Pediatric Avoidant-Restrictive Food Intake Disorder and gastrointestinal-related Somatic Symptom Disorders: Overlap in clinical presentation.

Katelynn E Boerner,Jennifer S Coelho,Amrit K Dhariwal,Deepika Bajaj,Fiza Syal,Natalie Finner

doi:10.1177/13591045211048170

Abstract

Certain presentations of Avoidant/Restrictive Food Intake Disorder (ARFID) and Somatic Symptom and Related Disorders (SSRDs) have conceptual overlap, namely, distress and impairment related to a physical symptom. This study compared characteristics of pediatric patients diagnosed with ARFID to those with gastrointestinal (GI)-related SSRD. A 5-year retrospective chart review at a tertiary care pediatric hospital comparing assessment data of patients with a diagnosis of ARFID (n = 62; 69% girls, Mage = 14.08 years) or a GI-related SSRD (n = 37; 68% girls, Mage = 14.25 years). Patients diagnosed with ARFID had a significantly lower percentage of median BMI than those with GI-related SSRD. Patients diagnosed with ARFID were most often assessed in the Eating Disorders Program, whereas patients diagnosed with an SSRD were most often assessed by Consultation-Liaison Psychiatry. Groups did not differ on demographics, psychiatric diagnoses, illness duration, or pre-assessment services/medications. GI symptoms were common across groups. Patients diagnosed with an SSRD had more co-occurring medical diagnoses. A subset (16%) of patients reported symptoms consistent with both diagnoses. Overlap is observed in the clinical presentation of pediatric patients diagnosed with ARFID or GI-related SSRD. Some group differences emerged, including anthropometric measurements and co-occurring medical conditions. Findings may inform diagnostic classification and treatment approach.

Highlights

There has been a subset of individuals with a clinically significant eating condition for whom the diagnosis of a specified eating disorder was not appropriate, because the youth did not report body image concerns
Groups were categorized based on the primary diagnosis listed, but it was noted whether they had features of both diagnoses
There was no significant difference in the number of participants in the Avoidant/Restrictive Food Intake Disorder (ARFID) (n = 8, 12.9%) and GI-related Symptom and Related Disorders (SSRD) (n = 8, 21.6%) groups who had both diagnoses, χ2(1, N = 99) = 1.300, p =

Summary

Introduction

There has been a subset of individuals with a clinically significant eating condition for whom the diagnosis of a specified eating disorder (i.e., anorexia nervosa or bulimia nervosa) was not appropriate, because the youth did not report body image concerns. Compared to patients with other eating disorders (EDs), patients with ARFID are more commonly: younger, male, with a comorbid medical condition or anxiety disorder, and present with selective eating, anxiety, and/or gastrointestinal (GI) symptoms (Fisher et al, 2014). Some of these characteristics suggest an overlap between symptoms of ARFID and Somatic Symptom and Related Disorders (SSRD). ARFID and SSRDs may share common etiological pathways

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