48.5 THE OBSERVATION OF FEEDING IN THE DIAGNOSIS AND TREATMENT OF AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID) SUBTYPE: FEAR OF AVERSIVE CONSEQUENCES (POSTTRAUMATIC FEEDING DISORDER)

Abstract

The operational criteria for avoidant/restrictive food intake disorder (ARFID) subtype, fear of aversive consequences (posttraumatic feeding disorder), will be explained. The child demonstrates food refusal after a traumatic event or repeated traumatic events to the oropharynx or esophagus (eg, choking, severe gagging, vomiting, reflux); the event triggers intense distress in the child; after the event, the child experiences distress when anticipating feeding (ie, when positioned for feeding); the child refuses to eat and becomes increasingly distressed when force-fed. The child’s irritability and emotional dependency increase (ie, co-sleeping in parent’s bed, separation anxiety); the child shows diminished interest in daily activities and routines, including play and social interactions. The Feeding Resistance Scale was developed by Chatoor (2001) as a complement of the Parent-Child Feeding Scale for observation of the child’s anticipatory anxiety and resistance to feeding. Clinical vignettes and videotapes of children with this ARFID subtype will be shown to demonstrate the characteristic feeding behavior of these children. The observation of these children during a meal show that they have a high level of anticipatory distress and defense strategies of resistance to feeding following past traumatic experiences of the oropharynx. Moreover, emotional dysregulation of these children shows an increase in negative affect, such as angry moods and aggression. The mothers of these children show high levels of distress and anxiety, which can compromise their capacity to compensate or moderate the impact of the child’s traumatic experience. Considering the child’s anticipatory anxiety and emotional dysregulation as a reaction to the past negative experience of the oropharynx, the therapeutic approach should be based on desensitization of the child’s fear of eating by gradual exposure to food of increasing texture and consistency, psychological support for the parents, and parent guidance on how to help their child.