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.

Case 18-2017 — An 11-Year-Old Girl with Difficulty Eating after a Choking Incident

“…Concurrent anxiety disorders are the most prevalent; they occur in more than 70% of patients in some clinical samples. 15 Rates of concurrent generalized anxiety disorder in particular have been estimated to be 50% among patients who are being treated for ARFID. 16 Major depressive disorder is also common among patients with ARFID, although it appears to occur less commonly in association with this condition than with anorexia nervosa and bulimia nervosa.…”

“…16 Major depressive disorder is also common among patients with ARFID, although it appears to occur less commonly in association with this condition than with anorexia nervosa and bulimia nervosa. 15 …”

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

“…7 Further, ARFID was even more common (22.5%) among youth in a day treatment program for eating disorders. 8 By contrast, a retrospective review of 2,231 consecutive referrals (aged 8–18 years) to pediatric gastrointestinal clinics in the Boston area showed an ARFID prevalence of only 1.5%. 9 A recent latent class analysis of three pediatric surveillance studies (in which pediatricians and child psychiatrists were asked to report on any children < 12 years with a newly diagnosed restrictive type eating disorder) performed across Canada, the United Kingdom, and Australia suggested that one of two identified clusters representing between 25–34% of children with incident restrictive type eating disorders mapped onto symptoms consistent with ARFID.…”

“…Psychiatric comorbidities, including anxiety disorders, 5,6 autism spectrum disorder, 8 and attention deficit hyperactivity disorder (ADHD) 8 are common among individuals with ARFID. A retrospective chart review of 34 pediatric patients with ARFID indicated that 50% also had generalized anxiety disorder.…”

Family-based treatment of eating disorders in adolescents: current insights

“…Avoidant/restrictive food-intake disorder (ARFID), introduced as a new disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),7 is characterized by an eating or feeding disturbance resulting in significant weight loss or failure to achieve expected weight, nutritional deficiencies, dependence on enteral feeding or nutritional supplements, or interference with psychosocial functioning. Prevalence estimates range from 5%8 to 22.5%,9 depending on the treatment setting.…”