96. Further Support For Diagnostically Meaningful Symptom Presentations of Avoidant/Restrictive Food Intake Disorder In An Adolescent Medicine Eating Disorders Partial Hospitalization Program

Abstract

In contrast to “traditional” eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN), individuals with avoidant/restrictive food intake disorder (ARFID) exhibit eating pathology that is not driven by weight or shape concerns. ARFID can be diagnosed in individuals of any age whose pattern of inadequate caloric intake and/or dietary variety leads to acute weight loss or chronic growth failure, nutritional deficiency, supplement dependence, and/or significant psychosocial interference. Patients with ARFID made up 12.5-25% of patients presenting to adolescent medicine eating disorders settings across several retrospective chart reviews. Three patterns of restrictive eating that can lead to ARFID are described in the DSM-5: (1) extreme selectivity about foods based on their sensory properties, (2) limited interest in eating or poor appetite, and (3) fear of aversive consequences from eating (e.g. choking). Although ARFID captures an array of eating symptoms, there is virtually no empirical data on the distinctness of these presentations from one another, their prevalence in treatment settings, or their clinical presentation. We conducted retrospective chart review of 83 patients ages 8-17 admitted to an adolescent medicine eating disorders partial hospital program and diagnosed with ARFID. Charts were independently reviewed by two coders, with high interrater agreement (κ=.77). Distinct categories were identified and groups were compared on demographics, anthropometrics, co-morbid psychopathology, and core ARFID symptoms. Chart data included medical comorbidities, weight/nutritional ARFID symptoms (e.g., weight loss, supplement dependence) diagnosed by physicians, and DSM-5 psychiatric diagnoses given by psychologists, psychiatrists, or clinical social workers. We identified cases characterized by predominantly selective eating based on aversions to the sensory properties of foods (Selective; 5.1%), lack of interest in eating/low appetite (Appetite; 11.2%), and fear of aversive consequences from eating (Fear; 49.0%). We also distinguished a subset of patients with eating restrictions consistent with both selectivity and limited interest/appetite (Co-primary; 16.1%). A significantly higher proportion of male patients were diagnosed with the Co-primary and Appetite presentations (χ2(3)=12.11, V=.37). Patients with the Appetite presentation were significantly more likely to be adolescents 13-17 years (χ2(3)=13.40, V=.43). Patients with the Fear and Appetite presentations were more likely to have acute weight loss than those with the Selective and Co-primary presentations (χ2(3)=16.70, V=.45), whereas ,ore patients with the Co-primary presentation had a history of poor growth (χ2(3)=10.78, V=.38). Co-primary patients experienced significantly longer illness duration than any other group (F(3,61)=7.94, η2=.24). Patients with the Appetite presentation were more likely than other patients to have a medical condition (χ2(3)=8.3, V=.31) or mood disorder (χ2(3)=20.43, V=.54). The present findings suggest that there are diagnostically meaningful ARFID subtypes that can be differentiated based on the nature of their eating restrictions, as well as other demographic, illness history features, and psychiatric co-morbidity. As treatments for childhood/adolescent ARFID are developed and refined, it will be important to take into consideration not only demographic differences, but the variability in symptoms, as this might require distinct interventions and levels of care. Additionally, differing mechanisms that maintain different types of eating restrictions might necessitate unique psychological and psychiatric interventions.