A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder

Abstract

Objective Avoidant/restrictive food intake disorder (ARFID) was introduced as a new diagnosis in the DSM‐5. This systematic scoping review explores how ARFID as a diagnostic entity is conceptualized in the research literature and evaluates the diagnostic validity according to the Feighner criteria. Method A systematic scoping review of papers on ARFID in PubMed/MEDLINE and Web of Science was undertaken, following PRISMA and Joanna Briggs Institute guidelines. Results Fifty‐one original research publications, 23 reviews and commentaries, and 20 case reports were identified. The use of ARFID as a conceptual category varies significantly within this literature. At this time, the ARFID diagnosis does not fulfil the Feighner criteria for evaluating the validity of diagnostic constructs, the most urgent problem being the demarcation toward other disorders. A three‐dimensional model—lack of interest in food, selectivity based on sensory sensitivity, and fear of aversive consequences—is gaining support in the research literature. Discussion The introduction of the ARFID diagnosis has undoubtedly increased the recognition of a previously largely neglected group of patients. However, this article points to an inability of the current DSM‐5 diagnostic criteria to ensure optimal diagnostic validity, which risks making them less useful in clinical practice and in epidemiological research. To increase the conceptual validity of the ARFID construct, several possible alterations to the current diagnostic criteria are suggested, including a stronger emphasis of the three identified subdomains and further clarifying the boundaries of ARFID.

Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample

“…The diagnostic coding proposed by Kurz et al (2015Kurz et al ( , 2016 required the following EDY-Q items to be reported at least often (≥4): (disinterest in food OR sensory food avoidance OR fear of choking) and underweight problems, while weight and shape concern had to be reported less than sometimes (<3). In addition, a broad symptom definition by Schmidt et al (2018) was reported in the supplement due to the fact that ARFID was found to be characterized by other restrictive eating behaviours as well (APA, 2013;Strand, von Hausswolff-Juhlin, & Welch, 2019). This latter definition of broad symptoms of ARFID additionally considered that general or emotional food avoidance, picky eating, avoidance to try new foods, or fear of swallowing could be reported at least often (≥4).…”

The changing profile of eating disorders and related sociocultural factors in Japan between 1700 and 2020: A systematic scoping review

“…The recovery rate of the ARFID group was significantly higher than that of the AN‐R group. In comparison to their Western counterparts, (Strand, von Hausswolff‐Juhlin, & Welch, 2018), these Japanese patients with ARFID were more likely to be women, and experienced better treatment outcomes.…”

Do Feeding and Eating Disorders Fit the General Definition of Mental Disorder?

“…Of course, a heterogeneous symptomatology that lacks specificity may simply reflect different ways in which a single underlying dysfunction is expressed. At present, there is a paucity of research into ARFID, due to its relatively recent inclusion in DSM-5 (Strand et al 2019). However, ARFID can be present alongside other mental disorders such as ASD, ADHD, intellectual disability, and reactive attachment disorder.…”