Eating disorders in children: is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment?

Kennedy, Grace A.; Wick, Madeline R.; Keel, Pamela K.

doi:10.12688/f1000research.13110.1

Cited by 31 publications

(22 citation statements)

References 24 publications

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“…In the reviewed literature, there appears to be some confusion regarding whether ARFID should be approached from a life-span perspective, as suggested by the overall changes in DSM-5, or if it is still primarily to be seen as a pediatric diagnosis. In part, this mirrors the uncertainty about whether ARFID should be seen primarily as an eating disorder or a feeding disorder described in a recent review (Kennedy et al, 2018). A majority of the reviewed original research publications report on a pediatric population (Table 1) and as described above, in comparisons between diagnostic groups, it is often noted that patients with ARFID tend to be younger than those with AN.…”

Section: Feighner Criterion 4: Course Over Timementioning

confidence: 70%

“…A reported overall longer duration of illness at presentation may reflect the fact that patients with ARFID also tend to be assessed by physicians in other fields of medicine before they are diagnosed (Ornstein et al, ) and that they are less often self‐referred (Kennedy et al, ). Naturally, the fact that a diagnosis is difficult to make or that it is unknown to large groups of clinicians is not the type of common characteristic that supports diagnostic validity per se.…”

Section: Resultsmentioning

confidence: 99%

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

Strand

Hausswolff-Juhlin

Welch

2018

Intl J Eating Disorders

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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.

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Section: Feighner Criterion 4: Course Over Timementioning

confidence: 70%

Section: Resultsmentioning

confidence: 99%

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

Strand

Hausswolff-Juhlin

Welch

2018

Intl J Eating Disorders

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“…Currently, the DSM‐5 lists three characteristic functions of restrictive eating: (1) dietary restriction secondary to sensory sensitivity, (2) fear of aversive consequences while eating, and (3) lack of interest in eating secondary to poor appetite. Clinicians and researchers have further recognized the diversity of presentations among patients with ARFID, and clinical observations suggest that these three functions of food refusal may represent clinically meaningful behavioural phenotypes (Fisher et al, ; Kennedy, Wick, & Keel, ; Norris et al, ; Thomas et al, ). Considering data suggesting that patients with ARFID may be more likely to drop out of treatment (Forman et al, ), exploring empirical methods for understanding symptom heterogeneity may offer one approach to more effectively tailor psychological treatments and promote better outcomes.…”

Section: Introductionmentioning

confidence: 99%

Exploring the cooccurrence of behavioural phenotypes for avoidant/restrictive food intake disorder in a partial hospitalization sample

Reilly

Brown

Gray

et al. 2019

Euro Eating Disorders Rev

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Objective Literature providing clinical characterizations of avoidant/restrictive food intake disorder (ARFID) has proposed the occurrence of three functions for food refusal: fear of negative consequences, lack of hunger, or sensory sensitivity. Recent studies have suggested that these functions may be used to subtype patients presenting with ARFID; however, other work suggests that these categories are not mutually exclusive and instead represent neurobiological dimensions that can cooccur. The current study explored the potential cooccurrence of behavioural phenotypes in patients with ARFID presenting to a partial hospitalization program. Method Two raters conducted a retrospective chart review of patients with ARFID presenting to treatment from June 2014 to May 2018 (N = 59). Results Regarding cooccurrence of symptoms consistent with behavioural phenotypes, raters showed excellent agreement, and over 50% of the sample endorsed symptoms consistent with more than one phenotype. The sensory sensitivity phenotype was most common in the sample and frequently cooccurred with both other phenotypes. Discussion Results suggest that multiple functions for food avoidance may be present within one individual. Future work should aim to further characterize individuals presenting with singular versus multiple phenotype characteristics.

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“…Yet, in some cases, PE is not benign. Clinically significant PE, also referred to as “selective” or “selective/neophobic” eating, can lead to a diagnosis of avoidant/restrictive food intake disorder (ARFID), an eating/feeding disorder characterized by restrictive eating not attributed to weight or shape concerns that leads to weight loss, nutritional insufficiencies, dependence on nutritional supplements, and/or psychosocial impairment (American Psychiatric Association, ; Fisher et al, ; Kennedy, Wick, & Keel, ; Reilly, Brown, Gray, Kaye, & Menzel, ; Thomas et al, ; Zickgraf, Lane‐Loney, Essayli, & Ornstein, ; Zickgraf, Murray, Kratz, & Franklin, ). PE is one of three patterns of restrictive eating that have been linked to ARFID symptoms in both nonclinical samples (e.g., Zickgraf & Ellis, ) and in treatment‐seeking patients diagnosed with ARFID (e.g., Reilly et al, ; Zickgraf, Lane‐Loney, et al, ).…”

Section: Introductionmentioning

confidence: 99%

Classifying and characterizing Chinese young adults reporting picky eating: A latent profile analysis

Zickgraf

Essayli

et al. 2020

Intl J Eating Disorders

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Objective: Picky eating (PE) is common across the lifespan and related to psychosocial impairment and limited dietary variety. However, research about PE in non-Western countries is limited. Because eating behaviors may differ by culture, operationalizing PE in non-Western countries (e.g., China) is needed. The present study aimed to replicate two previous studies identifying PE profiles in Western countries by using latent profile analysis (LPA) to classify and characterize adults reporting picky eating in a Chinese sample.Method: A sample of 1,068 Chinese young adults completed a battery of questionnaires including the adult eating behavior questionnaire (AEBQ). LPA was utilized to identify eating profiles. The three-step approach was used to examine predictors of latent memberships and profile differences on various self-reported measures.Results: The best fit was a four-profile solution, with two picky eating profiles emerging: picky eating and severe picky eating. Compared to those in the other two profiles, participants in the picky eating profile (19.4%) and severe picky eating profile (3.3%) had significantly higher scores on self-reported eating disorder symptoms and psychological distress, and lower scores on self-reported food-related life satisfaction.Relative to the picky eating profile, participants in the severe picky eating profile reported significantly greater self-reported eating disorder symptoms, psychological distress, and food-related dissatisfaction. Discussion: Characterizing PE profiles is an important step toward understanding eating behaviors among Chinese young adults. Identifying various eating profiles has implications for future research related to PE, including the development of diagnostic tools and interventions to address PE in a Chinese context. K E Y W O R D S adults, Chinese, eating behaviors, latent profile analysis, picky eating, selective eating

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Eating disorders in children: is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment?

Cited by 31 publications

References 24 publications

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

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

Exploring the cooccurrence of behavioural phenotypes for avoidant/restrictive food intake disorder in a partial hospitalization sample

Classifying and characterizing Chinese young adults reporting picky eating: A latent profile analysis

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