ARFID in adults: Problems with the DSM 5 and ICD-11 conceptualization of restrictive eating disorders

Abstract

Introduction The nosology of eating disorders is undergoing a vast change. As a part of the revision process, the new diagnostic category of Avoidant/Restrictive Food Intake (ARFID) replaces the Feeding Disorder of Infancy or Early Childhood of DSM-IV to include those patients who have restrictive patterns of diet, but do not endorse weight or body shape concerns as the primary reasons for these restrictions. DSM-5 broadened the scope of ARFID to also include adults with restrictive eating patterns, which cannot be explained otherwise. Aims & objectives To highlight the nosological issues with ARFID as a diagnosis among adults. Methods A case series describing four cases presenting with disordered eating causing significant dysfunction that occurred for the first time in adulthood. Results In each case, anxieties regarding the consequences of eating multiple types of food led to significant restrictions of the quantity or kinds of diet which was associated with distress and dysfunction, and, significant weight loss. However, in all the cases, the restriction was secondary to the fear of physical symptoms which could be explained by underlying ICD-10 somatoform disorder. The cases do not match the classic western description of ARFID. Conclusions This series highlights some of the issues relating to eating disorder, particularly its clinical and nosological status. Problems relating to classification in a non-western setting are also reflected by the difficulty in labeling eating-related problems amidst the interplay of somatization, culture and eating.