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Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) in the Orthodox and Secular Jewish Communities in Israel

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Abstract

Symptoms related to avoidant/restrictive food intake disorder (ARFID) are not well defined in the general population. The aim of this study was to determine whether differences exist in the presentation of ARFID-related eating disturbances between healthy, religious and secular Jewish children in Israel. Sixty-four families participated in this study. Parents completed standardized questionnaires to assess ARFID behaviors of children, parental feeding problems and overall functioning, anxiety and sensory-aversion. No significant between-group differences were found for almost all assessments. However, sensory-related pleasure and sensory-seeking behavior was greater in secular children. Overall, religious and non-religious Israeli children do not differ in parental-reported ARFID-related feeding and eating behaviors.

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References

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). pp. 583–596.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) pp. 329–354. https://doi.org/10.1176/appi.books.9780890425596

  • Amitai, M., Taler, M., Carmel, M., Michaelovsky, E., Eilat, T., Yablonski, M., Orpaz, N., Chen, A., Apter, A., Weizman, A., & Fennig, S. (2016). The relationship between plasma cytokine levels and response to selective serotonin reuptake unhibitor treatment in children and adolescents with depression and/or anxiety disorders. Journal of Child and Adolescent Psychopharmacology, 26(8), 727–732. https://doi.org/10.1089/cap.2015.0147

    Article  CAS  Google Scholar 

  • Austin, P. C. (2011). Anintroduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424. https://doi.org/10.1080/00273171.2011.568786

    Article  Google Scholar 

  • Bachner-Melman, R., & Zohar, A. H. (2019). Potential risk and protective factors for eating disorders in Haredi (ultra-Orthodox) Jewish women. Journal of Religion and Health, 58(6), 2161–2174. https://doi.org/10.1007/s10943-019-00854-2

    Article  Google Scholar 

  • Bar-Shalita, T., Seltzer, Z., Vatine, J. J., Yochman, A., & Parush, S. (2009). Development and psychometric properties of the sensory responsiveness questionnaire (SRQ). Disability and Rehabilitation, 31(3), 189–201. https://doi.org/10.1080/09638280801903096

    Article  Google Scholar 

  • Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. Journal of the American Academy of Child & Adolescent Psychiatry, 38(10), 1230–1236. https://doi.org/10.1097/00004583-199910000-00011

    Article  CAS  Google Scholar 

  • Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child & Adolescent Psychiatry, 36(4), 545–553. https://doi.org/10.1097/00004583-199704000-00018

    Article  CAS  Google Scholar 

  • Blissett, J., & Fogel, A. (2013). Intrinsic and extrinsic influences on children’s acceptance of new foods. Physiology & Behavior, 121, 89–95. https://doi.org/10.1016/j.physbeh.2013.02.013

    Article  CAS  Google Scholar 

  • Bourne, L., Bryant-Waugh, R., Cook, J., & Mandy, W. (2020). Avoidant/restrictive food intake disorder: A systematic scoping review of the current literature. Psychiatry Research, 288, 112961. https://doi.org/10.1016/j.psychres.2020.112961

    Article  Google Scholar 

  • Brand-Gothelf, A., Parush, S., Eitan, Y., Admoni, S., Gur, E., & Stein, D. (2016). Sensory modulation disorder symptoms in anorexia nervosa and bulimia nervosa: A pilot study. International Journal of Eating Disorders, 49(1), 59–68. https://doi.org/10.1002/eat.22460

    Article  Google Scholar 

  • Bryant-Waugh, R. (2019). Avoidant/restrictive food intake disorder. Child and Adolescent Psychiatric Clinics of North America, 28(4), 557–565. https://doi.org/10.1016/j.chc.2019.05.004

    Article  Google Scholar 

  • Chandran, J. J., Anderson, G., Kennedy, A., Kohn, M., & Clarke, S. (2015). Subacute combined degeneration of the spinal cord in an adolescent male with avoidant/restrictive food intake disorder: A clinical case report. International Journal of Eating Disorders, 48(8), 1176–1179. https://doi.org/10.1002/eat.22450

    Article  Google Scholar 

  • Chao, H. C. (2018). Association of picky eating with growth, nutritional status, development, physical activity, and health in preschool children. Frontiers in Pediatrics, 6, 22. https://doi.org/10.3389/fped.2018.00022

    Article  Google Scholar 

  • Claudino, A. M., Pike, K. M., Hay, P., Keeley, J. W., Evans, S. C., Rebello, T. J., Bryant-Waugh, R., Dai, Y., Zhao, M., Matsumoto, C., Herscovici, C. R., Mellor-Marsa, B., Stona, A. C., Kogan, C. S., Andrews, H. F., Monteleone, P., Pilon, D. J., Thiels, C., Sharan, P., … Reed, G. M. (2019). The classification of feeding and eating disorders in the ICD-11: Results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines. BMC Medicine, 17(1), 93. https://doi.org/10.1186/s12916-019-1327-4

    Article  Google Scholar 

  • Cohen, J. (1977). Chapter 1-The concepts of power analysis. In J. Cohen (Ed.), Statistical power analysis for the behavioral sciences (pp. 1–17). Academic Press. https://doi.org/10.1016/B978-0-12-179060-8.50006-2

    Chapter  Google Scholar 

  • Cole, N. C., An, R., Lee, S. Y., & Donovan, S. M. (2017). Correlates of picky eating and food neophobia in young children: A systematic review and meta-analysis. Nutrition Reviews, 75(7), 516–532. https://doi.org/10.1093/nutrit/nux024

    Article  Google Scholar 

  • Cooke, L., Carnell, S., & Wardle, J. (2006). Food neophobia and mealtime food consumption in 4–5 year old children. International Journal of Behavioral Nutrition and Physical Activity, 3(1), 14. https://doi.org/10.1186/1479-5868-3-14

    Article  Google Scholar 

  • Cooney, M., Lieberman, M., Guimond, T., & Katzman, D. K. (2018). Clinical and psychological features of children and adolescents diagnosed with avoidant/restrictive food intake disorder in a pediatric tertiary care eating disorder program: A descriptive study. Journal of Eating Disorders, 6, 7. https://doi.org/10.1186/s40337-018-0193-3

    Article  Google Scholar 

  • Dancyger, I., Fornari, V., Fisher, M., Schneider, M., Frank, S., Wisotsky, W., Sison, C., & Charitou, M. (2002) Cultural factors in orthodox Jewish adolescents treated in a day program for eating disorders. International Journal of Adolescent Medicine and Health, 14(4), 317–328. https://doi.org/10.1515/ijamh.2002.14.4.317

    Article  Google Scholar 

  • Dori Frenkel, T., Latzer, Y., & Lev-Wiesel, R. (2018). Relationship between the ideal woman model, self-figure drawing, and disordered eating among Jewish ultra-orthodox women and national religious women. Israel Journal of Psychiatry and Related Sciences, 55(1), 73–81.

    Google Scholar 

  • Dovey, T. M., Kumari, V., & Blissett, J. (2019). Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), autistic spectrum disorders or picky eating: Same or different? European Psychiatry, 61, 56–62. https://doi.org/10.1016/j.eurpsy.2019.06.008

    Article  Google Scholar 

  • Ellis, J. M., Galloway, A. T., Webb, R. M., Martz, D. M., & Farrow, C. V. (2016). Recollections of pressure to eat during childhood, but not picky eating, predict young adult eating behavior. Appetite, 97, 58–63. https://doi.org/10.1016/j.appet.2015.11.020

    Article  Google Scholar 

  • Ellis, J. M., Schenk, R. R., Galloway, A. T., Zickgraf, H. F., Webb, R. M., & Martz, D. M. (2018). A multidimensional approach to understanding the potential risk factors and covariates of adult picky eating. Appetite, 125, 1–9. https://doi.org/10.1016/j.appet.2018.01.016

    Article  Google Scholar 

  • Feinson, M. C., & Meir, A. (2012). Disordered eating and religious observance: A focus on ultra-orthodox Jews in an adult community study. International Journal of Eating Disorders, 45(1), 101–109. https://doi.org/10.1002/eat.20895

    Article  Google Scholar 

  • Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A “new disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49–52. https://doi.org/10.1016/j.jadohealth.2013.11.013

    Article  Google Scholar 

  • Gluck, M. E., & Geliebter, A. (2002). Body image and eating behaviors in orthodox and secular Jewish women. Journal of Gender-Specific Medicine, 5(1), 19–24.

    Google Scholar 

  • Goodman, R., Meltzer, H., & Bailey, V. (2003). The strengths and difficulties questionnaire: A pilot study on the validity of the self-report version. International Review of Psychiatry, 15(1–2), 173–177. https://doi.org/10.1080/0954026021000046137

    Article  CAS  Google Scholar 

  • Hay, P., Mitchison, D., Collado, A.E.L., González-Chica, D.A., Stocks, N., & Touyz, S. (2017) Burden and healthrelated quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. Journal of Eating Disorders, 5, 21. https://doi.org/10.1186/s40337-017-0149-z

    Article  Google Scholar 

  • Heilman, S. C., & Witztum, E. (1997). Value-sensitive therapy: Learning from ultra-orthodox patients. American Journal of Psychotherapy, 51(4), 522–541. https://doi.org/10.1176/appi.psychotherapy.1997.51.4.522

    Article  CAS  Google Scholar 

  • Hleihel, A. (2017). Fertility among Jewish Women in Israel, by Level of Religiosity, 1979–2041. Jerusalem: Central Bureau of Statistics. Retrieved from https://www.cbs.gov.il

  • Homan, K. J., & Boyatzis, C. J. (2010). The protective role of attachment to god against eating disorder risk factors: Concurrent and prospective evidence. Eating Disorders, 18(3), 239–258. https://doi.org/10.1080/10640261003719534

    Article  Google Scholar 

  • Iron-Segev, S., Best, D., Arad-Rubinstein, S., Efron, M., Serur, Y., Dickstein, H., & Stein, D. (2020). Feeding, eating, and emotional disturbances in children with avoidant/restrictive food intake disorder (ARFID). Nutrients, 12(11), 3385. https://doi.org/10.3390/nu12113385

    Article  Google Scholar 

  • Jacobi, C., Agras, W. S., Bryson, S., & Hammer, L. D. (2003). Behavioral validation, precursors, and concomitants of picky eating in childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 42(1), 76–84. https://doi.org/10.1097/00004583-200301000-00013

    Article  Google Scholar 

  • Jacobi, C., Schmitz, G., & Agras, W. S. (2008). Is picky eating an eating disorder? International Journal of Eating Disorders, 41(7), 626–634. https://doi.org/10.1002/eat.20545

    Article  Google Scholar 

  • Kennedy, G. A., Wick, M. R., & Keel, P. K. (2018). Eating disorders in children: Is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment? F1000Research, 7, 88. https://doi.org/10.12688/f1000research.13110.1

    Article  Google Scholar 

  • Klinger, A., Angel-Zeevi, D., Rehavi-Italiano, L., Eliav, M., Inhorn-Gerberchik, S., & Nahir, S. (2018). The face of society in Israel, Report No. 10, June 2018-Religion and self-definition of degree of religiosity. https://www.cbs.gov.il/he/publications/Pages/2018/

  • Koomar, T., Thomas, T. R., Pottschmidt, N. R., Lutter, M., & Michaelson, J. J. (2021). Estimating the prevalence and genetic risk mechanisms of ARFID in a large autism cohort. Frontiers in Psychiatry, 12, 668297. https://doi.org/10.3389/fpsyt.2021.668297

    Article  Google Scholar 

  • Kurz, S., van Dyck, Z., Dremmel, D., Munsch, S., & Hilbert, A. (2016). Variants of early-onset restrictive eating disturbances in middle childhood. International Journal of Eating Disorders, 49(1), 102–106. https://doi.org/10.1002/eat.22461

    Article  Google Scholar 

  • Latzer, Y., Orna, T., & Gefen, S. (2007). Level of religiosity and disordered eating psychopathology among modern-orthodox Jewish adolescent girls in Israel. International Journal of Adolescent Medicine and Health, 19(4), 511–521. https://doi.org/10.1515/ijamh.2007.19.4.511

    Article  Google Scholar 

  • Latzer, Y., Stein, D., & Witztum, E. (2019). Treating ultra-orthodox adolescents with eating disorders in Israel: Culturally-sensitive interventions, difficulties, and dilemmas. Journal of Clinical Psychology, 75(8), 1455–1468. https://doi.org/10.1002/jclp.22790

    Article  Google Scholar 

  • Latzer, Y., Weinberger-Litman, S. L., Gerson, B., Rosch, A., Mischel, R., Hinden, T., Kilstein, J., & Silver, J. (2015). Negative religious coping predicts disordered eating pathology among orthodox Jewish adolescent girls. Journal of Religion and Health, 54(5), 1760–1771. https://doi.org/10.1007/s10943-014-9927-y

    Article  Google Scholar 

  • Lindvall Dahlgren, C., Wisting, L., & Ro, O. (2017). Feeding and eating disorders in the DSM-5 era: A systematic review of prevalence rates in non-clinical male and female samples. Journal of Eating Disorders, 5, 56. https://doi.org/10.1186/s40337-017-0186-7

    Article  Google Scholar 

  • Malach, G., & Cahaner, L. (2018). 2018 Statistical report on ultra-orthodox society in Israel. https://en.idi.org.il/articles/25385

  • Mansbach-Kleinfeld, I., Apter, A., Farbstein, I., Levine, S. Z., & Ponizovsky, A. M. (2010). A population-based psychometric validation study of the strengths and difficulties questionnaire-hebrew version. Frontiers in Psychiatry, 1, 151. https://doi.org/10.3389/fpsyt.2010.00151

    Article  Google Scholar 

  • Mascola, A. J., Bryson, S. W., & Agras, W. S. (2010). Picky eating during childhood: A longitudinal study to age 11 years. Eating Behaviors, 11(4), 253–257. https://doi.org/10.1016/j.eatbeh.2010.05.006

    Article  Google Scholar 

  • McCullough, M. E., & Willoughby, B. L. (2009). Religion, self-regulation, and self-control: Associations, explanations, and implications. Psychological Bulletin, 135(1), 69–93. https://doi.org/10.1037/a0014213

    Article  Google Scholar 

  • McKay, R., & Whitehouse, H. (2015). Religion and morality. Psychological Bulletin, 141(2), 447–473. https://doi.org/10.1037/a0038455

    Article  Google Scholar 

  • Muris, P., & Steerneman, P. (2001). The revised version of the screen for child anxiety related emotional disorders (SCARED–R): First evidence for its reliability and validity in a clinical sample. British Journal of Clinical Psychology, 40(Pt 1), 35–44.

    Article  CAS  Google Scholar 

  • Nakai, Y., Nin, K., Noma, S., Hamagaki, S., Takagi, R., Teramukai, S., & Wonderlich, S. A. (2017). Clinical presentation and outcome of avoidant/restrictive food intake disorder in a Japanese sample. Eating Behaviors, 24, 49–53. https://doi.org/10.1016/j.eatbeh.2016.12.004

    Article  Google Scholar 

  • Nicely, T. A., Lane-Loney, S., Masciulli, E., Hollenbeak, C. S., & Ornstein, R. M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders, 2(1), 21. https://doi.org/10.1186/s40337-014-0021-3

    Article  Google Scholar 

  • Norris, M. L., Robinson, A., Obeid, N., Harrison, M., Spettigue, W., & Henderson, K. (2014). Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study. International Journal of Eating Disorders, 47(5), 495–499. https://doi.org/10.1002/eat.22217

    Article  Google Scholar 

  • Pang, W. W., McCrickerd, K., Quah, P. L., Fogel, A., Aris, I. M., Yuan, W. L., Fok, D., Chua, M. C., Lim, S. B., Shek, L. P., Chan, S. Y., Tan, K. H., Yap, F., Godfrey, K. M., Meaney, M. J., Wlodek, M. E., Eriksson, J. G., Kramer, M. S., Forde, C. G., … Chong, Y. S. (2020). Is breastfeeding associated with later child eating behaviours? Appetite, 150, 104653. https://doi.org/10.1016/j.appet.2020.104653

    Article  Google Scholar 

  • Pirutinsky, S., Schechter, I., Kor, A., & Rosmarin, D. (2015). Family size and psychological functioning in the orthodox Jewish community. Mental Health, Religion & Culture, 18(3), 218–230. https://doi.org/10.1080/13674676.2015.1042851

    Article  Google Scholar 

  • Prasetyo, Y. B., Kurnia, A. D., Masruroh, N. L., Nursalam, N., Hargono, R., Ahsan, A., & Kumboyono, K. (2019). Factors influencing promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder. Journal of Taibah University Medical Sciences, 14(5), 454–459. https://doi.org/10.1016/j.jtumed.2019.07.003

    Article  Google Scholar 

  • Rosmarin, D. H., Pargament, K. I., & Mahoney, A. (2009). The role of religiousness in anxiety, depression, and happiness in a Jewish community sample: A preliminary investigation. Mental Health, Religion & Culture, 12(2), 97–113. https://doi.org/10.1080/13674670802321933

    Article  Google Scholar 

  • Rosner, A. E., & Schulman, S. K. (1990). Birth interval among breast-feeding women not using contraceptives. Pediatrics, 86(5), 747–752.

    Article  CAS  Google Scholar 

  • Savage, J. S., Rollins, B. Y., Kugler, K. C., Birch, L. L., & Marini, M. E. (2017). Development of a theory-based questionnaire to assess structure and control in parent feeding (SCPF). International Journal of Behavioral Nutrition and Physical Activity, 14(1), 9. https://doi.org/10.1186/s12966-017-0466-2

    Article  Google Scholar 

  • Shafran, Y., & Wolowelsky, J. B. (2013). A note on eating disorders and appetite and satiety in the orthodox Jewish meal. Eating and Weight Disorders, 18(1), 75–78. https://doi.org/10.1007/s40519-013-0011-5

    Article  Google Scholar 

  • Sharp, W. G., Volkert, V. M., Scahill, L., McCracken, C. E., & McElhanon, B. (2017). A systematic review and meta-analysis of intensive multidisciplinary intervention for pediatric feeding disorders: How standard is the Standard of Care? The Journal of Pediatrics, 181, 116-124.e114. https://doi.org/10.1016/j.jpeds.2016.10.002

    Article  Google Scholar 

  • Shim, J. E., Kim, J., & Mathai, R. A. (2011). Associations of infant feeding practices and picky eating behaviors of preschool children. Journal of the Amercan Dietetic Associaton, 111(9), 1363–1368. https://doi.org/10.1016/j.jada.2011.06.410

    Article  Google Scholar 

  • Strandjord, S. E., Sieke, E. H., Richmond, M., & Rome, E. S. (2015). Avoidant/restrictive food intake disorder: Illness and hospital course in patients hospitalized for nutritional insufficiency. Journal of Adolescent Health, 57(6), 673–678. https://doi.org/10.1016/j.jadohealth.2015.08.003

    Article  Google Scholar 

  • Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/restrictive food intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8), 54. https://doi.org/10.1007/s11920-017-0795-5

    Article  Google Scholar 

  • Weinberger-Litman, S. L., Latzer, Y., Litman, L., & Ozick, R. (2018). Extrinsic religious orientation and disordered eating pathology among modern orthodox Israeli adolescents: The mediating role of adherence to the Superwoman Ideal and body dssatisfaction. Journal of Religion and Health, 57(1), 209–222. https://doi.org/10.1007/s10943-017-0443-8

    Article  Google Scholar 

  • Weinberger-Litman, S., Rabin, L., Fogel, J., & Mensinger, J. (2008). The influence of religious orientation and spiritual well-being on body dissatisfaction and disordered eating in a sample of Jewish women. International Journal of Child and Adolescent Health, 1, 373.

    Google Scholar 

  • Yochman, A., Parush, S., & Ornoy, A. (2004). Responses of preschool children with and without ADHD to sensory events in daily life. The American Journal of Occupational Therapy, 58(3), 294–302. https://doi.org/10.5014/ajot.58.3.294

    Article  Google Scholar 

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Acknowledgements

The authors wish to thank Dr. Aliza Stark who assisted in the proof-reading of the manuscript.

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Authors and Affiliations

  1. Robert H. Smith Faculty of Agriculture, Food and Environment, School of Nutritional Sciences, Institute of Biochemistry, Food Science and Nutrition, Hebrew University of Jerusalem, Rehovot, Israel

    Sharon Iron-Segev & Danielle Best

  2. School of Nutritional Sciences, Peres Academic Center, Rehovot, Israel

    Sharon Iron-Segev

  3. Pediatric Psychosomatic Department, Chaim Sheba Medical Center, Edmond and Lily Safra Children’s Hospital, Tel Hashomer, Israel

    Daniel Stein

  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Daniel Stein

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  1. Sharon Iron-Segev
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Authors SI-S, DB, and DS designed the study and wrote the protocol. Author SI-S, DB conducted literature searches and provided summaries of previous research studies. Author DB collected the data. Author SI-S, DB conducted the statistical analysis. Authors SI-S, DB, DS wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.

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Iron-Segev, S., Best, D. & Stein, D. Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) in the Orthodox and Secular Jewish Communities in Israel. J Relig Health 62, 268–286 (2023). https://doi.org/10.1007/s10943-022-01565-x

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