Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders

Abstract

BackgroundAvoidant/Restrictive Food Intake Disorder (ARFID) is a “new” diagnosis in the recently published DSM-5, but there is very little literature on patients with ARFID. Our objectives were to determine the prevalence of ARFID in children and adolescents undergoing day treatment for an eating disorder, and to compare ARFID patients to other eating disorder patients in the same cohort.MethodsA retrospective chart review of 7-17 year olds admitted to a day program for younger patients with eating disorders between 2008 and 2012 was performed. Patients with ARFID were compared to those with anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder/unspecified feeding or eating disorder with respect to demographics, anthropometrics, clinical symptoms, and psychometric testing, using Chi-square, ANOVA, and post-hoc analysis.Results39/173 (22.5%) patients met ARFID criteria. The ARFID group was younger than the non-ARFID group and had a greater proportion of males. Similar degrees of weight loss and malnutrition were found between groups. Patients with ARFID reported greater fears of vomiting and/or choking and food texture issues than those with other eating disorders, as well as greater dependency on nutritional supplements at intake. Children’s Eating Attitudes Test scores were lower for children with than without ARFID. A higher comorbidity of anxiety disorders, pervasive developmental disorder, and learning disorders, and a lower comorbidity of depression, were found in those with ARFID.ConclusionsThis study demonstrates that there are significant demographic and clinical characteristics that differentiate children with ARFID from those with other eating disorders in a day treatment program, and helps substantiate the recognition of ARFID as a distinct eating disorder diagnosis in the DSM-5.

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

“…These studies have generally not compared ARFID/selective eating samples with samples representing other eating and feeding disorders. However, compared to patients with other eating disorders, ARFID patients have been reported to score significantly lower on the Children's Eating Attitudes Test (Nicely et al, 2014;Ornstein et al, 2017) and on all subscales of the Eating Attitudes Test and the Eating Disorder Inventory (Nakai et al, 2017).…”

Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder

“…Most of these studies are on children and adolescents from intensive-treatment pediatric ED settings who have a heterogeneous and complex clinical presentation (Fisher et al, 2014;Nicely, Lane-Loney, Masciulli, Hollenbeak, & Ornstein, 2014;Norris et al, 2014;Strandjord, Sieke, Richmond, & Rome, 2015). Most of these studies are on children and adolescents from intensive-treatment pediatric ED settings who have a heterogeneous and complex clinical presentation (Fisher et al, 2014;Nicely, Lane-Loney, Masciulli, Hollenbeak, & Ornstein, 2014;Norris et al, 2014;Strandjord, Sieke, Richmond, & Rome, 2015).…”

Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms

“…Prior to the introduction of the ARFID diagnosis, individuals with ARFID were often referred to treatment designed for individuals with disordered eating attitudes consistent with restricting anorexia [23]. In a series of retrospective chart reviews up to 2014, 12–22 % of adolescents referred to eating disorder clinics meet criteria for ARFID rather than for a restricting eating disorder associated with weight and shape concerns and body image disturbance (e.g., [23, 24]). In order to show that ARFID is distinct from other restricting eating disorders, it is necessary to show that individuals with self-reported ARFID symptoms can be differentiated from those with self-reported attitudes associated with anorexia and bulimia on the basis of either comorbidity or eating behavior.…”