Abstract
BackgroundAvoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder first described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2013]. Patients with ARFID do not fear gaining weight or have body image distortions. ARFID involves a persistent disturbance in feeding and eating that results in an inability to meet nutritional and/or energy needs with one of the following: weight loss or failure to achieve appropriate weight gain, nutritional deficiency, dependence on enteral feeding or nutritional supplements and significant interference with psychosocial functioning. To date, studies on patients with ARFID have retrospectively applied the DSM-5 diagnostic criteria for ARFID to reclassify patients diagnosed with DSM-IV eating disorders.MethodsA descriptive retrospective chart review was completed on patients less than 18-years diagnosed with ARFID after a comprehensive eating disorder assessment between May 2013 and March 2016. The data collected included demographics, anthropometrics, historical information, clinical features, co-morbid diagnoses, need for inpatient hospitalization and psychometric measures.ResultsThree hundred and sixty-nine patients were assessed for an eating disorder between May 2013 and March 2016. Of these, 31 (8.4%) received a DSM-5 diagnosis of ARFID. A full chart review was performed on 28 (90.3%) patients. Weight loss or failure to achieve appropriate weight gain was the reason for diagnosis in 96.4% (27/28). All of our patients had 2 or more physical symptoms at the time of diagnosis and 16 (57.1%) had a co-morbid psychiatric disorder. Twenty (71.4%) reported a specific trigger for their eating disturbance. Admission for inpatient hospitalization occurred in 57.1% (16/28) of patients. Thirteen (46.4%) patients had been previously assessed by another specialist for their eating disturbance. None of the patients had elevated scores on commonly used psychometric tests used to assess eating disorders.ConclusionThis is the first study to retrospectively determine the incidence of ARFID in children and adolescents using the DSM-5 diagnostic criteria at assessment. The clinical presentation of patients with ARFID is complex with multiple physical symptoms and comorbid psychiatric disorders. Commonly used pediatric eating disorder psychometric measures are not specific for making a diagnosis of ARFID, and may not be sensitive as assessment tools.
Highlights
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder first described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2013]
At the time of the study, a total of 369 patients were assessed by the eating disorder program between May 2013 and April 2016; after a comprehensive eating disorder assessment, 31 (8.4%) received a DSM-5 diagnosis of ARFID
This study demonstrates that the clinical presentation of children and adolescents with ARFID is complex with multiple physical symptoms
Summary
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder first described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2013]. ARFID involves a persistent disturbance in feeding and eating that results in an inability to meet nutritional and/or energy needs and leads to at least one of the following: weight loss or failure to achieve appropriate weight gain; nutritional deficiency; dependence on enteral feeding or nutritional supplements; or significant interference with psychosocial functioning [1]. Previous studies examining the incidence and clinical characteristics of children and adolescents with ARFID in pediatric tertiary care eating disorder programs have found the incidence to be between 5 and 14% [3, 4] These studies found that patients with ARFID were more likely to be younger and male, have a longer duration of illness, and present more often before the age of 12 compared to patients with AN or bulimia nervosa (BN). There is no literature describing the incidence and clinical presentation of children and adolescents with ARFID prospectively following a comprehensive eating disorder assessment in a tertiary care pediatric eating disorder program
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