Treatment methods of avoidant/restrictive food intake disorder: Review with therapeutic implications

Abstract

Background: The introduction of Avoidant/Restrictive Food Intake Disorder (ARFID) have refined childhood and adolescent eating disorders, however it meant a significant change in the diagnostics. Hardly anything is known about its effective interventions and there is a lack of specific treatment guidelines. Thus, our aim was to review the risk factors, assessment methods, and chiefly the treatment methods of ARFID to support its clinical management and psychotherapy. Method: The reviewing process was conducted in two steps, with the primary focus on the literature since the introduction of ARFID using the term of 'avoidant/restrictive food intake disorder' with dates 2012 -2015. The PRISMA flow algorithm was applied to filter results. Results and discussion: Assessment methods involve structured DSM -V interview, supplemented with Bryant-Waugh's diagnostic guideline, and the Children's Eating Disorder Examination-Questionnaire, or the Eating Disturbances in Youth-Questionnaire. The heterogeneous treatment shall fit the patients' and families individual needs, and the different presentations ARFID (e.g. sensory-based selective eating, of chocking or vomiting phobia and interactional difficulties). A combination of medical treatment with the primary focus on the weight recovery, nutritional management, and psychotherapeutic interventions are suggested; in children parents should be involved. Behavior therapy with exposure, systematic desensitization, CBT with cognitive restructuring, anxiety management, and family based interventions seemed to be the most useful psychotherapeutic interventions. Conclusions: Studies should start assessing the effectiveness of different treatment approaches based on longitudinal researches to describe strict evidence-based guidelines for each presentations of ARFID.