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Monteleone AM, Abbate-Daga G. Effectiveness and predictors of psychotherapy in eating disorders: state-of-the-art and future directions. Curr Opin Psychiatry 2024:00001504-990000000-00135. [PMID: 39146554 DOI: 10.1097/yco.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers. RECENT FINDINGS Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes. SUMMARY Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.
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Affiliation(s)
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Ellison C, Philpot U, Fuller S, Banner A, Falcoski P, Watts M, Greenham A. What is avoidant restrictive food intake disorder? Br J Gen Pract 2024; 74:362-363. [PMID: 39054097 PMCID: PMC11299672 DOI: 10.3399/bjgp24x738957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Affiliation(s)
- Clare Ellison
- Advanced eating disorders dietitian working clinically with patients with avoidant restrictive food intake disorder (ARFID) and strategically with the North East and North Cumbria Provider Collaborative; committee member, British Dietetic Association (BDA) ARFID Sub-Group.
| | - Ursula Philpot
- Advanced eating disorder dietitian working clinically with patients with ARFID; committee member, BDA ARFID Sub-Group
| | - Sarah Fuller
- Advanced eating disorder dietitian working clinically with patients with ARFID; committee member, BDA ARFID Sub-Group
| | - Angharad Banner
- Advanced eating disorder dietitian working clinically with patients with ARFID; committee member, BDA ARFID Sub-Group
| | - Paola Falcoski
- Advanced eating disorder dietitian working clinically with patients with ARFID; committee member, BDA ARFID Sub-Group
| | - Mala Watts
- Advanced eating disorder dietitian working clinically with patients with ARFID; committee member, BDA ARFID Sub-Group
| | - Anna Greenham
- Practising GP with lived experience as a carer of a young person with ARFID
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Breiner CE, Miller ML, Hormes JM. ARFID Parent Training Protocol ("ARFID-PTP"): Results of a Randomized Pilot Trial Evaluating a Brief, Parent-Training Program for Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2024. [PMID: 39031449 DOI: 10.1002/eat.24269] [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: 01/28/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE Accessible treatment options for avoidant/restrictive food intake disorder (ARFID) in children are limited. The current study sought to assess acceptability, feasibility, and preliminary efficacy of a brief, virtual intervention for ARFID in children ("ARFID-PTP"). METHOD Families of children ages 5-12 with ARFID (n = 30) were randomized to immediate or waitlist treatment groups, with both groups ultimately receiving ARFID-PTP. ARFID-PTP consists of two, 2-h individual treatment sessions with an optional booster session at 4-week follow-up. Families completed acceptability and feasibility measures at end-of-treatment, as well as preliminary efficacy measures at 4-week, 3-month, and 6-month follow-up. RESULTS Of 30 families who completed an intake session, 27 (90%) completed treatment. Families rated acceptability as high (MCEQ-C = 7.75). Treatment was feasible by participant retention. Exposure adherence was lower than expected, and booster session requests were higher than expected, indicating that achieving feasibility across measures may require treatment modifications. Regarding preliminary efficacy, children in the immediate treatment group had a decrease in ARFID symptoms compared to those on the waitlist. Overall, at 6-month follow-up linear mixed models showed participants had significantly reduced ARFID symptoms by presentation (p < 0.05) and in follow-up completers, children incorporated eight new foods on average. DISCUSSION ARFID-PTP is acceptable and preliminarily efficacious. The protocol may benefit from modifications to increase feasibility; however, booster session content and treatment outcomes suggest a priori feasibility markers may not accurately capture the utility of ARFID-PTP. Further work should continue to examine the efficacy ARFID-PTP, particularly in diverse samples where treatment accessibility is urgently needed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04913194.
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Affiliation(s)
- Courtney E Breiner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - McKenzie L Miller
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
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Duffy F, Willmott E, Nimbley E, Lawton A, Sharpe H, Buchan K, Gillespie-Smith K. Avoidant Restrictive Food Intake Disorder (ARFID)-Looking beyond the eating disorder lens? EUROPEAN EATING DISORDERS REVIEW 2024; 32:824-827. [PMID: 38564375 DOI: 10.1002/erv.3093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Avoidant Restrictive Food Intake Disorder (ARFID) was first included as a diagnostic category in 2013, and over the past 10 years has been adopted by the international eating disorder community. While greater awareness of these difficulties has increased identification, demand and enabled advocacy for clinical services, the heterogeneous nature of ARFID poses unique challenges for eating disorder clinicians and researchers. This commentary aims to reflect on some of these challenges, focussing specifically on the risk of viewing ARFID through an eating disorder lens. This includes potential biases in the literature as most recent research has been conducted in specialist child and adolescent eating disorder clinic settings, bringing in to question the generalisability of findings to the broad spectrum of individuals affected by ARFID. We also consider whether viewing ARFID predominantly through an eating disorder lens risks us as a field being blinkered to the range of effective skills our multi-disciplinary feeding colleagues may bring. There are opportunities that may come with the eating disorder field navigating treatment pathways for ARFID, including more joined up working with multi-disciplinary colleagues, the ability to transfer skills used in ARFID treatment to individuals with eating disorder presentations, and most notably an opportunity to provide more effective treatment and service pathways for individuals with ARFID and their families. However, these opportunities will only be realised if eating disorder clinicians and researchers step out of their current silos.
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Affiliation(s)
- Fiona Duffy
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
- NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - Emma Willmott
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Emy Nimbley
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Andrew Lawton
- Lothian Eating Disorder Service, Royal Edinburgh Hospital, Edinburgh, Scotland
| | - Helen Sharpe
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Kyle Buchan
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
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Ahmed GK, Karim AA, Khedr EM, Elbeh K, Moheb A, Abokresha M, Haridy NA. Case report: Avoidant/restrictive food intake disorder after tonsillectomy. Front Psychiatry 2024; 15:1351056. [PMID: 38993387 PMCID: PMC11237393 DOI: 10.3389/fpsyt.2024.1351056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/29/2024] [Indexed: 07/13/2024] Open
Abstract
Background Avoidant Restrictive Food Intake Disorder (ARFID) is a newly classified eating disorder that requires further understanding of its presentation. There is no previous report of ARFID in a child post-tonsillectomy. ARFID may be a potential negative outcome for children following oropharyngeal surgery. Case presentation A female child aged 10 years and 2 months presented with ARFID associated with depression, anxiety and nutritional deficiency following tonsillectomy. She had more difficulty in swallowing solids than fluids and had repeated vomiting and spitting food after chewing it. She became dehydrated and malnourished with a BMI of 10.5 and was misdiagnosed with myasthenic gravis. Conclusions To our knowledge, this is the first case report of ARFID in a child post-tonsillectomy. We discuss the pathophysiology of ARFID, which remains elusive, and recommend psychiatric assessment when evaluating children post operative tonsillectomy.
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Affiliation(s)
- Gellan K. Ahmed
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ahmed A. Karim
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Eman M. Khedr
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khaled Elbeh
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amira Moheb
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marwa Abokresha
- Department of Internal Medicine, Gastroenterology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nourelhoda A. Haridy
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
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Richson BN, Abber SR, Wierenga CE. Conceptualizing avoidant/restrictive food intake disorder via an executive functioning lens. Int J Eat Disord 2024. [PMID: 38804560 DOI: 10.1002/eat.24233] [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: 11/30/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
Avoidant/restrictive food intake disorder (ARFID) is a heterogeneous disorder wherein restrictive eating is primarily attributed to non-shape/weight-based reasons (e.g., sensory sensitivity) that empirical research continues to explore. Mounting evidence suggests that ARFID often presents alongside neurodevelopmental diagnoses (NDs) or divergent neurodevelopment broadly. Executive functioning (EF) differences often characterize divergent neurodevelopmental trajectories. Additionally, restrictive eating in anorexia nervosa has been conceptualized as related to EF factors (e.g., set shifting). Given the neurodevelopmental phenotype that may be associated with ARFID and the role of EF in anorexia nervosa, this paper proposes EF as a potentially important, yet understudied factor in ARFID pathology. We posit that various observed ARFID behavioral/cognitive tendencies can be conceptualized in relation to EF differences. We contextualize commonly observed ARFID presentations within "core" EF components (i.e., cognitive flexibility, working memory, inhibitory control), leading to hypotheses about EF in ARFID. Finally, we offer additional considerations/directions for future research on EF in ARFID. Increased research on EF in ARFID is needed to consider this potential common factor in the etiology and maintenance of this heterogeneous disorder. We aim to promote further consideration of EF in ARFID etiology, maintenance, and treatment-outcome research. PUBLIC SIGNIFICANCE: This article proposes that aspects of executive functioning (EF) may play a role in the onset and maintenance of avoidant/restrictive food intake disorder (ARFID), although this notion is largely untested by existing research. Further research on the role of EF in ARFID may assist with refining models and treatments for this heterogeneous disorder.
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Affiliation(s)
- Brianne N Richson
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, San Diego, California, USA
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Lamparyk K, Szigethy E. Importance of Distinguishing Avoidant/Restrictive Food Intake Disorder From Other Eating Disorders in Patients With Disorders of Gut-brain Interaction. J Clin Gastroenterol 2024; 58:315. [PMID: 38277497 DOI: 10.1097/mcg.0000000000001970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Katherine Lamparyk
- Department of Psychiatry and Behavioral Health, Akron Children's Hospital Akron, Ohio
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MacDonald DE, Liebman R, Trottier K. Clinical characteristics, treatment course and outcome of adults treated for avoidant/restrictive food intake disorder (ARFID) at a tertiary care eating disorders program. J Eat Disord 2024; 12:15. [PMID: 38263130 PMCID: PMC10807227 DOI: 10.1186/s40337-024-00973-6] [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: 06/01/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is now recognized as a feeding/eating disorder that affects individuals across the lifespan, but research on ARFID in general and particularly in adults remains limited. The purpose of this study was to describe the demographic and clinical characteristics of adults with ARFID seeking treatment at a tertiary care eating disorders program, and to describe the course and outcomes of treatment at three levels of care-inpatient, intensive outpatient, and outpatient individual therapy. METHOD This retrospective chart review study examined the charts of 42 patients who received treatment for ARFID between April 2020 and March 2023. Following diagnostic assessment, patients were referred to either inpatient treatment, intensive outpatient treatment, or outpatient individual therapy. All three levels of care involved individual cognitive behaviour therapy. Inpatients typically transitioned to one of the outpatient treatments as part of a continuous care plan. We examined demographic and clinical characteristics, treatment length and completion, and changes in key indicators during treatment. RESULTS Patients were diverse with respect to demographics (e.g., 62% cisgender women; 21% cisgender men; 17% transgender, non-binary, or other gender) and comorbid concerns (e.g., 43% had neurodevelopmental disorders; > 50% had mood and anxiety disorders; 40% had posttraumatic stress disorder [PTSD]; 35% had medical conditions impacting eating/digestion). Most patients presented with more than one ARFID maintaining mechanism (i.e., lack of appetite/interest, sensory sensitivities, and/or fear of aversive consequences of eating). Treatment completion rates and outcomes were good. On average, patients showed significant improvement in impairment related to their eating disorder, and those who were underweight significantly improved on BMI and were not underweight at end of treatment. DISCUSSION These findings add to the literature by indicating that ARFID patients are commonly male or have diverse gender identities, and have high rates of neurodevelopmental, mood, anxiety, and gastrointestinal disorders. We also found high rates of PTSD. The findings show promise for treatment outcomes across the continuum of care. Next steps in ARFID treatment and research include incorporating ARFID-specific assessments into routine care, and ongoing research investigating the efficacy and effectiveness of treatments such as CBT-AR.
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Affiliation(s)
- Danielle E MacDonald
- Centre for Mental Health, University Health Network, 7-Eaton South, 200 Elizabeth Street, Toronto, ON, M3J 2Z3, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada.
| | - Rachel Liebman
- Centre for Mental Health, University Health Network, 7-Eaton South, 200 Elizabeth Street, Toronto, ON, M3J 2Z3, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
- Department of Psychology, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Kathryn Trottier
- Centre for Mental Health, University Health Network, 7-Eaton South, 200 Elizabeth Street, Toronto, ON, M3J 2Z3, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
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