Avoidant/Restrictive Food Intake Disorder: An Adult Case Responding to Cognitive Behavioral Therapy

Avoidant/restrictive food intake disorder (ARFID) is a new diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders-5 ( DSM-5) which replaces and extends the DSM-4 diagnosis of feeding disorder of infancy or early childhood. There is limited information as to the characteristics of the patients with ARFID, its course and prognosis and treatment. We aim to contribute to available literature on ARFID by presenting this case. We discussed a young lady with ARFID who responded well to cognitive behavioral therapy (CBT) with successful application of in vivo exposure, systematic desensitization, and cognitive restructuring techniques. After the 12 sessions of CBT as inpatient and eight sessions as outpatient, she gained 4 kg (8.81 lbs); her body mass index (BMI) rising from 16 to 17.5 kg/m2, Hamilton anxiety rating score dropped from 27 to 5. She continued to improve reaching the BMI of 18.3 kg/m2 6-month post-discharge. This case suggests that CBT can be a useful treatment modality in adults with ARFID.

Food avoidance and restriction in adults: a cross-sectional pilot study comparing patients from an immunology clinic to a general practice

BACKGROUND

With the introduction of avoidant/restrictive food intake disorder (ARFID) in the Diagnostic and Statistical Manual - fifth edition, there is an increased need to understand the prevalence and pattern of food avoidance and restriction in adults. High rates of food allergy and intolerance in immunology clinic populations, and subsequent high rates of elimination diets, place these individuals at a greater risk of developing pathological eating behaviours. This descriptive cross sectional pilot study aims to provide preliminary data on the prevalence and nature of food avoidance and restriction in an adult population, and to explore the reasons for this behaviour.

METHOD

A self-administered questionnaire was designed and distributed to adults presenting to an immunology clinic and a general practice over the course of 6 months to describe the prevalence and nature of avoidant and restrictive eating behaviours in this population. Pearson's chi square test was used to examine the strength of a potential link to a formal diagnosis of avoidant restrictive food intake disorder in these patients.

RESULTS

A total of 102 completed questionnaires were used for data analysis. Food avoidance or restriction was detected in 81 respondents (79%), with rates not significantly higher in the immunology clinic group compared to the general practice group (p = .242). Food allergy and intolerance were the most common reasons for disturbed eating patterns. Life impact secondary to food avoidance and restriction was reported by 26% of respondents, with significantly higher rates observed in the immunology clinic cohort compared to the general practice (p = .011).

CONCLUSIONS

Eating disturbances similar to those characteristic of ARFID are very common in adults. Food avoidance and restriction due to perceived food allergy and intolerance are significant reasons for such disordered eating patterns, particularly in an immunology clinic population. Further investigation is needed to determine if such eating behaviours are pathological and whether they qualify for a diagnosis of ARFID.

Illness anxiety and avoidant/restrictive food intake disorder: Cognitive-behavioral conceptualization and treatment

Eating difficulties are commonly present in medical and psychiatric settings. Some eating problems are resultant from fears about food consumption and can be conceptualized as anxiety disorders conditioned by perception of feared outcomes associated with eating and maintained by avoidance. The authors present a case in which a female patient with limited food intake is successfully treated with cognitive-behavioral therapy. Illness anxiety disorder and avoidant/restrictive food intake disorder, both newly included in DSM-V, are applied in this case.