Abstract
Avoidant/restrictive food intake disorder (ARFID) is characterized by dietary restrictions that are not based on weight or shape concerns but that result in marked interference in feeding, growth, or psychosocial functioning (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington, 2013; Eddy et al., Int J Eat Disord 52(4):361–366. https://doi.org/10.1002/eat.23042, 2019). ARFID was introduced as a diagnostic category in the 5th edition of the DSM in 2013, and research into ARFID remains limited and provides only partial understanding of the different aspects of the problem such as its prevalence, characteristics and driving factors, assessment, and treatment. The aim of this chapter is to summarize and discuss this knowledge with a focus on childhood ARFID.
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References
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington
Bloomfield BS, Fischer AJ, Clark RR, Dove MB (2019) Treatment of food selectivity in a child with avoidant/restrictive food intake disorder through parent teleconsultation. Behav Anal Pract 12(1):33–43. https://doi.org/10.1007/s40617-018-0251-y
Bourne L, Bryant-Waugh R, Cook J, Mandy W (2020) Avoidant/restrictive food intake disorder: a systematic scoping review of the current literature. Psychiatry Res 288:112961. https://doi.org/10.1016/j.psychres.2020.112961
Brewerton TD, D’Agostino M (2017) 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 27(10):920–922. https://doi.org/10.1089/cap.2017.0133
Brigham KS, Manzo LD, Eddy KT, Thomas JJ (2018) Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents. Curr Pediatr Rep 6(2):107–113. https://doi.org/10.1007/s40124-018-0162-y
Bryant-Waugh R (2013) Avoidant restrictive food intake disorder: an illustrative case example. Int J Eat Disord 46(5):420–423. https://doi.org/10.1002/eat.22093
Bryant-Waugh R (2019) Avoidant/restrictive food intake disorder. Child Adolesc Psychiatr Clin N Am 28(4):557–565. https://doi.org/10.1016/j.chc.2019.05.004
Bryant-Waugh R, Higgins C (2020) Avoidant restrictive food intake disorder in childhood and adolescence: a clinical guide. Routledge/Taylor & Francis Group, New York
Bryant-Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ (2019) 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 52(4):378–387. https://doi.org/10.1002/eat.22958
Bryson AE et al (2018) 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 51(5):470–474
Burton Murray H, Dreier MJ, Zickgraf HF, Becker KR, Breithaupt L, Eddy KT, Thomas JJ (2021) Validation of the nine item ARFID screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. Int J Eat Disord 54(10). https://doi.org/10.1002/eat.23520
Burton C et al (2021) Case presentations combining family-based treatment with the unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents for comorbid Avoidant Restrictive Food Intake Disorder and Autism Spectrum Disorder. J Can Acad Child Adolesc Psychiatry/Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent 30(4)
Chen YL, Chen WJ, Lin KC, Shen LJ, Gau SS (2019) Prevalence of DSM-5 mental disorders in a nationally representative sample of children in Taiwan: methodology and main findings. Epidemiol Psychiatr Sci 29:e15. https://doi.org/10.1017/S2045796018000793
Claudino AM, Pike KM, Hay P, Keeley JW, Evans SC, Rebello TJ, Bryant-Waugh R, Dai Y, Zhao M, Matsumoto C, Herscovici CR, Mellor-Marsa B, Stona AC, Kogan CS, Andrews HF, Monteleone P, Pilon DJ, Thiels C, Sharan P, Al-Adawi S, Reed GM (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 Med 17(1):93. https://doi.org/10.1186/s12916-019-1327-4
Cooke LJ, Haworth CM, Wardle J (2007) Genetic and environmental influences on children’s food neophobia. Am J Clin Nutr 86(2):428–433. https://doi.org/10.1093/ajcn/86.2.428
Cooney M, Lieberman M, Guimond T, Katzman DK (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. J Eat Disord 6:7. https://doi.org/10.1186/s40337-018-0193-3
Dahlsgaard KK, Bodie J (2019) 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 26(3):492–505. https://doi.org/10.1016/j.cbpra.2018.11.001
Dinkler L, Bryant-Waugh R (2021) Assessment of avoidant restrictive food intake disorder, pica and rumination disorder: interview and questionnaire measures. Curr Opin Psychiatry 34(6):532–542. https://doi.org/10.1097/YCO.0000000000000736
Dinkler L, Yasumitsu-Lovell K, Eitoku M, Fujieda M, Suganuma N, Hatakenaka Y, Hadjikhani N, Bryant-Waugh R, Rastam M, Gillberg C (2022) 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 168:105735. https://doi.org/10.1016/j.appet.2021.105735
Dolman L, Thornley S, Doxtdator K, Leclerc A, Findlay S, Grant C, Breakey VR, Couturier J (2021) Multimodal therapy for rigid, persistent avoidant/restrictive food intake disorder (ARFID) since infancy: a case report. Clin Child Psychol Psychiatry 26(2):451–463. https://doi.org/10.1177/1359104520981401
Dovey TM, Wilken M, Martin CI, Meyer C (2018) Definitions and clinical guidance on the enteral dependence component of the avoidant/restrictive food intake disorder diagnostic criteria in children. JPEN J Parenter Enteral Nutr 42(3):499–507. https://doi.org/10.1177/0148607117718479
Dumont E, Jansen A, Kroes D, de Haan E, Mulkens S (2019) 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 52(4):447–458. https://doi.org/10.1002/eat.23053
Duncombe Lowe K, Barnes TL, Martell C, Keery H, Eckhardt S, Peterson CB, Lesser J, Le Grange D (2019) Youth with avoidant/restrictive food intake disorder: examining differences by age, weight status, and symptom duration. Nutrients 11(8). https://doi.org/10.3390/nu11081955
Eckhardt S, Martell C, Duncombe Lowe K, Le Grange D, Ehrenreich-May J (2019) An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children. J Eat Disord 7:34. https://doi.org/10.1186/s40337-019-0267-x
Eddy KT, Thomas JJ, Hastings E, Edkins K, Lamont E, Nevins CM, Patterson RM, Murray HB, Bryant-Waugh R, Becker AE (2015) Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord 48(5):464–470. https://doi.org/10.1002/eat.22350
Eddy KT, Harshman SG, Becker KR, Bern E, Bryant-Waugh R, Hilbert A, Katzman DK, Lawson EA, Manzo LD, Menzel J, Micali N, Ornstein R, Sally S, Serinsky SP, Sharp W, Stubbs K, Walsh BT, Zickgraf H, Zucker N, Thomas JJ (2019) Radcliffe ARFID Workgroup: toward operationalization of research diagnostic criteria and directions for the field. Int J Eat Disord 52(4):361–366. https://doi.org/10.1002/eat.23042
Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196(4286). https://doi.org/10.1126/science.847460
Fairburn CG, Beglin S (2008) Eating disorder examination questionnaire (EDE-Q 6.0). In: Fairburn CG (ed) Cognitive behavior therapy and eating disorders. Guilford Press, New York, pp 309–313
Fischer AJ, Luiselli JK, Dove MB (2015) Effects of clinic and in-home treatment on consumption and feeding-associated anxiety in an adolescent with avoidant/restrictive food intake disorder. Clin Prac Pediatr Psychol 3(2):154–166. https://doi.org/10.1037/cpp0000090
Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, Rome ES, Callahan ST, Malizio J, Kearney S, Walsh BT (2014) Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. J Adolesc Health 55(1):49–52. https://doi.org/10.1016/j.jadohealth.2013.11.013
Gray E, Chen T, Menzel J, Schwartz T, Kaye WH (2018) Mirtazapine and weight gain in avoidant and restrictive food intake disorder. J Am Acad Child Adolesc Psychiatry 57(4):288–289. https://doi.org/10.1016/j.jaac.2018.01.011
Harshman SG, Wons O, Rogers MS, Izquierdo AM, Holmes TM, Pulumo RL, Asanza E, Eddy KT, Misra M, Micali N, Lawson EA, Thomas JJ (2019) 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 11(9). https://doi.org/10.3390/nu11092013
Harshman SG, Jo J, Kuhnle M, Hauser K, Murray HB, Becker KR, Misra M, Eddy KT, Micali N, Lawson EA, Thomas JJ (2021) A moving target: how we define avoidant/restrictive food intake disorder can double its prevalence. J Clin Psychiatry 82(5). https://doi.org/10.4088/JCP.20m13831
Hay P, Mitchison D, Collado AEL, Gonzalez-Chica DA, Stocks N, Touyz S (2017) Burden and health-related quality of life of eating disorders, including avoidant/restrictive food intake disorder (ARFID), in the Australian population. J Eat Disord 5:21. https://doi.org/10.1186/s40337-017-0149-z
Izquierdo A, Plessow F, Becker KR, Mancuso CJ, Slattery M, Murray HB, Hartmann AS, Misra M, Lawson EA, Eddy KT, Thomas JJ (2019) Implicit attitudes toward dieting and thinness distinguish fat-phobic and non-fat-phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents. Int J Eat Disord 52(4):419–427. https://doi.org/10.1002/eat.22981
Kurz S, van Dyck Z, Dremmel D, Munsch S, Hilbert A (2015) Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry 24(7):779–785. https://doi.org/10.1007/s00787-014-0622-z
Lane-Loney SE, Zickgraf HF, Ornstein RM, Mahr F, Essayli JH (2020) A cognitive-behavioral family-based protocol for the primary presentations of avoidant/restrictive food intake disorder (arfid): case examples and clinical research findings. Cogn Behav Pract. https://doi.org/10.1016/j.cbpra.2020.06.010
Lebowitz ER, Panza KE, Bloch MH (2016) Family accommodation in obsessive-compulsive and anxiety disorders: a five-year update. Expert Rev Neurother 16(1):45–53. https://doi.org/10.1586/14737175.2016.1126181
Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK (2019) Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of supportive parenting for anxious childhood emotions. J Am Acad Child Adolesc Psychiatry. https://doi.org/10.1016/j.jaac.2019.02.014
Lock JD (2021) Family-based treatment for avoidant/restrictive food intake disorder. Routledge
Lock J, Sadeh-Sharvit S, L’Insalata A (2019a) Feasibility of conducting a randomized clinical trial using family-based treatment for avoidant/restrictive food intake disorder. Int J Eat Disord 52(6):746–751
Lock J, Robinson A, Sadeh-Sharvit S, Rosania K, Osipov L, Kirz N, Derenne J, Utzinger L (2019b) 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 52(4):439–446. https://doi.org/10.1002/eat.22994
Lucarelli J, Pappas D, Welchons L, Augustyn M (2017) Autism Spectrum disorder and avoidant/restrictive food intake disorder. J Dev Behav Pediatr 38(1):79–80. https://doi.org/10.1097/DBP.0000000000000362
Mennella JA, Jagnow CP, Beauchamp GK (2001) Prenatal and postnatal flavor learning by human infants. Pediatrics 107(6):E88. https://doi.org/10.1542/peds.107.6.e88
Menzel JE, Reilly EE, Luo TJ, Kaye WH (2019) Conceptualizing the role of disgust in avoidant/restrictive food intake disorder: implications for the etiology and treatment of selective eating. Int J Eat Disord 52(4):462–465. https://doi.org/10.1002/eat.23006
Murphy J, Zlomke KR (2016) A behavioral parent-training intervention for a child with avoidant/restrictive food intake disorder. Clin Prac Pediatr Psychol 4(1):23–34. https://doi.org/10.1037/cpp0000128
Naviaux AF (2019) Management of ARFID (Avoidant restrictive food intake disorder) in a 12-year-old on a paediatric ward in a general hospital: use of mirtazapine, partial hospitalisation model and family based therapy. Psychiatr Danub 31(Suppl 3):421–426
Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM (2014) Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord 2(1):21. https://doi.org/10.1186/s40337-014-0021-3
Norris ML, Robinson A, Obeid N, Harrison M, Spettigue W, Henderson K (2014) Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord 47(5):495–499. https://doi.org/10.1002/eat.22217
Norris ML, Spettigue WJ, Katzman DK (2016) Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatr Dis Treat 12:213–218
Norris ML, Spettigue W, Hammond NG, Katzman DK, Zucker N, Yelle K, Santos A, Gray M, Obeid N (2018) Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder. Int J Eat Disord 51(2):170–173. https://doi.org/10.1002/eat.22814
Ornstein RM, Essayli JH, Nicely TA, Masciulli E, Lane-Loney S (2017) 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 50(9):1067–1074. https://doi.org/10.1002/eat.22737
Peebles R, Lesser A, Park CC, Heckert K, Timko CA, Lantzouni E, Liebman R, Weaver L (2017) Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders. J Eat Disord 5:7. https://doi.org/10.1186/s40337-017-0134-6
Pitt PD, Middleman AB (2018) a focus on behavior management of avoidant/restrictive food intake disorder (ARFID): a case series. Clin Pediatr (Phila) 57(4):478–480. https://doi.org/10.1177/0009922817721158
Rosania K, Lock J (2020) Family-based treatment for a preadolescent with avoidant/restrictive food intake disorder with sensory sensitivity: a case report. Front Psych 11:350
Satter E (1999) The feeding relationship. In: Kessler DB, Dawson P (eds) Failure to thrive and pediatric undernutrition: a transdisciplinary approach. Paul H. Brookes Publishing Co, Baltimore
Savage JS, Fisher JO, Birch LL (2007) Parental influence on eating behavior: conception to adolescence. J Law Med Ethics 35(1):22–34. https://doi.org/10.1111/j.1748-720X.2007.00111.x
Schermbrucker J, Kimber M, Johnson N, Kearney S, Couturier J (2017) Avoidant/restrictive food intake disorder in an 11-year old South American boy: medical and cultural challenges. J Can Acad Child Adolesc Psychiatry 26(2):110–113
Schmidt R, Kirsten T, Hiemisch A, Kiess W, Hilbert A (2019) 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 52(4):388–397. https://doi.org/10.1002/eat.23063
Sharp WG, Stubbs KH, Adams H, Wells BM, Lesack RS, Criado KK, Simon EL, McCracken CE, West LL, Scahill LD (2016) Intensive, manual-based intervention for pediatric feeding disorders: results from a randomized pilot trial. J Pediatr Gastroenterol Nutr 62(4):658–663. https://doi.org/10.1097/MPG.0000000000001043
Sharp WG, Allen AG, Stubbs KH, Criado KK, Sanders R, McCracken CE, Parsons RG, Scahill L, Gourley SL (2017) Successful pharmacotherapy for the treatment of severe feeding aversion with mechanistic insights from cross-species neuronal remodeling. Transl Psychiatry 7(6):e1157. https://doi.org/10.1038/tp.2017.126
Shimshoni Y, Lebowitz ER (2020) Childhood ARFID: review of treatments and a novel parent-based approach. J Cogn Psychother 34(3):200–224
Shimshoni Y, Shrinivasa B, Cherian AV, Lebowitz ER (2019) Family accommodation in psychopathology: a synthesized review. Indian J Psychiatry 61(Suppl 1):S93–S103. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_530_18
Shimshoni Y, Silverman WK, Lebowitz ER (2020) SPACE-ARFID: a pilot trial of a novel parent-based treatment for avoidant/restrictive food intake disorder. Int J Eat Disord 53(10):1623–1635. https://doi.org/10.1002/eat.23341
Spettigue W, Norris ML, Santos A, Obeid N (2018) 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 6:20. https://doi.org/10.1186/s40337-018-0205-3
Strand M, von Hausswolff-Juhlin Y, Welch E (2019) A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder. Int J Eat Disord 52(4):331–360. https://doi.org/10.1002/eat.22962
Strandjord SE, Sieke EH, Richmond M, Rome ES (2015) Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency. J Adolesc Health 57(6):673–678. https://doi.org/10.1016/j.jadohealth.2015.08.003
Sysko R, Glasofer DR, Hildebrandt T, Klimek P, Mitchell JE, Berg KC, Peterson CB, Wonderlich SA, Walsh BT (2015) The eating disorder assessment for DSM-5 (EDA-5): development and validation of a structured interview for feeding and eating disorders. Int J Eat Disord 48(5):452–463. https://doi.org/10.1002/eat.22388
Taylor CM, Emmett PM (2019) Picky eating in children: causes and consequences. Proc Nutr Soc 78(2):161–169. https://doi.org/10.1017/S0029665118002586
Taylor CM, Wernimont SM, Northstone K, Emmett PM (2015) Picky/fussy eating in children: review of definitions, assessment, prevalence and dietary intakes. Appetite 95:349–359. https://doi.org/10.1016/j.appet.2015.07.026
Thomas JJ, Eddy KT (2019) Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: children, adolescents, and adults. Cambridge University Press, Cambridge, UK
Thomas JJ, Brigham KS, Sally ST, Hazen EP, Eddy KT (2017a) Case 18-2017 – an 11-year-old girl with difficulty eating after a choking incident. N Engl J Med 376(24):2377–2386. https://doi.org/10.1056/NEJMcpc1616394
Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT (2017c) Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Curr Psychiatry Rep 19(8):54. https://doi.org/10.1007/s11920-017-0795-5
Thomas JJ, Wons OB, Eddy KT (2018) Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Curr Opin Psychiatry 31(6):425–430. https://doi.org/10.1097/YCO.0000000000000454
Thomas JJ, Becker KR, Kuhnle MC, Jo JH, Harshman SG, Wons OB, Keshishian AC, Hauser K, Breithaupt L, Liebman RE, Misra M, Wilhelm S, Lawson EA, Eddy KT (2020) Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: feasibility, acceptability, and proof-of-concept for children and adolescents. Int J Eat Disord 53(10). https://doi.org/10.1002/eat.23355
Zickgraf HF, Ellis JM (2018) Initial validation of the nine item avoidant/restrictive food intake disorder screen (NIAS): a measure of three restrictive eating patterns. Appetite 123:32–42. https://doi.org/10.1016/j.appet.2017.11.111
Zickgraf HF, Lane-Loney S, Essayli JH, Ornstein RM (2019a) Further support for diagnostically meaningful ARFID symptom presentations in an adolescent medicine partial hospitalization program. Int J Eat Disord 52(4):402–409. https://doi.org/10.1002/eat.23016
Zickgraf HF, Murray HB, Kratz HE, Franklin ME (2019b) Characteristics of outpatients diagnosed with the selective/neophobic presentation of avoidant/restrictive food intake disorder. Int J Eat Disord 52(4):367–377. https://doi.org/10.1002/eat.23013
Zucker NL, LaVia MC, Craske MG, Foukal M, Harris AA, Datta N, Savereide E, Maslow GR (2019) Feeling and body investigators (FBI): ARFID division-an acceptance-based interoceptive exposure treatment for children with ARFID. Int J Eat Disord 52(4):466–472. https://doi.org/10.1002/eat.22996
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Shimshoni, Y., Lebowitz, E.R. (2022). Avoidant/Restrictive Food Intake Disorder in Children. In: Patel, V., Preedy, V. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-67929-3_74-1
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