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James RM, O'Shea J, Micali N, Russell SJ, Hudson LD. Physical health complications in children and young people with avoidant restrictive food intake disorder (ARFID): a systematic review and meta-analysis. BMJ Paediatr Open 2024; 8:e002595. [PMID: 38977355 DOI: 10.1136/bmjpo-2024-002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder with known acute and longstanding physical health complications in children and young people (CYP) and commonly presents to paediatricians. OBJECTIVE To systematically review the published literature on physical health complications in CYP with ARFID using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A systematic search of PubMed, Embase, Web of Science, PsycINFO and Cochrane Library was performed on 14 February 2024. Studies reporting physical health complications in CYP ≤25 years with ARFID were included. We pooled studies for meta-analysis comparing ARFID with healthy controls or anorexia nervosa (AN). RESULTS Of 9058 studies found in searches, we included 132 studies. We found evidence for low weight, nutritional deficiencies and low bone mineral density. CYP with ARFID can present across the weight spectrum; however, the majority of CYP with ARFID were within the healthy weight to underweight range. Most studies reported normal range heart rates and blood pressures in ARFID, but some CYP with ARFID do experience bradycardia and hypotension. CYP with ARFID had higher heart rates than AN (weighted mean difference: 12.93 bpm; 95% CI: 8.65 to 17.21; n=685); heterogeneity was high (I2: 81.33%). CONCLUSION There is a broad range of physical health complications associated with ARFID requiring clinical consideration. Many CYP with ARFID are not underweight yet still have complications. Less cardiovascular complications found in ARFID compared with AN may be related to chronicity. PROSPERO REGISTRATION NUMBER CRD42022376866.
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Affiliation(s)
| | | | - Nadia Micali
- UCL GOS Institute of Child Health, London, UK
- Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
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Fonseca NKO, Curtarelli VD, Bertoletti J, Azevedo K, Cardinal TM, Moreira JD, Antunes LC. Avoidant restrictive food intake disorder: recent advances in neurobiology and treatment. J Eat Disord 2024; 12:74. [PMID: 38849953 PMCID: PMC11157884 DOI: 10.1186/s40337-024-01021-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. ARFID, before referred to as "selective eating disorder", was introduced recently in the DSM-5 as a replacement for and expansion of the previous diagnosis. Individuals with ARFID may limit food variety and intake due to avoidance based on the sensory characteristics of the food or related to any adverse consequences of eating without the intention of losing weight and concerns of body image. The limited understanding of avoidant and restrictive eating poses challenges to effective treatment and management, impacting directly on the growth and development of children and adolescents. The ARFID neurobiological concept has not yet been clearly defined to clinical practice for nutritionists, thereby hindering screening and impeding the development of treatment recommendations. This narrative review provide useful practical information to consult the pathophysiology, the neurobiology, the clinical features, the assessment and the treatment for healthcare professionals seeking to enhance their clinical knowledge and management of this disorder.
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Affiliation(s)
- Natasha K O Fonseca
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
| | | | | | - Karla Azevedo
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Tiago M Cardinal
- Laboratory of Neuroscience and Eating Behavior, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Júlia D Moreira
- Department of Nutrition, Health Sciences Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Luciana C Antunes
- Laboratory of Neuroscience and Eating Behavior, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Department of Nutrition, Health Sciences Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
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Zhu LY, Trolio V, Miller AE, Bicaker E, Racine SE. Daily instability in body dissatisfaction in individuals with and without eating disorders. Body Image 2024; 49:101688. [PMID: 38442437 DOI: 10.1016/j.bodyim.2024.101688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
Body dissatisfaction (BD) includes negative thoughts and feelings about one's body shape. Although typically assessed as a trait, BD has been found to fluctuate within a day. The present study examined whether daily instability in BD differs according to trait BD, eating disorder (ED) diagnosis, and engagement in maladaptive exercise. Participants with EDs (n = 166) and controls (n = 44) completed a self-report measure of trait BD and reported BD and engagement in maladaptive exercise five times daily for 14 days as part of an ecological momentary assessment protocol. BD instability was calculated as adjusted mean squared successive difference. On average across assessments, participants with EDs reported a 16% change in their BD ratings between consecutive assessments, which was significantly higher than the 12% change in controls. Trait BD was significantly inversely associated with BD instability in individuals with EDs, but not in controls. BD instability did not differ across ED diagnoses or between days with versus without maladaptive exercise. Findings suggest that BD is a dynamic state that varies within a day, especially in participants with EDs. Further research is needed to clarify whether this heightened instability in BD is a clinically relevant factor underlying ED symptoms.
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Affiliation(s)
- Lisa Y Zhu
- Department of Psychology, McGill University, Canada
| | | | | | - Ege Bicaker
- Department of Psychology, McGill University, Canada
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Ye Q, Sun S, Deng J, Chen X, Zhang J, Lin S, Du H, Gao J, Zou X, Lin X, Cai Y, Lu Z. Using 16S rDNA and metagenomic sequencing technology to analyze the fecal microbiome of children with avoidant/restrictive food intake disorder. Sci Rep 2023; 13:20253. [PMID: 37985845 PMCID: PMC10661725 DOI: 10.1038/s41598-023-47760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
To investigate the gut microbiota distribution and its functions in children with avoidant/restrictive food intake disorder (ARFID). A total of 135 children were enrolled in the study, including 102 children with ARFID and 33 healthy children. Fecal samples were analyzed to explore differences in gut microbiota composition and diversity and functional differences between the ARFID and healthy control (HC) groups via 16S rDNA and metagenomic sequencing. The gut microbiota composition and diversity in children with ARFID were different from those in heathy children, but there is no difference in the composition and diversity of gut microbiota between children at the age of 3-6 and 7-12 with ARFID. At the phylum level, the most abundant microbes in the two groups identified by 16S rDNA and metagenomic sequencing were the same. At the genus level, the abundance of Bacteroides was higher in the ARFID group (P > 0.05); however, different from the result of 16SrDNA sequencing, metagenomic sequencing showed that the abundance of Bacteroides in the ARFID group was significantly higher than that in the HC group (P = 0.041). At the species level, Escherichia coli, Streptococcus thermophilus and Lachnospira eligens were the most abundant taxa in the ARFID group, and Prevotella copri, Bifidobacterium pseudocatenulatum, and Ruminococcus gnavus were the top three microbial taxa in the HC group; there were no statistically significant differences between the abundance of these microbial taxa in the two groups. LefSe analysis indicated a greater abundance of the order Enterobacterales and its corresponding family Enterobacteriaceae, the family Bacteroidaceae and corresponding genus Bacteroides, the species Bacteroides vulgatus in ARFID group, while the abundance of the phylum Actinobacteriota and its corresponding class Actinobacteria , the order Bifidobacteriales and corresponding family Bifidobacteriaceae, the genus Bifidobacterium were enriched in the HC group. There were no statistically significant differences in the Chao1, Shannon and Simpson indices between the Y1 and Y2 groups (P = 0.1, P = 0.06, P = 0.06). At the phylum level, Bacillota, Bacteroidota, Proteobacteria and Actinobacteriota were the most abundant taxa in both groups, but there were no statistically significant differences among the abundance of these bacteria (P = 0.958, P = 0.456, P = 0.473, P = 0.065). At the genus level, Faecalibacterium was more abundant in the Y2 group than in the Y1 group, and the difference was statistically significant (P = 0.037). The KEGG annotation results showed no significant difference in gut microbiota function between children with ARFID and healthy children; however, GT26 was significantly enriched in children with ARFID based on the CAZy database. The most abundant antibiotic resistance genes in the ARFID group were the vanT, tetQ, adeF, ermF genes, and the abundance of macrolide resistance genes in the ARFID group was significantly higher than that in the HC group (P = 0.041). Compared with healthy children, children with ARFID have a different distribution of the gut microbiota and functional genes. This indicates that the gut microbiome might play an important role in the pathogenesis of ARFID.Clinical trial registration: ChiCTR2300074759.
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Affiliation(s)
- Qina Ye
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Shaodan Sun
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jian Deng
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Xiaogang Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jing Zhang
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Suihua Lin
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Hongxuan Du
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Jinxiong Gao
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Xiaoyin Zou
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China
| | - Xiaoling Lin
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yawen Cai
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhuoming Lu
- Department of Traditional Chinese Medicine, Guangzhou Women and Children Medical Center, No. 9 Jinsui Road, Guangzhou, 510623, China.
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Brosig L, Düplois D, Hiemisch A, Kiess W, Hilbert A, Schlensog-Schuster F, Schmidt R. Birth-related, medical, and diagnostic characteristics in younger versus older children with avoidant/restrictive food intake disorder (ARFID). J Eat Disord 2023; 11:190. [PMID: 37885020 PMCID: PMC10601262 DOI: 10.1186/s40337-023-00908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Although avoidant/restrictive food intake disorder (ARFID) presents the replacement and extension of feeding disorders of infancy and childhood, previous research into ARFID concentrated mainly on older patients. While birth-related characteristics play an etiologic role in feeding disorders, virtually nothing is known so far in ARFID. Therefore, the first aim of the study was to identify differences in birth-related characteristics in younger vs. older children with ARFID. Second, differences in physical and mental comorbidities, and third, diagnostic features between age groups were analysed. METHODS Among N = 51 in- and outpatient treatment-seeking patients, n = 23 patients aged 0-5 years (30% girls) and n = 28 patients aged 6-17 years (57% girls), with an interview-based diagnosis of ARFID were included. Data on the pre- and perinatal period and mental and physical comorbidities were derived from patients' medical records, while diagnostic criteria, main ARFID presentation, and sociodemographic variables were collected through diagnostic interview. RESULTS Significantly, younger patients with ARFID were born more often preterm and had more pre- and perinatal complications and a higher incidence of postnatal invasive procedures. Patients with ARFID aged 0-5 years presented significantly more physical comorbidities and conditions, especially congenital anomalies, while mental comorbidities, especially mood disorders, were significantly more common in patients with ARFID aged 6-17 years. No age differences were found for the distribution of diagnostic criteria and main ARFID presentation. CONCLUSION This is the first study which aimed to identify age-specific characteristics in patients with ARFID with potential relevance for diagnosis and treatment. Especially birth-related complications, including invasive procedures postnatally, may be associated with developing ARFID, highlighting the importance of a closer view on these potential risk factors of the disorder. Future research with longitudinal design and larger samples may allow more detailed information on further age-specific associations, symptom trajectories, and age-specific risk factors for ARFID.
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Affiliation(s)
- Luise Brosig
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Stephanstrasse 9a, 04103, Leipzig, Germany
| | - Dominik Düplois
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Stephanstrasse 9a, 04103, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Anja Hilbert
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Stephanstrasse 9a, 04103, Leipzig, Germany
| | - Franziska Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Medical Center, Liebigstrasse 20a, 04103, Leipzig, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ricarda Schmidt
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Stephanstrasse 9a, 04103, Leipzig, Germany.
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Düplois D, Brosig L, Hiemisch A, Kiess W, Hilbert A, Schlensog-Schuster F, Schmidt R. Distribution and clinical comparison of restrictive feeding and eating disorders using ICD-10 and ICD-11 criteria. Int J Eat Disord 2023; 56:1717-1729. [PMID: 37243388 DOI: 10.1002/eat.23994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Within the eleventh edition of the International Classification of Diseases (ICD-11), diagnostic criteria for feeding and eating disorders were revised and new diagnoses including avoidant/restrictive food intake disorder (ARFID) are classifiable; however, nothing is known about how these changes affect the prevalence of feeding and eating disorders. This study compared the distribution and clinical characteristics of restrictive feeding and eating disorders between ICD-10 and ICD-11. METHOD The Eating Disorder Examination (EDE), its child version, and the EDE ARFID module were administered to N = 82 patients (0-17 years) seeking treatment for restrictive feeding and eating disorders and their parents. Clinical characteristics were derived from medical records, questionnaires, and objective anthropometrics. RESULTS The number of residual restrictive eating disorders (rrED) significantly decreased from ICD-10 to ICD-11 due to a crossover to full-threshold disorders, especially anorexia nervosa (AN) or ARFID. Patients reclassified to ICD-11 ARFID were younger, had an earlier age of illness onset, more restrictive eating behaviors, and tended to have more somatic comorbidities compared to those reclassified to ICD-11 AN. Patients with rrED according to both ICD-10 and ICD-11 were younger, had an earlier age of illness onset, less shape concern, and more somatic comorbidities than patients who were reclassified from ICD-10 rrED to ICD-11 AN or ARFID. DISCUSSION This study highlights the inclusive approach of ICD-11 criteria, paving the way for more targeted treatment, and ARFID's high clinical relevance. Future studies considering nonrestrictive feeding and eating disorders across the life span may allow further analyses on diagnostic crossover. PUBLIC SIGNIFICANCE Changes in diagnostic criteria for restrictive eating disorders within the newly published ICD-11 led to an increase in full-threshold disorders, while the number of rrED was significantly lowered compared to ICD-10 criteria. The results thus highlight the diagnostic utility of ICD-11 criteria and may help providing adequate treatment to children and adolescents with rrED.
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Affiliation(s)
- Dominik Düplois
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Luise Brosig
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Franziska Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Medical Center, Leipzig, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ricarda Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
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Fekih-Romdhane F, Hallit R, Malaeb D, Sakr F, Dabbous M, Sawma T, Obeid S, Hallit S. Psychometric properties of an Arabic translation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a community sample of adults. J Eat Disord 2023; 11:143. [PMID: 37612764 PMCID: PMC10463449 DOI: 10.1186/s40337-023-00874-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND No epidemiological data is yet available on Avoidant/Restrictive Food Intake Disorder (ARFID) in Arab countries, which may in part be due to the lack of measures available in Arabic language. This constitutes a major obstacle to further progress of our understanding of the nature, aetiology, course, treatment, and prevention of ARFID, especially as some evidence suggested that ARFID may vary across cultures and food environments. We aimed to contribute to the literature in the eating disorders field by examining the psychometric properties of an Arabic translation of the Nine Item ARFID Screen (NIAS). METHOD This was a cross-sectional, web-based study. A total of 515 Lebanese community adults (mean age of 27.55 ± 10.92 years, 69.9% females) participated. The forward-backward method was adopted to translate the NIAS from English to Arabic. RESULTS Confirmatory Factor Analyses provided evidence for the adequate fit indices for the three-factor model (i.e., Picky eating, Fear, and Appetite) and the 9-item version of the NIAS. An adequate reliability of the Arabic NIAS was achieved, with McDonald's ω ranging from .75 to .90 for the total score and all three subscores. Multi-group analyses demonstrated measurement invariance by sex (males vs. females) and weight groups (underweight/healthy weight [BMI ≤ 25] vs. overweight/obese [BMI > 25]) at the configural, metric, and scalar levels. Adequate patterns of correlations between the NIAS and measures of disordered eating symptoms, psychological distress and well-being were seen. In particular, fear was significantly associated with non-ARFID disordered eating symptoms. Appetite and Picky eating, but not Fear, were inversely correlated with well-being. All three NIAS subscores and the total score were positively correlated with psychological distress. CONCLUSION Findings provided evidence that the Arabic NIAS is a short, valid and reliable self-report measure to screen for ARFID symptoms. In light of these findings, we recommend its use for clinical and research purposes among Arabic-speaking adults.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours University Hospital, Postal Code 3, Byblos, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Toni Sawma
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, 21478, Jeddah, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Archibald T, Bryant‐Waugh R. Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions. JCPP ADVANCES 2023; 3:e12160. [PMID: 37753149 PMCID: PMC10519741 DOI: 10.1002/jcv2.12160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
Background ARFID (avoidant restrictive food intake disorder) is a relatively new diagnostic term covering a number of well-recognised, clinically significant disturbances in eating behaviour unrelated to body weight/shape concerns. Its phenotypic heterogeneity combined with much about the condition remaining unknown, can contribute to uncertainties about best practice. While other reviews of the evidence base for ARFID exist, few specifically target health care professionals and implications for clinical practice. Methods A narrative review was conducted to synthesise the findings of ARFID papers in scientific journals focussing on four key areas relevant to clinical practice: prevalence, assessment and characterisation of clinical presentations, treatment, and service delivery. Freely available online databases were searched for case studies and series, research reports, review articles, and meta-analyses. Findings were reviewed and practice implications considered, resulting in proposed clinical recommendations and future research directions. Results We discuss what is currently known about the four key areas included in this review. Based on available evidence as well as gaps identified in the literature, recommendations for clinical practice are derived and practice-related research priorities are proposed for each of the four of the areas explored. Conclusion Prevalence studies highlight the need for referral and care pathways to be embedded across a range of health care services. While research into ARFID is increasing, further studies across all areas of ARFID are required and there remains a pressing need for guidance on systematic assessment, evidence-based management, and optimal service delivery models. Informed clinical practice is currently predominantly reliant on expert consensus and small-scale studies, with ongoing routine clinical data capture, robust treatment trials and evaluation of clinical pathways all required. Despite this, a number a positive practice points emerge.
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Affiliation(s)
- Tanith Archibald
- Maudsley Centre for Child and Adolescent Eating DisordersMichael Rutter CentreMaudsley HospitalLondonUK
| | - Rachel Bryant‐Waugh
- Maudsley Centre for Child and Adolescent Eating DisordersMichael Rutter CentreMaudsley HospitalLondonUK
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and NeuroscienceKings College LondonLondonUK
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9
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Parker MN, Lavender JM, Schvey NA, Tanofsky-Kraff M. Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents. Adolesc Health Med Ther 2023; 14:63-85. [PMID: 36860931 PMCID: PMC9969870 DOI: 10.2147/ahmt.s220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).
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Affiliation(s)
- Megan N Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA,The Metis Foundation, San Antonio, TX, USA,Correspondence: Jason M Lavender, Military Cardiovascular Outcomes Research Program, 4301 Jones Bridge Road, Building 17, Suite 2A, Bethesda, MD, 20814, USA, Email
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA
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Abstract
PURPOSE OF REVIEW To review the literature pertaining to the assessment and treatment of avoidant/restrictive food intake disorder (ARFID) ten years following its introduction to DSM-5. RECENT FINDINGS Several structured clinical interviews for assessing ARFID have been developed, each with its own strengths and limitations. There is no clear leading self-report measure for tracking treatment progress and outcome in ARFID. Medical assessment is comprised of examining anthropometrics, vitamin deficiencies, and other comorbidities. To date, several studies have reported on cognitive behavioral therapy, family-based treatment, and other approaches to the treatment of ARFID. These treatments appear promising; however, they rely on data from clinical case series and very small randomized controlled trials. Several promising assessments and treatments for ARFID are in the early stages of research. Yet, controversies remain. These include (a) overlap with criteria for pediatric feeding disorder; (b) the optimal method for assessing nutrient deficiencies; (c) disciplines involved in treatment. Future research innovation is necessary to improve the psychometric properties of ARFID assessments and evaluate treatment efficacy with larger samples and randomized designs.
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Affiliation(s)
- P Evelyna Kambanis
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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11
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Schmidt R, Hiemisch A, Kiess W, von Klitzing K, Schlensog-Schuster F, Hilbert A. Validation study on the child, adult, and parent version of the ARFID module 2.0 for the Eating Disorder Examination. Int J Eat Disord 2022; 55:1708-1720. [PMID: 36054036 DOI: 10.1002/eat.23805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study presents a psychometric evaluation of the avoidant/restrictive food intake disorder (ARFID) module 2.0 for the Eating Disorder Examination (EDE), its child (ChEDE), and parent version. Within a pediatric sample seeking treatment for restrictive feeding or eating disorders and non-treatment-seeking controls, the module's interrater reliability, parent-child agreement, and its convergent, divergent, and discriminant validity were examined. METHOD The child, adult, and/or parent version of the German ARFID module was administered to N = 176 children and adolescents (0-17 years) and their parents, as were the (Ch)EDE, well-established measures on food-avoidance behaviors, food variety, and body esteem, and objective anthropometric measures. RESULTS Across all versions of the ARFID module, substantial to almost perfect interrater reliability was shown. Parent-child agreement for ARFID diagnosis was substantial. Based on medium-to-large associations between interview-assessed avoidant/restrictive food intake and questionnaire-assessed food-avoidance behaviors, food variety, and objective weight status, the module showed high convergent validity, especially for the child and parent version. Low associations of avoidant/restrictive food intake with weight and shape concern demonstrated divergent validity. Individuals with ARFID differed significantly from those with anorexia nervosa and individually matched controls in a range of clinical characteristics, indicating discriminant validity. DISCUSSION This comprehensive validation supports the EDE ARFID module to be a valuable measure for the assessment and diagnosis of ARFID in 0-17-year-olds based on self- and parent-report. Validation of the ARFID module against other interview-based measures on ARFID and its evaluation in an adult sample are pending. PUBLIC SIGNIFICANCE Based on good reliability and validity of the avoidant/restrictive food intake disorder (ARFID) module for the Eating Disorder Examination (EDE) in its child, adult, and parent version, the present study paves the way for the clinical and research use of the interview-based EDE ARFID module for assessing ARFID across childhood and adolescence.
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Affiliation(s)
- Ricarda Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany.,Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany.,Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Leipzig, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Medical Center, Leipzig, Germany
| | - Franziska Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
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12
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Bryant-Waugh R, Stern CM, Dreier MJ, Micali N, Cooke LJ, Kuhnle MC, Burton Murray H, Wang SB, Breithaupt L, Becker KR, Misra M, Lawson EA, Eddy KT, Thomas JJ. Preliminary validation of the pica, ARFID and rumination disorder interview ARFID questionnaire (PARDI-AR-Q). J Eat Disord 2022; 10:179. [PMID: 36419081 PMCID: PMC9682666 DOI: 10.1186/s40337-022-00706-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a structured interview that can be used to determine diagnosis, presenting characteristics, and severity across three disorders, including avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the psychometric properties of a questionnaire focused specifically on ARFID (PARDI-AR-Q), which has the potential to provide related information with less participant burden. METHODS Adolescents and adults (n = 71, ages 14-40 years) with ARFID (n = 42) and healthy control participants (HC, n = 29) completed the PARDI-AR-Q and other measures. A subset of the ARFID group (n = 27) also completed the PARDI interview. RESULTS An exploratory factor analysis of proposed subscale items identified three factors corresponding to the ARFID phenotypes of avoidance based on the sensory characteristics of food, lack of interest in eating or food, and concern about aversive consequences of eating. Further analyses supported the internal consistency and convergent validity of the PARDI-AR-Q subscales, and subscale ratings on the questionnaire showed large and significant correlations (all p-values < 0.001; r's ranging from 0.48 to 0.77) with the corresponding subscales on the interview. The ARFID group scored significantly higher than HC on all subscales. Furthermore, 90% of the ARFID group scored positive on the PARDI-AR-Q diagnostic algorithm while 93% of the HC scored negative. CONCLUSIONS Though replication in larger and more diverse samples is needed, findings provide early support for the validity of the PARDI-AR-Q as a self-report measure for possible ARFID in clinical or research settings.
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Affiliation(s)
- Rachel Bryant-Waugh
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Casey M Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
| | - Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Department of Psychology, Rutgers University, Piscataway, USA
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Eating Disorders Research Unit, Mental Health Center Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Lucy J Cooke
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Megan C Kuhnle
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Department of Epidemiology, Boston University, Boston, USA
| | - Helen Burton Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Center for Neurointestinal Health, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Shirley B Wang
- Department of Psychology, Harvard University, Cambridge, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Harvard Medical School, Boston, USA.,Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Boston, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Harvard Medical School, Boston, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, USA.,Neuroendocrine Unit, Massachusetts General Hospital, Boston, USA
| | - Elizabeth A Lawson
- Harvard Medical School, Boston, USA.,Neuroendocrine Unit, Massachusetts General Hospital, Boston, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Harvard Medical School, Boston, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, USA.
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13
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Cooper‐Vince CE, Nwaka C, Eddy KT, Misra M, Hadaway NA, Becker KR, Lawson EA, Cooke L, Bryant‐Waugh R, Thomas JJ, Micali N. The factor structure and validity of a diagnostic interview for avoidant/restrictive food intake disorder in a sample of children, adolescents, and young adults. Int J Eat Disord 2022; 55:1575-1588. [PMID: 36324295 PMCID: PMC9641545 DOI: 10.1002/eat.23792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE There is a paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID) to aid identification and classification of cases for both clinical and research purposes. To evaluate the factor structure, construct validity, and criterion validity of the Pica ARFID and Rumination Disorder Interview (PARDI; ARFID module), we administered the PARDI to 129 children and adolescents ages 9-23 years (M = 16.1) with ARFID (n = 84), subclinical ARFID (n = 11), and healthy controls (n = 34). METHOD We used exploratory factor analysis to examine the factor structure of the PARDI in children, adolescents, and young adults with an ARFID diagnosis, the Kruskal-Wallis analysis of variance and Spearman correlations to test the construct validity of the measure, and non-parametric receiver operating characteristic curves to evaluate the criterion validity of the PARDI. RESULTS Exploratory factor analysis yielded a 3-factor structure: (1) concern about aversive consequences of eating, (2) low appetite/low interest in food, and (3) sensory sensitivity. Participants with ARFID demonstrated significantly higher levels of sensory sensitivity, low appetite/low-food interest, and concern about aversive consequences of eating symptoms relative to control participants. The construct validity for each PARDI subscale was supported and clinical cutoffs for the low appetite/low interest in food (1.1) and sensory sensitivity subscales (0.6) were established. DISCUSSION These data present evidence for the factor structure and validity of the PARDI diagnostic interview for diagnosing ARFID in children, adolescents, and young adults, supporting the use of this tool to facilitate ARFID clinical assessment and research. PUBLIC SIGNIFICANCE Due to the paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID), we evaluated the factor structure and validity of the Pica ARFID and Rumination Disorder Interview (ARFID module). Findings suggest that the interview assesses 3 components of ARFID: concern about aversive consequences of eating, low-appetite, and sensory sensitivity, and that clinical threshold scores on the latter two subscales can be used to advance ARFID assessment.
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Affiliation(s)
| | - Chika Nwaka
- Department of PsychiatryUniversity of GenevaGenevaSwitzerland
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Madhusmita Misra
- Division of Pediatric EndocrinologyMassachusetts General HospitalMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA,Neuroendocrine UnitMassachusetts General HospitalMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Natalia A. Hadaway
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Neuroendocrine UnitMassachusetts General HospitalMassachusettsUSA
| | - Kendra R. Becker
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Elizabeth A. Lawson
- Neuroendocrine UnitMassachusetts General HospitalMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Lucy Cooke
- Feeding and Eating Disorders ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Rachel Bryant‐Waugh
- South London and Maudsley NHS Foundation TrustLondonUK,Department of Child Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKings College LondonLondonUK
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA
| | - Nadia Micali
- Department of PsychiatryUniversity of GenevaGenevaSwitzerland,Department of Pediatrics, Gynecology and ObstetricsUniversity of GenevaGenevaSwitzerland,GOS Institute of Child HealthUniversity College LondonLondonUK
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14
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Bryant E, Spielman K, Le A, Marks P, Touyz S, Maguire S, Brennan L, Bryant E, Byrne S, Caldwell B, Calvert S, Carroll B, Castle D, Caterson I, Chelius B, Chiem L, Clarke S, Conti J, Crouch L, Dammery G, Dzajkovski N, Fardouly J, Feneley J, Foroughi N, Fuller-Tyszkiewicz M, Fursland A, Gonzalez-Arce V, Gouldthorp B, Griffin K, Griffiths S, Hambleton A, Hannigan A, Hart M, Hart S, Hay P, Hickie I, Kay-Lambkin F, King R, Kohn M, Koreshe E, Krug I, Le A, Linardon J, Long R, Long A, Madden S, Maguire S, Maloney D, Marks P, McLean S, Meddick T, Miskovic-Wheatley J, Mitchison D, O’Kearney R, Paterson R, Paxton S, Pehlivan M, Pepin G, Phillipou A, Piccone J, Pinkus R, Raykos B, Rhodes P, Rieger E, Rodan S, Rockett K, Russell J, Russell H, Salter F, Sawyer S, Shelton B, Singh U, Smith S, Smith E, Spielman K, Squire S, Thomson J, Tiggemann M, Touyz S, Utpala R, Vartanian L, Wallis A, Ward W, Wells S, Wertheim E, Wilksch S, Williams M, Touyz S, Maguire S. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord 2022; 10:78. [PMID: 35672777 PMCID: PMC9175461 DOI: 10.1186/s40337-022-00597-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. METHODS This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. RESULTS Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. CONCLUSIONS A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karen Spielman
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, New South Wales Health, Sydney, Australia
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Bourne L, Mandy W, Bryant-Waugh R. Avoidant/restrictive food intake disorder and severe food selectivity in children and young people with autism: A scoping review. Dev Med Child Neurol 2022; 64:691-700. [PMID: 35112345 DOI: 10.1111/dmcn.15139] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022]
Abstract
AIM To assess the extent of the scientific literature on avoidant/restrictive food intake disorder (ARFID) in children and young people with autism in order to evaluate and synthesize the evidence on (a) the nature of feeding and eating difficulties in children and young people with autism; (b) the consequences of a severely restricted diet; and (c) what is known about effective treatment approaches. METHOD PubMed and PsycInfo databases were searched, identifying 56 studies and a narrative synthesis was effected. RESULTS The literature suggested that ARFID-like presentations are common in children and young people with autism, with severe consequences for physical and mental health. The three drivers mentioned in the DSM-5 criteria, namely a sensory-based avoidance, fear- or phobia-based restriction, and a lack of interest in eating, are present in this population, although sensory sensitivities are currently the most commonly described. Research suggests that ARFID symptoms in children and young people with autism can be amenable to treatment, with evidence that behavioural interventions are feasible and potentially effective in this population. INTERPRETATION ARFID is a common and impactful problem among young people with autism but is currently under researched. Work is required to (a) identify the prevalence of ARFID in children and young people with autism; (b) uncover the key drivers of ARFID in this population; (c) adapt currently available interventions for use with children and young people with autism; and (d) rigorously test these interventions in clinical trials. WHAT THIS PAPER ADDS Significant food restriction is common in children and young people with autism. Sensory sensitivities are frequently cited as a reason for food restriction. The prevalence and causes of avoidant/restrictive food disorders in children and young people with autism need further research.
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Affiliation(s)
- Laura Bourne
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - William Mandy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
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16
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Dinkler L, Bryant-Waugh R. Assessment of avoidant restrictive food intake disorder, pica and rumination disorder: interview and questionnaire measures. Curr Opin Psychiatry 2021; 34:532-542. [PMID: 34402460 DOI: 10.1097/yco.0000000000000736] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article reviews available assessment instruments for three of the feeding and eating disorder diagnostic categories: avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD). It includes an overview of the current status of screening tools, questionnaire measures, and diagnostic instruments. RECENT FINDINGS Screening instruments are available for all three disorders; however, for pica and RD, these typically include single screening items only and do not cover any specific features of these presentations. Only one questionnaire suitable for clinical populations is included, covering ARFID only. Standardized diagnostic interviews are limited to two covering both pica and RD, only one of which provides further clinical information. Of the five diagnostic instruments for ARFID described here, two include diagnostic items as well as allowing more detailed assessment of clinical features. SUMMARY There are a limited number of assessment measures available for all three disorders, with instruments for ARFID being the greatest in number and widest in terms of scope. A commonly encountered difficulty is that many assessment instruments do not adequately cover diagnostic exclusion criteria, which raises the likelihood of false positive findings. All currently available measures require further study to determine their reliability and validity.
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Affiliation(s)
- Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital
- Kings College London, London, UK
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17
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Bertrand V, Tiburce L, Sabatier T, Dufour D, Déchelotte P, Tavolacci MP. Estimated Prevalence and Care Pathway of Feeding and Eating Disorders in a French Pediatric Population. Nutrients 2021; 13:nu13062048. [PMID: 34203957 PMCID: PMC8232740 DOI: 10.3390/nu13062048] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 01/12/2023] Open
Abstract
Feeding and Eating Disorders (FED) are mostly described in infants and adolescents but are less well-known in children. Information on the prevalence of FED in the general pediatric population is still limited. The aim of this study was to estimate the prevalence and the care pathway of FED in a population aged 0-18 years old, using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 classification. Two physicians interviewed 401 families using a questionnaire including demographics, BMI, dietary behavior data, and age-appropriate screening tools. Qualitative and quantitative variables were compared using the Chi2 test and Student's t-test, respectively. After a headcount adjustment based on the French population by age group, the estimated prevalence rate was 3% [95%CI (1.7-5.1)] for Avoidant and Restrictive Food Intake Disorder (ARFID), and 9.7% [95%CI (7.2-13.0)] for Unspecified FED (UFED), which included other restrictive and compulsive FED. The median age for ARFID was 4.8 years (0.8-9 years), and 7.5 years (0.6-17 years) for UFED. The interviews did not identify cases of anorexia, bulimia, binge eating disorder, other specified FED, pica or rumination. Only 15.2% of children with an FED were receiving medical care. The development of validated pediatric screening tools, as well as the training of health professionals in children FED is necessary.
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Affiliation(s)
- Valérie Bertrand
- Pediatric Unit, Le Havre Hospital, 76083 Le Havre, France;
- French National Institute of Health and Medical Research (INSERM) U1073, UNIROUEN, Normandie University, 76031 Rouen, France; (P.D.); (M.-P.T.)
- Correspondence: ; Tel.: +33-011-232734195
| | - Lyvia Tiburce
- Pediatric Unit, Le Havre Hospital, 76083 Le Havre, France;
| | - Thibaut Sabatier
- Clinical Investigation Center 1404, Rouen University Hospital, 76031 Rouen, France;
| | - Damien Dufour
- Pediatric Emergency Care, Le Havre Hospital, 76083 Le Havre, France;
| | - Pierre Déchelotte
- French National Institute of Health and Medical Research (INSERM) U1073, UNIROUEN, Normandie University, 76031 Rouen, France; (P.D.); (M.-P.T.)
- Department of Nutrition, Rouen University Hospital, 76031 Rouen, France
| | - Marie-Pierre Tavolacci
- French National Institute of Health and Medical Research (INSERM) U1073, UNIROUEN, Normandie University, 76031 Rouen, France; (P.D.); (M.-P.T.)
- Clinical Investigation Center 1404, Rouen University Hospital, 76031 Rouen, France;
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18
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Coelho JS, Norris ML, Tsai SCE, Wu YJ, Lam PY. Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder. Int J Eat Disord 2021; 54:587-594. [PMID: 33300613 DOI: 10.1002/eat.23438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The current study explored the experience and familiarity of pediatric health professionals with avoidant/restrictive food intake disorder (ARFID), and assessed the application of diagnostic criteria in a series of clinical vignettes. METHOD Pediatric health professionals were invited to complete an online survey. Data from 93 health professionals from medical and allied health roles who completed the survey were analyzed. RESULTS Respondents providing care for pediatric feeding/eating disorders were more likely to report familiarity with ARFID than those not typically providing care for feeding/eating disorders. Clinicians who had provided care for pediatric ARFID reported more confidence in clinical management of ARFID than did those who had not yet provided care for ARFID, though there were overall relatively low levels of confidence in providing care for ARFID. Respondents to the clinical vignettes were more likely to confer a diagnosis of ARFID when there were symptoms of both psychosocial impairment and weight loss than when there was psychosocial impairment alone. DISCUSSION The results suggest variability in current application of diagnostic criteria for ARFID, low confidence in clinical management of ARFID, and ambiguity in clinicians' judgments regarding whether psychosocial impairment is sufficient to meet a diagnosis of ARFID.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark L Norris
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen C E Tsai
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuwei J Wu
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Hilbert A, Zenger M, Eichler J, Brähler E. Psychometric evaluation of the Eating Disorders in Youth-Questionnaire when used in adults: Prevalence estimates for symptoms of avoidant/restrictive food intake disorder and population norms. Int J Eat Disord 2021; 54:399-408. [PMID: 33283329 DOI: 10.1002/eat.23424] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Restrictive eating behaviors occur across ages, but little is known about symptoms of avoidant/restrictive food intake disorder (ARFID), especially in adults. This study sought to examine the prevalence of symptoms of ARFID in the adult population, providing a psychometric evaluation of the Eating Disorders in Youth-Questionnaire (EDY-Q) and population norms. METHOD In a representative survey of the German population, N = 2,424 adults (1,297 women, 1,127 men; age 49.5 ± 17.5 years) were assessed with the EDY-Q and measures of eating disorder and general psychopathology for divergent validation. RESULTS The point prevalence of self-reported symptoms of ARFID amounted to 0.8% (20/2,424), with 0.8% of women (10/1,297) and 0.9% of men (10/1,127) being affected. Adults with symptoms of ARFID were significantly more likely to have underweight or normal weight, were more likely to report restrictive behaviors and lower levels of eating disorder psychopathology and binge eating than noneating-disordered controls and adults with symptoms of an eating disorder, but did not significantly differ in levels of compensatory behaviors, or depression and anxiety. The EDY-Q revealed favorable item statistics, heterogeneity, and satisfactory construct validity, including factorial, discriminant, and divergent validity. Weight-status specific norms were provided. DISCUSSION Both women and men from the population reported symptoms of ARFID with an anthropometric and psychopathological profile similar to that seen in youth with symptoms of ARFID, however, with lower prevalence estimates, and distinctive from that in other eating disorders. Interview-based assessment of this symptomatology is required to confirm the prevalence of ARFID diagnosis.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Markus Zenger
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.,Faculty of Applied Human Studies, University of Applied Sciences Magdeburg and Stendal, Stendal, Germany
| | - Janina Eichler
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Elmar Brähler
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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20
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Macro- and Micronutrient Intake in Children with Avoidant/Restrictive Food Intake Disorder. Nutrients 2021; 13:nu13020400. [PMID: 33513954 PMCID: PMC7911718 DOI: 10.3390/nu13020400] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022] Open
Abstract
Although case studies in avoidant/restrictive food intake disorder (ARFID) indicate severe nutritional deficiencies in those with a highly limited amount or variety of food intake, systematic analyses on food intake in treatment-seeking children and adolescents with ARFID are lacking. Within this study, n = 20 patients with an interview-based diagnosis of ARFID (0–17 years) were included and compared to n = 20 healthy controls individually matched for age and sex. Children or parents completed three-day food diaries and a food list. Macronutrient, vitamin, and mineral supply was determined based on the percentage of their recommended intake. The results showed a significantly lower total energy and protein intake in ARFID versus controls, with trends for lower fat and carbohydrate intake. ARFID subtypes of limited amount versus variety of food intake significantly differed in macro-, but not micronutrient intake. Those with ARFID met only 20–30% of the recommended intake for most vitamins and minerals, with significantly lower intake relative to controls for vitamin B1, B2, C, K, zinc, iron, and potassium. Variety of food intake was significantly reduced in ARFID versus controls in all food groups except carbohydrates. This study demonstrated that ARFID goes along with reduced everyday life macro- and micronutrient intake, which may increase the risk for developmental and health problems. Future studies additionally assessing serum nutrient levels in a larger sample may further explore differences in food intake across diverse ARFID presentations.
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21
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Schöffel H, Hiemisch A, Kiess W, Hilbert A, Schmidt R. Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample. EUROPEAN EATING DISORDERS REVIEW 2020; 29:60-73. [PMID: 33089950 DOI: 10.1002/erv.2799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/05/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Although patients with avoidant/restrictive food intake disorder (ARFID) often consult general paediatric services initially, existing literature mostly concentrated on intensive eating disorder treatment settings. This cross-sectional study sought to describe symptoms of ARFID and their associations with eating disorder psychopathology, quality of life, anthropometry, and physical comorbidities in a general paediatric sample. METHODS In N = 111 patients (8-18 years) seeking treatment for physical diseases, prevalence of ARFID-related restrictive eating behaviours was estimated by self-report and compared to population-based data (N = 799). Using self-report and medical record data, further ARFID diagnostic criteria were evaluated. Patients with versus without symptoms of ARFID based on self-report and medical records were compared in diverse clinical variables. RESULTS The prevalence of self-reported symptoms of ARFID was not higher in the inpatient than population-based sample. Only picky eating and shape concern were more common in the inpatient than population-based sample. Although 68% of the inpatient sample reported any restrictive eating behaviours, only 7% of patients showed symptoms of ARFID based on medical records in addition to self-report, particularly those with underweight, without significant effects for age, sex, and medical diagnoses. DISCUSSION The study revealed the importance of considering ARFID within the treatment of children and adolescents with physical diseases, especially for those with underweight. Further research is needed to replicate the findings with interview-based measures and to investigate the direction of effects in ARFID and its physical correlates.
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Affiliation(s)
- Hannah Schöffel
- Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Centre for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Centre for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
| | - Ricarda Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
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22
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Shimshoni Y, Lebowitz ER. Childhood Avoidant/Restrictive Food Intake Disorder: Review of Treatments and a Novel Parent-Based Approach. J Cogn Psychother 2020; 34:200-224. [PMID: 32817402 DOI: 10.1891/jcpsy-d-20-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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, 2013; Eddy et al., 2019). The aim of the current article was to review available reports of treatment for childhood ARFID published since its inclusion in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and to introduce a novel parent-based treatment for child ARFID through a case presentation. Empirical support for psychosocial treatments for child ARFID currently stems from two small-scale pilot randomized control trials, one pilot open trial, case reports, case series, and retrospective chart reviews. Treatment approaches for outpatient care generally apply family-based therapy, child-centered cognitive behavioral therapy, or parent-based behavioral approaches. SPACE-ARFID is a novel outpatient parent-based treatment that focuses on parental responses to child problematic eating habits. SPACE-ARFID aims to promote flexibility and adjustment in food related situations. The treatment helps parents to systematically reduce family accommodation, or changes that they make to their own behavior to help their child avoid or alleviate distress related to the disorder, while increasing supportive responses to the child's symptoms.
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Affiliation(s)
- Yaara Shimshoni
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Eli R Lebowitz
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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23
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Bourne L, Bryant-Waugh R, Cook J, Mandy W. Avoidant/restrictive food intake disorder: A systematic scoping review of the current literature. Psychiatry Res 2020; 288:112961. [PMID: 32283448 DOI: 10.1016/j.psychres.2020.112961] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 01/16/2023]
Abstract
Avoidant/restrictive food intake disorder (ARFID) was recently introduced to psychiatric nosology to describe a group of patients who have avoidant or restrictive eating behaviours that are not motivated by a body image disturbance or a desire to be thinner. This scoping review aimed to systematically assess the extent and nature of the ARFID literature, to identify gaps in current understanding, and to make recommendations for further study. Following an extensive database search, 291 unique references were identified. When matched against pre-determined eligibility criteria, 78 full-text publications from 14 countries were found to report primary, empirical data relating to ARFID. This literature was synthesised and categorised into five subject areas according to the central area of focus: diagnosis and assessment, clinical characteristics, treatment interventions, clinical outcomes, and prevalence. The current evidence base supports ARFID as a distinct clinical entity, but there is a limited understanding in all areas. Several possible avenues for further study are indicated, with an emphasis placed on first parsing this disorder's heterogeneous presentation. A better understanding of the varied mechanisms which drive food avoidance and/or restriction will inform the development of targeted treatment interventions, refine screening tools and impact clinical outcomes.
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Affiliation(s)
- Laura Bourne
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Julia Cook
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - William Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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24
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Abstract
Avoidant/restrictive food intake disorder (ARFID) is a relatively newly introduced diagnostic category within the feeding and eating disorders. This article summarizes current knowledge and clinical practice relating to ARFID in youth. It discusses epidemiology, diagnosis, clinical assessment, treatment interventions, prognosis, and outcome. Gaps in the existing research literature are highlighted, promising avenues of current research signposted, and potentially useful future directions proposed. The article is relevant to clinicians wishing to ensure their practice is based on up-to-date information, as well as researchers interested in furthering knowledge relating to ARFID.
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Affiliation(s)
- Rachel Bryant-Waugh
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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25
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Duncombe Lowe K, Barnes TL, Martell C, Keery H, Eckhardt S, Peterson CB, Lesser J, Le Grange D. Youth with Avoidant/Restrictive Food Intake Disorder: Examining Differences by Age, Weight Status, and Symptom Duration. Nutrients 2019; 11:E1955. [PMID: 31434268 PMCID: PMC6723819 DOI: 10.3390/nu11081955] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 01/12/2023] Open
Abstract
The primary purpose of this study was to examine differences among youth with avoidant/restrictive food intake disorder (ARFID) by age, weight status, and symptom duration. A secondary goal was to report the frequencies of ARFID using DSM-5 clinical presentations (i.e., fear of aversive consequences, lack of interest in food, sensory sensitivities). Participants (N = 102), ages 8-18 years, were recruited through an eating disorder service within a pediatric hospital. They were evaluated using semi-structured interviews and questionnaires. Patients were assigned to groups according to age, weight status, and symptom duration. Frequencies of clinical presentations, including combinations of DSM-5 categories, were also examined. Our findings suggest that adolescents presented with higher rates of Depression (p = 0.04). Youth with chronic ARFID symptoms presented with significantly lower weight (p = 0.03), and those with acute symptoms rated significantly higher suicidal ideation and/or self- harm (p = 0.02). Half of patients met criteria for more than one ARFID symptom presentation. This study provides preliminary evidence that youth with ARFID differ in clinical presentation depending on age, weight status, and symptom duration, and highlights safety concerns for those with acute symptoms of ARFID. High rates of overlapping symptom presentations might suggest a dimensional approach in the conceptualization of ARFID.
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Affiliation(s)
- Kristina Duncombe Lowe
- Center for the Treatment of Eating Disorders, Children's Minnesota, Minneapolis, MN 55404, USA.
| | - Timothy L Barnes
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Carolyn Martell
- Center for the Treatment of Eating Disorders, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Helene Keery
- Center for the Treatment of Eating Disorders, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Sarah Eckhardt
- Center for the Treatment of Eating Disorders, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA
| | - Julie Lesser
- Rogers Behavioral Health, Eden Prairie, MN 55344, USA
| | - Daniel Le Grange
- Department of Psychiatry and Department of Pediatrics, University of California, San Francisco, CA 94143, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL 60637, USA
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26
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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. Radcliffe ARFID Workgroup: Toward operationalization of research diagnostic criteria and directions for the field. Int J Eat Disord 2019; 52:361-366. [PMID: 30758864 PMCID: PMC6485247 DOI: 10.1002/eat.23042] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Since its introduction to the psychiatric nomenclature in 2013, research on avoidant/restrictive food intake disorder (ARFID) has proliferated highlighting lack of clarity in how ARFID is defined. METHOD In September 2018, a small multi-disciplinary pool of international experts in feeding disorder and eating disorder clinical practice and research convened as the Radcliffe ARFID workgroup to consider operationalization of DSM-5 ARFID diagnostic criteria to guide research in this disorder. RESULTS By consensus of the Radcliffe ARFID workgroup, ARFID eating is characterized by food avoidance and/or restriction, involving limited volume and/or variety associated with one or more of the following: weight loss or faltering growth (e.g., defined as in anorexia nervosa, or by crossing weight/growth percentiles); nutritional deficiencies (defined by laboratory assay or dietary recall); dependence on tube feeding or nutritional supplements (≥50% of daily caloric intake or any tube feeding not required by a concurrent medical condition); and/or psychosocial impairment. CONCLUSIONS This article offers definitions on how best to operationalize ARFID criteria and assessment thereof to be tested in existing clinical populations and to guide future study to advance understanding and treatment of this heterogeneous disorder.
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Affiliation(s)
- Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Stephanie G. Harshman
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Elana Bern
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Rachel Bryant-Waugh
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Debra K. Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Laurie D. Manzo
- Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Jessie Menzel
- Department of Psychiatry, University of California, San Diego, California.,University of California San Diego Eating Disorder Center for Treatment and Research, San Diego, California
| | - Nadia Micali
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Sarah Sally
- Department of Speech, Language, and Swallowing Disorders, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Sharon P. Serinsky
- Occupational Therapy Services, MassGeneral Hospital for Children, Boston, Massachusetts
| | - William Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, Atlanta, Georgia
| | - Kathryn Stubbs
- Pediatric Psychology and Feeding Disorders Program, The Marcus Autism Center, Atlanta, Georgia
| | - B. Timothy Walsh
- Columbia Center for Eating Disorders, Department of Psychiatry, Columbia University, New York, New York.,Eating Disorders Research Unit, New York State Psychiatric Institute, New York, New York
| | - Hana Zickgraf
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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27
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Eddy KT, Thomas JJ. Introduction to a special issue on child and adolescent feeding and eating disorders and avoidant/restrictive food intake disorder. Int J Eat Disord 2019; 52:327-330. [PMID: 30793776 DOI: 10.1002/eat.23052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We are very pleased to introduce a special issue of the International Journal of Eating Disorders on child and adolescent feeding and eating disorders and avoidant/restrictive food intake disorder (ARFID). METHOD Contributions focused on five main themes: (1) the definition and assessment of ARFID; (2) the clinical phenomenology of ARFID; (3) similarities and differences between ARFID and anorexia nervosa (AN); (4) novel treatments for ARFID; and (5) new ideas for improving treatment outcomes in AN. RESULTS These papers highlight the importance of clear operationalization and measurement of the ARFID diagnostic criteria. ARFID phenotypes bear both similarities and important differences in clinical profile, course, and outcome from AN. Findings suggest the utility of adapting existing treatments for restrictive eating disorders to apply to ARFID and engender clinical creativity to move beyond existing treatments and develop novel interventions that address the heterogeneity of ARFID. Furthermore, burgeoning understanding of ARFID offers the potential that novel treatments for ARFID may also be applied to improve outcomes for AN. DISCUSSION This collection of papers features child and adolescent feeding and eating disorder patient groups that have been understudied and we hope that this catalyzes clinical research in these important presentations.
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Affiliation(s)
- Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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