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Avoidant/Restrictive Food Intake Disorder

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Eating Disorders in Boys and Men

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Abstract

Avoidant/restrictive food intake disorder (ARFID) is a newer eating disorder diagnosis in the DSM-5 that captures a range of disordered eating behaviors that can present across the lifespan. Whereas other eating disorders such as anorexia nervosa and bulimia nervosa are notably more prevalent among girls and women than boys and men, ARFID appears to have a more equal gender distribution, and early research suggests that some presentations may be even more common in boys and/or men. ARFID is associated with serious medical and psychological consequences that warrant prompt recognition and treatment. This chapter will cover the current literature on ARFID prevalence, correlates, and long-term outcomes. Recommendations for diagnosis and assessment are reviewed. Finally, current treatment options and their evidence base are described.

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References

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

    Book  Google Scholar 

  2. Hay P, et al. Burden and health-related quality of life of eating disorders, including avoidant/restrictive food intake disorder (ARFID), in the Australian population. J Eat Disord. 2017;5:21.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kurz S, et al. Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry. 2015;24(7):779–85.

    Article  PubMed  Google Scholar 

  4. Eddy KT, 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 

  5. Murray HB, et al. Prevalence and characteristics of avoidant/restrictive food intake disorder in adult neurogastroenterology patients. Clin Gastroenterol Hepatol. 2020;18(9):1995–2002.e1.

    Article  PubMed  Google Scholar 

  6. Williams K, et al. Implications of avoidant/restrictive food intake disorder (ARFID) on children with feeding problems. Child Health Care. 2015;44:307–21.

    Article  Google Scholar 

  7. Krom H, et al. Health related quality of life of infants and children with avoidant restrictive food intake disorder. Int J Eat Disord. 2019;52(4):410–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nakai Y, et al. Characteristics of avoidant/restrictive food intake disorder in a cohort of adult patients. Eur Eat Disord Rev. 2016;24(6):528–30.

    Article  PubMed  Google Scholar 

  9. Reilly EE, et al. Exploring the cooccurrence of behavioural phenotypes for avoidant/restrictive food intake disorder in a partial hospitalization sample. Eur Eat Disord Rev. 2019;27(4):429–35.

    Article  PubMed  Google Scholar 

  10. Ornstein RM, et al. Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders. Int J Eat Disord. 2017;50(9):1067–74.

    Article  PubMed  Google Scholar 

  11. Cooney M, et al. 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. J Eat Disord. 2018;6:7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bloomfield BS, et al. Treatment of food selectivity in a child with avoidant/restrictive food intake disorder through parent teleconsultation. Behav Anal Pract. 2019;12(1):33–43.

    Article  PubMed  Google Scholar 

  13. Lopes R, et al. A case of choking phobia: towards a conceptual approach. Eat Weight Disord. 2014;19(1):125–31.

    Article  PubMed  Google Scholar 

  14. Murphy J, Zlomke KR. A behavioral parent-training intervention for a child with avoidant/restrictive food intake disorder. Clin Pract Pediatr Psychol. 2016;4(1):23–34.

    Article  Google Scholar 

  15. Bryant-Waugh R, et al. Feeding and eating disorders in childhood. Int J Eat Disord. 2010;43(2):98–111.

    PubMed  Google Scholar 

  16. Kreipe RE, Palomaki A. Beyond picky eating: avoidant/restrictive food intake disorder. Curr Psychiatry Rep. 2012;14(4):421–31.

    Article  PubMed  Google Scholar 

  17. Thomas JJ, et al. Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Curr Psychiatry Rep. 2017;19(8):54.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Norris ML, et al. Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder. Int J Eat Disord. 2018;51(2):170–3.

    Article  PubMed  Google Scholar 

  19. Zickgraf HF, et al. Further support for diagnostically meaningful ARFID symptom presentations in an adolescent medicine partial hospitalization program. Int J Eat Disord. 2019;52(4):402–9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kambanis PE, et al. Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. Int J Eat Disord. 2020;53(2):256–65.

    Article  PubMed  Google Scholar 

  21. Duncombe Lowe K, et al. Youth with avoidant/restrictive food intake disorder: examining differences by age, weight status, and symptom duration. Nutrients. 2019;11(8):1955.

    Article  PubMed Central  Google Scholar 

  22. Norris ML, et al. 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 

  23. Makhzoumi SH, et al. Hospital course of underweight youth with ARFID treated with a meal-based behavioral protocol in an inpatient-partial hospitalization program for eating disorders. Int J Eat Disord. 2019;52(4):428–34.

    Article  PubMed  Google Scholar 

  24. Keery H, et al. Attributes of children and adolescents with avoidant/restrictive food intake disorder. J Eat Disord. 2019;7:31.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Strandjord SE, et al. Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency. J Adolesc Health. 2015;57(6):673–8.

    Article  PubMed  Google Scholar 

  26. Fisher MM, 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 

  27. Robson J, et al. Avoidant/restrictive food intake disorder in diet-treated children with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2019;69(1):57–60.

    Article  PubMed  Google Scholar 

  28. Nicely TA, et al. 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 

  29. Harrison R, et al. Blindness caused by a junk food diet. Ann Intern Med. 2019;171(11):859–61.

    Article  PubMed  Google Scholar 

  30. Chandran JJ, et al. Subacute combined degeneration of the spinal cord in an adolescent male with avoidant/restrictive food intake disorder: a clinical case report. Int J Eat Disord. 2015;48(8):1176–9.

    Article  PubMed  Google Scholar 

  31. Chiarello F, et al. Optic neuropathy due to nutritional deficiency in a male adolescent with avoidant/restrictive food intake disorder: a case report. Eat Weight Disord. 2018;23(4):533–5.

    Article  PubMed  Google Scholar 

  32. Norris ML, et al. Characteristics and clinical trajectories of patients meeting criteria for avoidant/restrictive food intake disorder that are subsequently reclassified as anorexia nervosa. Eur Eat Disord Rev. 2020;28(1):26–33.

    Article  PubMed  Google Scholar 

  33. Bryson AE, et al. Outcomes of low-weight patients with avoidant/restrictive food intake disorder and anorexia nervosa at long-term follow-up after treatment in a partial hospitalization program for eating disorders. Int J Eat Disord. 2018;51(5):470–4.

    Article  PubMed  Google Scholar 

  34. Becker KR, et al. Co-occurrence of avoidant/restrictive food intake disorder and traditional eating psychopathology. J Am Acad Child Adolesc Psychiatry. 2020;59(2):209–12.

    Article  PubMed  Google Scholar 

  35. Taylor CM, Hays NP, Emmett PM. Diet at age 10 and 13 years in children identified as picky eaters at age 3 years and in children who are persistent picky eaters in a longitudinal birth cohort study. Nutrients. 2019;11(4):807.

    Article  CAS  PubMed Central  Google Scholar 

  36. Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: a longitudinal study to age 11 years. Eat Behav. 2010;11(4):253–7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zucker N, et al. Psychological and psychosocial impairment in preschoolers with selective eating. Pediatrics. 2015;136(3):e582–90.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lange CRA, et al. Long-term follow-up study of low-weight avoidant restrictive food intake disorder compared with childhood-onset anorexia nervosa: psychiatric and occupational outcome in 56 patients. Int J Eat Disord. 2019;52(4):435–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zickgraf HF, Franklin ME, Rozin P. Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms. J Eat Disord. 2016;4:26.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Eddy KT, et al. Radcliffe ARFID Workgroup: toward operationalization of research diagnostic criteria and directions for the field. Int J Eat Disord. 2019;52(4):361–6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Society for Adolescent Health and Medicine, et al. Position paper of the Society for Adolescent Health and Medicine: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2015;56(1):121–5.

    Article  Google Scholar 

  42. Harshman SG, et al. A diet high in processed foods, total carbohydrates and added sugars, and low in vegetables and protein is characteristic of youth with avoidant/restrictive food intake disorder. Nutrients. 2019;11(9):2013.

    Article  CAS  PubMed Central  Google Scholar 

  43. Trofholz AC, Schulte AK, Berge JM. How parents describe picky eating and its impact on family meals: a qualitative analysis. Appetite. 2017;110:36–43.

    Article  PubMed  Google Scholar 

  44. Fishbein M, Benton K, Struthers W. Mealtime disruption and caregiver stress in referrals to an outpatient feeding clinic. J Parenter Enter Nutr. 2016;40(5):636–45.

    Article  Google Scholar 

  45. Wolstenholme H, et al. Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies. Int J Behav Nutr Phys Act. 2020;17(1):2.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Cole NC, et al. Correlates of picky eating and food neophobia in young children: a systematic review and meta-analysis. Nutr Rev. 2017;75(7):516–32.

    Article  PubMed  Google Scholar 

  47. The Columbia Center for Eating Disorders. Eating disorder assessment for DSM-5 (EDA-5). n.d. [2020, May 15]. Available from: https://eda5.org/.

  48. Schmidt R, et al. Interview-based assessment of avoidant/restrictive food intake disorder (ARFID): a pilot study evaluating an ARFID module for the Eating Disorder Examination. Int J Eat Disord. 2019;52(4):388–97.

    Article  PubMed  Google Scholar 

  49. Bryant-Waugh R, 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 10-22. Int J Eat Disord. 2019;52(4):378–87.

    Article  PubMed  Google Scholar 

  50. Kurz S, et al. Variants of early-onset restrictive eating disturbances in middle childhood. Int J Eat Disord. 2016;49(1):102–6.

    Article  PubMed  Google Scholar 

  51. Zickgraf HF, Ellis JM. Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS): a measure of three restrictive eating patterns. Appetite. 2018;123:32–42.

    Article  PubMed  Google Scholar 

  52. Zickgraf HF, Elkins A. Sensory sensitivity mediates the relationship between anxiety and picky eating in children/adolescents ages 8-17, and in college undergraduates: a replication and age-upward extension. Appetite. 2018;128:333–9.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Bryant-Waugh R, Higgins C. Avoidant restrictive food intake disorder in childhood and adolescence: a clinical guide. New York: Routledge; 2020.

    Book  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  55. Bryant-Waugh R. ARFID avoidant restrictive food intake disorder: a guide for parents and carers. 1st ed. New York: Routledge; 2020.

    Book  Google Scholar 

  56. Sharp WG, et al. 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 

  57. Sharp WG, et al. Intensive, manual-based intervention for pediatric feeding disorders: results from a randomized pilot trial. J Pediatr Gastroenterol Nutr. 2016;62(4):658–63.

    Article  PubMed  Google Scholar 

  58. Lock J, 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.

    Article  PubMed  Google Scholar 

  59. Eckhardt S, et al. An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children. J Eat Disord. 2019;7:34.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Dahlsgaard KK, Bodie J. The (extremely) picky eaters clinic: a pilot trial of a seven-session group behavioral intervention for parents of children with avoidant/restrictive food intake disorder. Cogn Behav Pract. 2019;26(3):492–505.

    Article  Google Scholar 

  61. Fischer AJ, Luiselli JK, Dove MB. Effects of clinic and in-home treatment on consumption and feeding-associated anxiety in an adolescent with avoidant/restrictive food intake disorder. Clin Pract Pediatr Psychol. 2015;3(2):154–66.

    Article  Google Scholar 

  62. Dumont E, et al. A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: a clinical case series. Int J Eat Disord. 2019;52(4):447–58.

    Article  PubMed  PubMed Central  Google Scholar 

  63. King LA, Urbach JR, Stewart KE. Illness anxiety and avoidant/restrictive food intake disorder: cognitive-behavioral conceptualization and treatment. Eat Behav. 2015;19:106–9.

    Article  PubMed  Google Scholar 

  64. Zucker NL, et al. Feeling and body investigators (FBI): ARFID division-an acceptance-based interoceptive exposure treatment for children with ARFID. Int J Eat Disord. 2019;52(4):466–72.

    Article  PubMed  Google Scholar 

  65. Brewerton TD, D’Agostino M. Adjunctive use of olanzapine in the treatment of avoidant restrictive food intake disorder in children and adolescents in an eating disorders program. J Child Adolesc Psychopharmacol. 2017;27(10):920–2.

    Article  CAS  PubMed  Google Scholar 

  66. Spettigue W, et al. Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments. J Eat Disord. 2018;6:20.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Gray E, et al. Mirtazapine and weight gain in avoidant and restrictive food intake disorder. J Am Acad Child Adolesc Psychiatry. 2018;57(4):288–9.

    Article  PubMed  Google Scholar 

  68. Sharp WG, et al. Successful pharmacotherapy for the treatment of severe feeding aversion with mechanistic insights from cross-species neuronal remodeling. Transl Psychiatry. 2017;7(6):e1157.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Sant’Anna AM, et al. Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program. J Pediatr Gastroenterol Nutr. 2014;59(5):674–8.

    Article  PubMed  CAS  Google Scholar 

  70. Merhar SL, et al. A retrospective review of cyproheptadine for feeding intolerance in children less than three years of age: effects and side effects. Acta Paediatr. 2016;105(8):967–70.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of California, San Diego, San Diego, CA, USA

    Jessie E. Menzel & Tana Luo

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  1. Jessie E. Menzel
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  2. Tana Luo
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Correspondence to Jessie E. Menzel .

Editor information

Editors and Affiliations

  1. Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA

    Jason M. Nagata

  2. Department of Psychiatry, University of California, San Diego, San Diego, CA, USA

    Tiffany A. Brown

  3. Department of Psychiatry and Behavioral Sciences, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Stuart B. Murray

  4. Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences, The Metis Foundation, Bethesda, MD, USA

    Jason M. Lavender

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Menzel, J.E., Luo, T. (2021). Avoidant/Restrictive Food Intake Disorder. In: Nagata, J.M., Brown, T.A., Murray, S.B., Lavender, J.M. (eds) Eating Disorders in Boys and Men. Springer, Cham. https://doi.org/10.1007/978-3-030-67127-3_6

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  • DOI: https://doi.org/10.1007/978-3-030-67127-3_6

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