Anorexia Nervosa (AN) is the most intensive level of care, often aimed at emergency renutrition. As per international guidelines, vital signs alterations, psychiatric symptoms, Body Mass Index (BMI) thresholds (extreme when <15 kg/m2), and severe rate of weight loss (>1 kg/week) should all be used as indicators of severity when considering hospitalization. Hospital care must be multidisciplinary and integrated, and caregivers should be involved in the treatment decision whenever possible. Weight gain (0.5–1.4 kg/week) aiming at weight restoration is the main goal of nutritional rehabilitation and is achieved mainly through oral diet, nutritional supplements, and tube feeding, alone or combined. Caloric prescriptions (starting from 5–20 kcal/kg and increasing every 2–4 days) must be balanced to avoid both refeeding and underfeeding syndromes. Psychological treatments during hospitalization are useful in sustaining weight recovery, and clinicians should value therapeutic alliance and interventions fostering patient motivation. The use of psychoactive drugs can be useful in treating psychiatric comorbidities, however not in pursuing weight gain. Clinicians should be aware that rehospitalization is common, mostly due to symptoms’ persistence after discharge. On this line, inpatient and outpatient services should collaborate to promote continuity of care.