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ARFID at 10 years: A Review of Medical, Nutritional and Psychological Evaluation and Management

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Abstract

Purpose of Review

Avoidant restrictive food intake disorder (ARFID) is a diagnostic term that was established 10 years ago to describe those patients with an eating disorder, mostly children and adolescents, who have poor nutrition that is not due to body image or weight concerns. This article reviews the diagnosis and subtypes of ARFID, as well as the medical, nutritional and psychological principles of evaluation and management of the disorder.

Recent Findings

In the past 10 years, clinicians have refined their approaches to managing the two major subtypes of ARFID: (1) those patients with a longer-term restriction in the amount and/or variety of the foods they eat, and (2) those patients with a shorter-term decrease in eating because of fear of aversive consequences such as vomiting, choking, GI symptoms or an allergic reaction to food. In that same time, the field of psychology has been developing evidence-based approaches to management of ARFID in each of its manifestations.

Summary

Each patient with ARFID presents with a unique set of medical, nutritional and psychological factors that requires an individualized and multi-disciplinary approach in the management of this difficult to treat disorder.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.

    Book  Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manuel of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association; 1990.

    Google Scholar 

  3. Fisher M, Gonzalez M, Malizio J. Eating disorders in adolescents: how does the DSM-5 change the diagnosis? Int J Adolesc Med Health. 2015;27(4):437–41.

    Article  PubMed  Google Scholar 

  4. Fisher MM, Rosen DS, Ornstein RM, et al. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. J Adolesc Health. 2014;55(1):49–52.

    Article  PubMed  Google Scholar 

  5. Ornstein RM, Rosen DS, Mammel KA, et al. Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders. J Adolesc Health. 2013;53(2):303–5.

    Article  PubMed  Google Scholar 

  6. Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord. 2014;2(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Norris MI, Robinson A, Obeid N, Harrison M, Spettigue W, Henderson K. Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord. 2014;47(5):495–9.

    Article  PubMed  Google Scholar 

  8. Eddy KT, Thomas JJ, Hastings E, et al. Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord. 2015;48(5):464–70.

    Article  PubMed  Google Scholar 

  9. Norris M, Spettigue W, Hammond N, et al. Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder. Int J Eat Disord. 2018;51:170–5.

    Article  PubMed  Google Scholar 

  10. Reilly E, Brown T, Gray E, et al. Exploring the co-occurrence of behavioral phenotypes for avoidant/restrictive food intake disorder in a partial hospitalization program. Eur Eating Disord Rev. 2019;27:429–35.

    Article  Google Scholar 

  11. Zickgraf H, Lane-Loney S, Essayli J, Ornstein R. Further support for diagnostically meaningful ARFID support presentations in an adolescent medicine partial hospitalization program. Int J Eat Disord. 2019;52:402–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Richmond T, Carmody J, Feiziinger M, et al. Assessment of patients with ARFID presenting to multi-disciplinary tertiary care program. J Pediatr Gastroenterol Nutr. 2023;76:743–8. This study highlights the subtypes of ARFID and the overlap between them.

    Article  PubMed  Google Scholar 

  13. Burton Murray H, Dreier M, Zickgraf H, et al. Validation of the nine item ARFID screen (NAIS) subscales for distinguishing ARFID. Int J Eat Disord. 2021;54:1782–92. This paper presents a screening tool for the diagnosis of ARFID.

    Article  PubMed  Google Scholar 

  14. Kurz S, van Dyck Z, Munsch S, Hilbert A. Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry. 2015;24:779–85.

    Article  PubMed  Google Scholar 

  15. Bryant-Waugh R, Micali N, Cooke L, Lawson E, et al. Development of the PICA, ARFID and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10 to 22. Int J Eat Disord. 2019;52:378–87.

    Article  PubMed  Google Scholar 

  16. Dinkler L, Yasmitsu-Lovell K, Eitoku M, et al. Development of a parent-reported screening tool for avoidant/restrictive food intake disorder (ARFID): Initial validation and prevalence in 4–7 year old Japanese children. Appetite. 2022;168:105735. https://doi.org/10.1016/jappet.2021.105735.

    Article  PubMed  Google Scholar 

  17. Schmidt R, Hiemisch A, Kiess W, von Klitzing K, Schlensog-Schuster F, Hilbert A. Macro- and micronutrient intake in children with avoidant/restrictive food intake disorder. Nutrients. 2021;13(2):400. https://doi.org/10.3390/nu13020400. This article demonstrates the degree to which macro-and micro-nutrient intake is decreased in patients with ARFID.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Białek-Dratwa A, Szymańska D, Grajek M, Krupa-Kotara K, Szczepańska E, Kowalski O. ARFID-strategies for dietary management in children. Nutrients. 2022;14(9):1739. https://doi.org/10.3390/nu14091739.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bryant-Waugh R, Loomes R, Munuve A, Rhind C. Towards an evidence-based out-patient care pathway for children and young people with avoidant restrictive food intake disorder. J Behav Cogn Ther. 2021;31(1):15–26.

    Article  Google Scholar 

  20. Sharp WG, Volkert VM, Scahill L, McCracken CE, McElhanon B. A systematic review and meta-analysis of intensive multidisciplinary intervention for pediatric feeding disorders: How standard is the standard of care? J Pediatr. 2017;181:116-124.e4.

    Article  PubMed  Google Scholar 

  21. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ. 1996;312(7023):71–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders [Internet]. Fourth Edition. American Psychiatric Association Publishing; 2023 [cited 2023 Jun 10]. Available from: https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890424865.

  23. Shimshoni Y, Shrinivasa B, Cherian AV, Lebowitz ER. Family accommodation in psychopathology: A synthesized review. Indian J Psychiatry. 2019;61(Suppl 1):S93-103.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lock J, Le Grange D. Treatment manual for anorexia nervosa: A family-based approach. 2nd ed. New York: Guilford; 2015. p. p289.

    Google Scholar 

  25. Lock J, Robinson A, Sadeh-Sharvit S, Rosania K, Osipov L, Kirz N, et al. Applying family-based treatment (FBT) to three clinical presentations of avoidant/restrictive food intake disorder: Similarities and differences from FBT for anorexia nervosa. Int J Eat Disord. 2019;52(4):439–46. This study introduces the use of Family Based Treatment (FBT) in the management of ARFID.

    Article  PubMed  Google Scholar 

  26. Nadeau PO, Leichner P. Treating bulimia in adolescents: A family-based approach. J Can Acad Child Adolesc Psychiatry. 2009;18(1):67–8.

    PubMed Central  Google Scholar 

  27. Lock J, Sadeh-Sharvit S, L’Insalata A. Feasibility of conducting a randomized clinical trial using family-based treatment for avoidant/restrictive food intake disorder. Int J Eat Disord. 2019;52(6):746–51.

    Article  PubMed  Google Scholar 

  28. Rosania K, Lock J. Family-based treatment for a preadolescent with avoidant/restrictive food intake disorder with sensory sensitivity: A case report. Front Psychiatry. 2020;8:11.

    Google Scholar 

  29. Lock J. Family-based treatment for avoidant/restrictive food intake disorder. New York: Routledge, Taylor & Francis Group; 2022. p. 246.

    Google Scholar 

  30. Thomas JJ, Wons O, Eddy K. Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Curr Opin Psychiatry. 2018;31(6):425–30.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thomas JJ, Becker KR, Kuhnle MC, Jo JH, Harshman SG, Wons OB, et al. Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents. Int J Eat Disord. 2020;53(10):1636–46. This study demonstrates the use of cognitive behavioral therapy (CBT) in the treatment of children and adolescents with ARFID.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Thomas JJ, Becker KR, Breithaupt L, Murray HB, Jo JH, Kuhnle MC, et al. Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder. J Behav Cogn Ther. 2021;31(1):47–55.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lebowitz ER, Omer H, Hermes H, Scahill L. Parent training for childhood anxiety disorders: The SPACE Program. Cogn Behav Pract. 2014;21(4):456–69.

    Article  Google Scholar 

  34. Shimshoni Y, Lebowitz ER. Childhood ARFID: Review of treatments and a novel parent-based approach. J Cogn Psychother [Internet]. 2020 Jun 26 [cited 2023 Apr 11]; Available from: https://connect.springerpub.com/content.

  35. Shimshoni Y, Silverman WK, Lebowitz ER. SPACE-ARFID: A pilot trial of a novel parent-based treatment for avoidant/restrictive food intake disorder. Int J Eat Disord. 2020;53(10):1623–35. This paper introduces the use of the psychological approach, Supportive Parenting for Anxious Childhood Emotions (SPACE) in the treatment of patients with ARFID.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Adolescent Medicine, Cohen Children’s Medical Center, 410 Lakeville Road, Suite 108, New Hyde Park, NY, 11042, USA

    Martin Fisher & Jacqueline Zimmerman

  2. Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Martin Fisher, Jacqueline Zimmerman & Lauren Yadlosky

  3. Division of Child and Adolescent Psychiatry, Zucker Hillside Hospital Northwell Health, Glen Oaks, NY, USA

    Caroline Bucher & Lauren Yadlosky

  4. Hofstra University, Hempstead, NY, USA

    Caroline Bucher

Authors
  1. Martin Fisher
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  2. Jacqueline Zimmerman
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  3. Caroline Bucher
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  4. Lauren Yadlosky
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Contributions

Martin Fisher MD wrote the Introduction, Diagnosis and Subtypes and Medical Management sections of the paper. Jacqueline Zimmerman MS, RD wrote the Nutrition Management section of the paper. Caroline Boucher MA and Lauren Yadlosky PhD wrote the Psychological Management section of the paper.

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Correspondence to Martin Fisher.

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Fisher, M., Zimmerman, J., Bucher, C. et al. ARFID at 10 years: A Review of Medical, Nutritional and Psychological Evaluation and Management. Curr Gastroenterol Rep 25, 421–429 (2023). https://doi.org/10.1007/s11894-023-00900-w

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  • DOI: https://doi.org/10.1007/s11894-023-00900-w

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