Clinical and psychological features of children and adolescents diagnosed with avoidant/restrictive food intake disorder in a pediatric tertiary care eating disorder program: a descriptive study

Abstract

BackgroundAvoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder first described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2013]. Patients with ARFID do not fear gaining weight or have body image distortions. ARFID involves a persistent disturbance in feeding and eating that results in an inability to meet nutritional and/or energy needs with one of the following: weight loss or failure to achieve appropriate weight gain, nutritional deficiency, dependence on enteral feeding or nutritional supplements and significant interference with psychosocial functioning. To date, studies on patients with ARFID have retrospectively applied the DSM-5 diagnostic criteria for ARFID to reclassify patients diagnosed with DSM-IV eating disorders.MethodsA descriptive retrospective chart review was completed on patients less than 18-years diagnosed with ARFID after a comprehensive eating disorder assessment between May 2013 and March 2016. The data collected included demographics, anthropometrics, historical information, clinical features, co-morbid diagnoses, need for inpatient hospitalization and psychometric measures.ResultsThree hundred and sixty-nine patients were assessed for an eating disorder between May 2013 and March 2016. Of these, 31 (8.4%) received a DSM-5 diagnosis of ARFID. A full chart review was performed on 28 (90.3%) patients. Weight loss or failure to achieve appropriate weight gain was the reason for diagnosis in 96.4% (27/28). All of our patients had 2 or more physical symptoms at the time of diagnosis and 16 (57.1%) had a co-morbid psychiatric disorder. Twenty (71.4%) reported a specific trigger for their eating disturbance. Admission for inpatient hospitalization occurred in 57.1% (16/28) of patients. Thirteen (46.4%) patients had been previously assessed by another specialist for their eating disturbance. None of the patients had elevated scores on commonly used psychometric tests used to assess eating disorders.ConclusionThis is the first study to retrospectively determine the incidence of ARFID in children and adolescents using the DSM-5 diagnostic criteria at assessment. The clinical presentation of patients with ARFID is complex with multiple physical symptoms and comorbid psychiatric disorders. Commonly used pediatric eating disorder psychometric measures are not specific for making a diagnosis of ARFID, and may not be sensitive as assessment tools.

Children with avoidant/restrictive food intake disorder and anorexia nervosa in a tertiary care pediatric eating disorder program: A comparative study

“…These findings align with the clinical presentation of what we know about individuals with ARFID, given the lack of preoccupation with weight and shape, and greater concerns about eating specific types of foods (Thomas et al, ). Current measures used to assess EDs in children were designed specifically for AN and BN, and are limited for capturing the clinical features of ARFID (Cooney et al, ). Developing measures specific to ARFID symptoms is necessary, including lack of interest in food, fear of choking, and sensitivities to textures, which are not captured in most psychometric batteries for EDs.…”

“…In a retrospective chart review of children in an ED day hospital program, patients with ARFID had significantly lower scores on the dieting and food preoccupation subscales, but not on the oral control subscale of the Children's Eating Attitudes Test (ChEAT) relative to patients meeting criteria for AN and BN (Nicely et al, ). Similarly, Cooney, Lieberman, Guimond, and Katzman () found that only 27.3% of patients ( n = 11) presenting with ARFID in a hospital setting scored above clinical criteria on the ChEAT total scale. These results suggest that current ED measures do not adequately capture the behaviors and cognitions of children with ARFID.…”

Conceptualizing the role of disgust in avoidant/restrictive food intake disorder: Implications for the etiology and treatment of selective eating

“…Selective eating is a predominant symptom reported in some presentations of Avoidant/Restrictive Food Intake Disorder (ARFID; Cooney, Liberman, Guimond, & Katzman, ). Individuals with selective eating endorse sensitivity to tastes, textures, and other sensory qualities of food, can be extremely limited in their dietary variety, and often endorse anxiety related to trying novel foods (food neophobia).…”

Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder

“…Small sample sizes may have led to unreliable prevalence estimates of psychiatric diagnoses among individuals with ARFID. Further, with the exception of a few studies that conducted a real‐time eating disorder diagnostic evaluation using DSM‐ 5 criteria (Cooney et al, ; Duncombe Lowe et al, ; Lieberman et al, ) and another study that used an unstructured clinical interview (Reilly, Brown, Gray, Kaye, & Menze, ), the majority of studies have utilized chart reviews to retrospectively confer ARFID diagnoses. Considering that the first structured clinical interview to assess ARFID across the lifespan—the Pica, ARFID, and Rumination Disorder Interview (PARDI; Bryant‐Waugh et al, )—was not published until recently, the studies to date reporting psychiatric comorbidities in ARFID have been hindered by the lack of empirically validated assessments, which may have impacted diagnostic validity and reliability.…”