Avoidant/restrictive Food Intake Disorder Patients Research Articles

Clinical characteristics, treatment course and outcome of adults treated for avoidant/restrictive food intake disorder (ARFID) at a tertiary care eating disorders program

BackgroundAvoidant/restrictive food intake disorder (ARFID) is now recognized as a feeding/eating disorder that affects individuals across the lifespan, but research on ARFID in general and particularly in adults remains limited. The purpose of this study was to describe the demographic and clinical characteristics of adults with ARFID seeking treatment at a tertiary care eating disorders program, and to describe the course and outcomes of treatment at three levels of care—inpatient, intensive outpatient, and outpatient individual therapy.MethodThis retrospective chart review study examined the charts of 42 patients who received treatment for ARFID between April 2020 and March 2023. Following diagnostic assessment, patients were referred to either inpatient treatment, intensive outpatient treatment, or outpatient individual therapy. All three levels of care involved individual cognitive behaviour therapy. Inpatients typically transitioned to one of the outpatient treatments as part of a continuous care plan. We examined demographic and clinical characteristics, treatment length and completion, and changes in key indicators during treatment.ResultsPatients were diverse with respect to demographics (e.g., 62% cisgender women; 21% cisgender men; 17% transgender, non-binary, or other gender) and comorbid concerns (e.g., 43% had neurodevelopmental disorders; > 50% had mood and anxiety disorders; 40% had posttraumatic stress disorder [PTSD]; 35% had medical conditions impacting eating/digestion). Most patients presented with more than one ARFID maintaining mechanism (i.e., lack of appetite/interest, sensory sensitivities, and/or fear of aversive consequences of eating). Treatment completion rates and outcomes were good. On average, patients showed significant improvement in impairment related to their eating disorder, and those who were underweight significantly improved on BMI and were not underweight at end of treatment.DiscussionThese findings add to the literature by indicating that ARFID patients are commonly male or have diverse gender identities, and have high rates of neurodevelopmental, mood, anxiety, and gastrointestinal disorders. We also found high rates of PTSD. The findings show promise for treatment outcomes across the continuum of care. Next steps in ARFID treatment and research include incorporating ARFID-specific assessments into routine care, and ongoing research investigating the efficacy and effectiveness of treatments such as CBT-AR.

The clinical presentation of avoidant restrictive food intake disorder in children and adolescents is largely independent of sex, autism spectrum disorder and anxiety traits

Avoidant restrictive food intake disorder (ARFID) is a new eating disorder with a heterogeneous clinical presentation. It is unclear which patient characteristics contribute to its heterogeneity. To identify these patient characteristics, we performed symptom-level correlation and driver-level regression analyses in our cross-sectional study in up to 261 ARFID patients (51% female; median age=12.7 years) who were assessed at the Maudsley Centre for Child and Adolescent Eating Disorders, London between November 2019 and July2022. Symptoms across the three drivers 1) avoidance based on sensory characteristics of food; 2) apparent lack of interest in eating; and 3) concern about aversive consequences positively correlated with each other. Patients' anxiety traits showed the greatest positive correlations with symptoms of concern about aversive consequences of eating. Patient sex was not significantly associated with any of the three ARFID drivers. Patients with comorbid autism spectrum disorder (ASD; 28%) showed more food-related sensory sensitivities (RR=1.26) and greater lack of interest in eating (RR=1.18) than those of patients without ASD (49%). In our clinical sample, the ARFID drivers occurred together and did not show clinically meaningful differences between the sexes. ASD may accentuate food-related sensory sensitivities and lack of interest, but may not drive a completely different symptom presentation. ARFID is multi-faceted and heterogenous, requiring a comprehensive multidisciplinary assessment to sufficiently understand the drivers of the restrictive eating behaviour. Results need replication in larger samples with more statistical power. None.

Self-reported expertise and confidence in diagnosing and treating avoidant restrictive food intake disorder among Swedish clinicians.

To assess self-reported knowledge and confidence regarding avoidant restrictive food intake disorder (ARFID) diagnosis and treatment in Swedish clinicians from various disciplines. The study included 489 clinicians who attended educational lectures about ARFID. Participants responded to 20 ARFID-related questions and statements using the online audience engagement platform Mentimeter. Items assessed ARFID-related knowledge, education, and experience, as well as treatment methods offered to ARFID patients at clinicians' healthcare units. We found predominantly correct responses to three basic knowledge-based items about ARFID. However, most participants (64.0%) reported never having received education about ARFID, and few participants reported feeling confident in their ability to diagnose (13.4%) and treat (10.7%) ARFID. Nearly half the sample reported either not knowing which ARFID treatments their unit offered (22.3%) or that no treatment was offered (21.3%). Experience and confidence in diagnosing and treating ARFID are generally low in Swedish clinicians, and many individuals with ARFID do not receive treatment. We identify a pressing need for resources, clearer organisation, and structure, and for additional education and training opportunities for clinicians meeting individuals with ARFID.

Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study.

The purpose of this study is to describe the clinical features of adult patients with avoidant/restrictive food intake disorder (ARFID) to better understand the medical findings, psychological comorbidities, and laboratory abnormalities in this population. We completed a retrospective chart review of all adult patients with a diagnosis of ARFID, admitted for medical stabilization, between April 2016 and June 2021, to an inpatient hospital unit, which specializes in severe eating disorders. Information collected included anthropomorphic data, laboratory assessments, and medical history at time of admission. One hundred and twenty-two adult patients with ARFID were identified as meeting inclusion criteria for the study. The most common ARFID presentation was "fear of adverse consequences." The majority were female (70%), with an average age of 32.7 ± 13.7 years and mean percent of ideal body weight (m%IBW) of 68.2 ± 10.9. The most common laboratory abnormalities were low serum prealbumin and vitamin D, hypokalemia, leukopenia, and elevated serum bicarbonate. The most common psychiatric diagnoses were anxiety and depressive disorders, and the most common medical diagnoses were disorders of gut-brain interaction (DGBI). This is the largest study to the authors' knowledge of medical presentations in adult patients with ARFID. Our results reflect that the adult patient with ARFID may, in some aspects, present differently than pediatric and adolescent patients with ARFID, or from ARFID patients requiring less intensive care. This study highlights the need for further investigation of adult patients with ARFID. ARFID is a restrictive eating disorder first defined in 2013. This study explores the medical presentations of adult patients (>18 years old) with ARFID presenting for specialized eating disorder treatment and identifies unique features of the adult presentation for treatment, compared to pediatric and adolescent peers.

Examination of pediatric tube feeding schedules and oral intake: A retrospective cross-sectional study.

A common treatment goal for children dependent on enteral feeding is to advance oral nutrition intake and decrease enteral feeding dependence. The purpose of this study was to investigate the relationship between tube feeding schedule and oral intake in feeding tube-dependent children diagnosed with avoidant restrictive food intake disorder (ARFID). A retrospective chart review was completed including 76 tube-dependent children with ARFID between the ages of 1 and 14 years who were evaluated by a registered dietitian, in conjunction with a multidisciplinary feeding team, during January 1, 2018, to May 31, 2019. Eligible participants were diagnosed with ARFID and receiving enteral nutrition via nasogastric or gastrostomy tube during the time of evaluation. The participants were categorized into groups according to tube feeding schedule type (bolus vs. overnight continuous) and further stratified by severity of oral motor deficit, as documented by the speech language pathologist or occupational therapist: none/mild and moderate/severe. The exclusion criteria included children aged <1 year, appetite stimulant listed as an active medication, overnight enteral feeding infusion of >12 h, or calculated percentage of calories from oral intake not specified. The primary study outcome was dichotomized percentage of oral intake, >0% vs 0%. Following adjustment for confounders, this retrospective chart review showed statistically higher odds of percentage of oral intake >0% in ARFID patients receiving overnight continuous enteral feeding schedules (odds ratio = 0.20, 95% CI: 0.05-0.83, P = 0.027). A bolus feeding schedule may not promote oral intake in feeding tube-dependent children diagnosed with ARFID.

Sleep and Avoidant Restrictive Food Intake Disorder (ARFID): Correlation With Psychopathology, Gender, and Academic Performance.

ObjectiveNo studies have investigated sleep disturbance in avoidant/restrictive food intake disorder (ARFID). We examined sleep disturbance in ARFID and its association with eating problems, body mass index (BMI), gender, internalizing and externalizing symptoms, cognitive performance, and academic difficulties.MethodsData from 71 ARFID patients from our partial hospitalization program (PHP) for children and adolescents were examined. Sleep data were extracted from measures administered at admission including Achenbach Child Behavior Checklist (CBCL), Children's Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS). Correlational analyses were conducted to evaluate the convergent validity of parent-reported and participant-reported sleep problems. Association with the severity of eating problems, BMI, percentage of median body weight (% MBW), age, gender, psychotropic medication, psychopathology, and academic difficulties was examined using analysis of variance (ANOVA) and Pearson’s correlation. ResultsFifty-two percent of parents and 74% of participants reported two or more sleep symptoms. Trouble sleeping was reported by 46.48% and nightmares by 35.21% of parents. Parent-reported trouble sleeping highly correlated with internalizing disorders. Parent-reported trouble sleeping and participant-reported difficulty sleeping positively correlated with attention and attention-deficit/hyperactivity disorder (ADHD) problems. Parent-reported less sleep and feeling tired correlated with sluggish cognitive tempo, while walking/talking in sleep negatively correlated with school performance. Gender differences were noted in parent-reported sleep problems. Sleep disturbances were not associated with lower BMI or median body weight at intake. Parent-reported talking/walking in sleep and participant-reported bad dreams and bedtime worries positively correlated with Children's Eating Attitudes Test (ChEAT) scores at intake and discharge.DiscussionOur results provide compelling evidence to screen for sleep disturbance in ARFID patients regardless of median body weight and BMI. Exploration of sleep disturbances in ARFID using objective measures is warranted.

Comparison of neuropsychological profiles in children and adolescent with anorexia nervosa and avoidant/restrictive food intake disorder (ARFID)

IntroductionAnorexia Nervosa (AN) is an eating disorder characterized by low body weight, fear of gaining weight and distorted perception of body. Patients have rigidity, repetition of thoughts, alterations in decision-making skills and poor ability to provide new solutions. Avoidant/Restrictive Food Intake Disorder (ARFID) is a new eating disorder characterized by the absence of distress about body shape or fear of weight gain. Studies on neurocognitive aspects are few and no effective treatments are known.ObjectivesThe aim of our study was to further investigate the executive functions’ domains in AN and ARFID children and adolescents, to provide possible distinct neurocognitive traits in these patients.MethodsAN or ARFID patients (15 + 15; range 6-18 years), were assessed by neuropsychological tools, such as: Wechsler Intelligence Scale to measure I.Q. profile, NEPSY-II to explore attention and executive functions, Tower of London test to detect planning and problem solving abilities, the Bells Test to evaluate visual selective and focused attention, the Wisconsing Card Sorting Test (WCST) for assessment of flexibility and directing behaviors by achieving a goal and the Rey-Osterrieth complex figure test (ROCF) to assess visual-spatial abilities.ResultsPatients with ARFID presented impairments in several executive functions domains, with difficulties in the impulse inhibition, in the sustained attention and in visual-spatial skills. Finally, in their anamnesis a higher comorbidity with neurodevelopmental disorders such as specific learning disorder has been underlined.ConclusionsThe identification of specific deficit in neuropsychological profile of ARFID patients could be a rehabilitation target, together with standardized treatment.

Mentalization in developmental age’s eating disorders: Comparison between anorexia nervosa and avoidant/restrictive food intake disorder (ARFID)

IntroductionAnorexia Nervosa (AN) and Avoidant/Restrictive Food Intake Disorder (ARFID) are two primary restrictive eating disorders described in DSM-5, characterized both of them by insufficient food intake. This behavior In ARFID is not driven by weight and shape concerns that tipify AN. While there are several studies that highlight the presence of mentalizing difficulties in AN, there are still no data about mentalizing profile in ARFID.ObjectivesThe aim of this study was to better characterize the mentalizing profile of AN and ARFID children and adolescent.MethodsTwo groups of AN or ARFID outpatients (15+15), aged 6 to 18 years, were assessed by Alexythimia Questionnaire for Children (AQC) and Toronto Alexythimia Scale-20 (TAS-20) to evaluate alexythimia; by Interpersonal Reactivity Index (IRI) and Basic Empathy Scale (BES) to assess empathy; by NEPSY-II social perception subtests to evaluate Theory of Mind and Emotion recognition. Exclusion criteria were the presence of intellectual disability, pervasive developmental disorders and binge eating behavior (eating disorder other than AN or ARFID).ResultsPreliminary results showed different mentalizing profiles between ARFID and AN patients, with differences in the score for affective empathy, lower in ARFID than in AN patients while the score for alexythimia traits resulted higher in AN population.ConclusionsBy our results, mentalization impairment appeared trans-diagnostic across several eating disorders. This first result should be further improved to better analyze this construct in order to develop effective clinical intervention to improve the subject’s affective regulation.DisclosureNo significant relationships.

Caregiver accommodation in adolescents with avoidant/restrictive food intake disorder and anorexia nervosa: Relationships with distress, eating disorder psychopathology, and symptom change.

The role of family and caregiver accommodation is a well-defined maintenance factor for anxiety disorders and OCD. Family accommodation for patients with eating disorders is beginning to be described and characterized, but gaps in the literature remain. The current project compares levels of accommodation in families of those with anorexia nervosa (AN) to those with avoidant/restrictive food intake disorder (ARFID). It additionally establishes whether accommodation changes over the course of treatment and the extent to which these changes are related to changes in eating disorder pathology. A total of 39 adolescents with ARFID and 59 with AN presenting to a partial hospitalization program were included, with measures completed at intake and discharge. Caregivers of adolescents with AN and those with ARFID reported similar levels of accommodation, with the exception of the Reassurance Seeking subscale of the Accommodation and Enabling Scale for Eating Disorders (AESED). Additionally, accommodation decreased significantly from intake to discharge for both patient groups. Intake AESED scores were also significantly related to caregiver distress, and changes in AESED scores were related to decreases in relevant eating disorder psychopathology for both groups. The results of the current study highlight the importance of considering family accommodation for ARFID patients and point to the need for future research to capture changes in accommodation over the course of treatment in relation to the delivery of evidence-based interventions and subsequent changes in ED symptoms.

&lt;p&gt;An Inpatient Observational Study: Characteristics And Outcomes Of Avoidant/Restrictive Food Intake Disorder (ARFID) In Children And Adolescents In Japan&lt;/p&gt;

PurposeTo determine the clinical characteristics and course of severe avoidant/restrictive food intake disorder (ARFID) in hospitalized children and adolescents and compare them with those of patients with restricting-type anorexia nervosa (R-AN).Patients and methodsWe conducted a retrospective chart review of inpatients diagnosed with ARFID or R-AN based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at Jichi Children’s Medical Center Tochigi between April 1, 2007 and March 31, 2017. We compared the characteristics of the ARFID and R-AN patients at admission, during hospitalization, and after discharge.ResultsBoth the ARFID (n=13) and R-AN (n=79) patients required hospitalization for their medically unstable state. The features of ARFID group included concern about the aversive consequences of eating and avoidance of eating due to sensory concerns. Significant differences were found at admission between ARFID and R-AN groups in age (10.7 vs 12.7 years), family history of mental disorders (46.2% vs 17.7%), comorbid developmental disorders (6 vs 3 cases), and the time from onset to admission (3.9 vs 6.3 months). The body weight status, % ideal body weight (%IBW), % expected body weight (%EBW), <75% IBW rate, and <75% EBW rate did not differ significantly between the two groups at admission or discharge. The duration of post-discharge outpatient follow-up treatment did not differ significantly between ARFID and R-AN groups (15.3 vs 18.4 months); however, ARFID group recovery rate was significantly higher than that of R-AN group (77% vs 43%). The reasons that the patients with ARFID had significantly better outcomes than the R-AN patients remain unclear. Compared to those in previous studies, the present patients were younger and demonstrated better outcomes. Our results indicate that the body weight status is similar between ARFID and R-AN patients, but the ARFID patients achieved better outcomes.ConclusionThese findings suggest that early onset in childhood, early disease recognition, and early intervention are important factors for achieving better outcomes for patients with ARFID.

466 Avoidant/Restrictive Food Intake Disorder (ARFID) Among Adult Gastroenterology Behavioral Health Patients: Comparison of ARFID vs. Non-ARFID Patients

INTRODUCTION: Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder characterized by avoidance or restriction of food associated with weight loss, nutritional deficiency, dependence on tube feeds/oral supplements, or significant psychosocial impairment. Emerging evidence has shown 6-19% of gastroenterology (GI) patients have concurrent ARFID; however, these patients have not been characterized. METHODS: Retrospective analysis of 223 adult GI patients seen by a gastroenterologist and GI psychologist at a tertiary care center from 2016 to 2018. ARFID diagnosis was based on chart review by a gastroenterologist and GI psychologist for evidence of DSM-5 ARFID criteria. Demographic, clinical, and questionnaire data were recorded. RESULTS: Of 223 patients, 28 (12.6%) met criteria for ARFID. Concern for ARFID was raised in 0% of cases. There was no difference between ARFID and non-ARFID patient gender, age, educational level, GI diagnosis, GI symptom severity, mean BMI, or frequency of nutrition referral (Table 1). ARFID patients were less likely to be using a psychotropic medication (17.9% vs 50%, P &lt; 0.01). There was no difference in eating disorder history (ARFID 3.6% vs non-ARFID 8.7%, P = 0.12). On the IBS-QOL questionnaire, ARFID patients reported more severe food avoidance concerns, more frustration with not being able to eat what they wanted, and less severe body image concerns (all P&lt; 0.5). Following completion of GI-directed psychological therapies, IBS-QOL scores improved less in ARFID patients (Table 2). There was no difference between groups in Brief Symptoms Inventory scores or sleep quality scores (Table 3). CONCLUSION: This is the first study comparing ARFID vs non-ARFID adult GI behavioral health patients. Of 223 patients, 12.6% met ARFID criteria. ARFID and non-ARFID patients were clinically indistinguishable based on age, gender, BMI, GI diagnosis, or GI symptom severity. Although ARFID is often associated by gastroenterologists with underlying psychiatric or eating disorders, ARFID patients were less likely to be using psychotropic agents, reported lower body image concerns, and reported increased frustration with not being able to eat than non-ARFID patients. ARFID patients had decreased improvement in post-behavioral health therapy IBS-QOL scores. This data demonstrates the need to appropriately screen patients for ARFID and raises concern regarding the need utilize a multidisciplinary treatment approach that takes into account GI, psychological, and nutritional needs.

Health related quality of life of infants and children with avoidant restrictive food intake disorder.

ObjectiveThe aim of this study was to compare health related quality of life (HRQOL) in infants and children with avoidant restrictive food intake disorder (ARFID) to healthy and chronically ill controls.MethodA cross‐sectional study was conducted in children who meet ARFID criteria at our tertiary care pediatric feeding clinic (September 2014 to July 2016). Before consultation, parents of patients (n = 100) were asked to complete questionnaires to determine HRQOL: the TNO‐AZL Preschool Children Quality of Life (0–5 years), and “Pediatric Quality of Life Inventory” (6–7 and 8–10 years). HRQOL of ARFID patients was compared to both healthy (0–5 years n = 241; 6–7 years n = 61; 8–10 years n = 192) and chronically ill (0–5 years n = 79; 6–7 years n = 11; 8–10 years n = 26) controls.ResultsThe prevalence of ARFID was 64%. HRQOL of ARFID patients aged 0–5 years (n = 37) was significantly lower on 6/12 scales (appetite, lungs, stomach, motor functioning, positive mood and liveliness) compared to healthy controls (P < .01), and on 4/12 scales (appetite, stomach, motor functioning, and liveliness) compared to chronically ill controls (P < .01). The ARFID patients scored significantly better on the problem behavior scale compared to healthy and chronically ill controls (P < .01). ARFID patients aged 6–7 (n = 9) had significantly lower scores in 3/6 scales (total score, psychosocial health, and school functioning) (P < .01), and aged 8–10 (n = 2) had a significantly lower school functioning scale (P < .01) compared to healthy controls.ConclusionHRQOL of children with ARFID is decreased on multiple scales. The effect on HRQOL should be incorporated in clinical practice, and clinical studies should add HRQOL as an outcome measure.

Clinical presentation and outcome of avoidant/restrictive food intake disorder in a Japanese sample

We conducted a study of the clinical presentation and outcome in patients with avoidant/restrictive food intake disorder (ARFID), aged 15–40years, and compared this group to an anorexia nervosa (AN) group in a Japanese sample. A retrospective chart review was completed on 245 patients with feeding and eating disorders (FEDs), analyzing prevalence, clinical presentation, psychopathological properties, and outcomes. Using the DSM-5 criteria, 27 (11.0%) out of the 245 patients with a FED met the criteria for ARFID at entry. All patients with ARFID were women. In terms of eating disorder symptoms, all patients with ARFID had restrictive eating related to emotional problems and/or gastrointestinal symptoms. However, none of the ARFID patients reported food avoidance related to sensory characteristics or functional dysphagia. Additionally, none of them exhibited binge eating or purging behaviors, and none of them reported excessive exercise. The ARFID group had a significantly shorter duration of illness, lower rates of admission history, and less severe psychopathology than the AN group. The ARFID group reported significantly better outcome results than the AN group. These results suggest that patients with ARFID in this study were clinically distinct from those with AN and somewhat different from pediatric patients with ARFID in previous studies.

Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study

To assess and compare clinical characteristics of patients with avoidant/restrictive food intake disorder (ARFID) to those with anorexia nervosa (AN). A retrospective review of adolescent eating disorder (ED) patients assessed between 2000 and 2011 that qualified for a diagnosis of ARFID was completed. A matched AN sample was used to compare characteristics between groups. Two hundred and five patients met inclusion criteria and were reviewed in detail. Of these, 34 (5%) patients met criteria for ARFID. A matched sample of 36 patients with AN was used to draw comparisons. Patients with ARFID were younger than those with AN, more likely to present before age 12, and more likely to be male. Patients in both groups presented at low weights. Common eating-specific behaviors and symptoms in the ARFID group included food avoidance, loss of appetite, abdominal pain, and fear of vomiting. Rates of comorbid psychiatric diagnoses and medical morbidity were high in both groups. Almost 80% of AN patients and one-third of ARFID patients required hospital admission as a result of medical instability. Symptom profiles in 4/34 ARFID patients resulted in eventual reclassification to AN. This study supports the notion that a small percentage of adolescent patients presenting with restrictive eating disorders meet criteria for ARFID. Patients are younger than average, more likely to be male compared to adolescent AN samples, and have high rates of psychiatric and medical morbidity. The study also suggests that a proportion of patients evolve into AN as treatment progresses.