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Restrictive eating disorders in children and adolescents: a comparison between clinical and psychopathological profiles

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript



DSM-5 describe three forms of restrictive and selective eating: Anorexia Nervosa-Restrictive (AN-R), Anorexia Nervosa-Atypical (AN-A), and Avoidant/Restrictive Food Intake Disorder (ARFID). While AN is widely studied, the psychopathological differences among these three diseases are not clear. The aim of this study was to (i) compare the clinical features of AN-R, AN-A, and ARFID, in a clinical sample recruited from a specialized EDs program within a tertiary care children’s Hospital; (ii) identifying three specific symptom profiles, to better understand if restrictive ED share a common psychopathological basis.


Data were collected retrospectively. Psychometric assessment included: the Children’s Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Child Behavior Checklist (CBCL), and the Eating Disorder Inventory-3 (EDI-3).


A final sample of 346 children and adolescent patients were analyzed: AN-R was the most frequent subtype (55.8%), followed by ARFID (27.2%) and AN-A (17%). Patients with ARFID presented different features from AN-R and AN-A, characterized by lower weight and medical impairment, younger age at onset, and a frequent association with separation anxiety and ADHD symptoms. EDI-3 profiles showed specific different impairment for both AN groups compared to ARFID. However, no differences was detected for items: ‘Interpersonal Insecurity’, “Interoceptive Deficits”, “Emotional Dysregulation”, and “Maturity Fears”.


Different ED profiles was found for the three groups, but they share the same general psychopathological vulnerability, which could be at the core of EDs in adolescence.

Level of evidence

III. Evidence obtained from case–control analytic studies.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations



The manuscript has been seen and reviewed by all authors and all authors have contributed to it in a meaningful way. VZ and SV: designed and executed the study and wrote the paper. AM and MC: collaborated with the design and writing of the paper. PP, AM, and MC: analyzed the data and wrote results. AET, IC, CM, GC, and MCC: collaborated in the writing and editing of the final manuscript.

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Correspondence to Valeria Zanna.

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The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the appropriate Ethics Committee (protocol number 1701_OPBG_2018) and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific Italian laws have been observed, too.

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Informed consent was obtained from all individual participants included in the study.

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Zanna, V., Criscuolo, M., Mereu, A. et al. Restrictive eating disorders in children and adolescents: a comparison between clinical and psychopathological profiles. Eat Weight Disord 26, 1491–1501 (2021).

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