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Kaşak M, Öğütlü H, Doğan U, Zickgraf HF, Türkçapar MH. Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish adolescents. J Eat Disord 2024; 12:105. [PMID: 39060938 PMCID: PMC11282626 DOI: 10.1186/s40337-024-01066-0] [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: 04/23/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study evaluates the psychometric properties of the Turkish version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a population of Turkish adolescents. METHOD The NIAS, designed to screen for ARFID symptoms, including picky eating, fear-related eating behaviors, and low appetite, was administered to secondary school students between 13 and 18 ages in Muğla, Turkiye. RESULTS Based on a sample of 268 adolescents, the NIAS's reliability and validity in this demographic are supported. The research utilized confirmatory factor analysis to verify its three-factor structure and various reliability tests, including Cronbach's alpha and test-retest reliability, confirming the scale's internal consistency and temporal stability. The descriptive analysis highlighted significant differences in NIAS scores across BMI categories, with underweight adolescents scoring higher, suggesting a potential link between ARFID symptoms and lower body weight. Criterion validity was supported by significant correlations between NIAS subscales and measures of anxiety, depression, and eating behaviors, indicating the scale's effectiveness in reflecting relevant psychopathological features. CONCLUSION Overall, the study establishes the Turkish NIAS as a useful tool for identifying ARFID in Turkish adolescents, aiding early detection and intervention in this at-risk age group. Further research is recommended to explore the scale's utility across different clinical settings and refine its diagnostic accuracy, enhancing our understanding of ARFID's impact on youth mental health and nutritional status.
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Affiliation(s)
- Meryem Kaşak
- Department of Child and Adolescent Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
| | - Hakan Öğütlü
- Department of Child and Adolescent Psychiatry, Cognitive Behavioral Psychotherapies Association, Karum Is Merkezi Iran Caddesi No: 21 06680 Gaziosmanpasa Mah., Ankara, Turkey.
| | - Uğur Doğan
- Departmant of Guidance and Counseling, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Hana F Zickgraf
- Department of Psychology, University of South Alabama, Mobile, AL, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
- Rogers Behavioral Health, Oconomowoc, WI, USA
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Breiner CE, Knedgen MM, Proctor KB, Zickgraf HF. Relation between ARFID symptomatology and picky eating onset and duration. Eat Behav 2024; 54:101900. [PMID: 38941675 DOI: 10.1016/j.eatbeh.2024.101900] [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: 01/18/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Picky eating (PE) is common in early childhood, peaking between ages 1 and 5 years. However, PE may persist beyond this normative period and pose threats to health and psychosocial functioning. Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by appetite, preference/selectivity, and/or fear of eating, leading to significant medical and/or psychosocial impairment. This retrospective study examined the relation between early childhood PE onset/duration and ARFID eating restrictions and symptoms. METHOD Parents of children ages 6-17 (N = 437) completed a survey about their child's eating behavior, including the Nine-item ARFID Screen (NIAS) and questions about PE onset and impacts. Children were then categorized into groups based on PE onset (before or after age 5) and duration: never picky, normative picky, persistent picky, and late-onset picky. RESULTS The groups differed (all p < .05) in mean NIAS subscales (picky eating, NIAS-PE; appetite, NIAS-A; fear, NIAS-F) and total scores (NIAS-T). Tukey post-hoc tests found that persistent PEs had significantly higher NIAS-PE, NIAS-A, and NIAS-T scores than never or normative PEs (all p < .05). Chi-Square tests found that persistent PEs were significantly more likely than all other groups to endorse ARFID criteria. CONCLUSION Findings from this study suggest that PE that persists beyond or is identified after the normative period is associated with elevated ARFID symptoms compared to normative and never PEs. Persistent PE increases risk of impairment from PE and other ARFID eating restrictions. Given the health and psychosocial risks associated with ARFID, early identification and intervention for this group is warranted.
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Affiliation(s)
- Courtney E Breiner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Megan M Knedgen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, PA, USA
| | - Kaitlin B Proctor
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Hana F Zickgraf
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA; Rogers Behavioral Health, Oconomowoc, WI, USA
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Ban KF, Hazzard VM, Zickgraf HF, O'Connor SM. Examining measurement invariance of appetitive trait and ARFID symptom measures by food security status. Appetite 2024; 197:107304. [PMID: 38467192 PMCID: PMC11089937 DOI: 10.1016/j.appet.2024.107304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Measures assessing appetitive traits (i.e., individual differences in the desire to consume food) and disordered eating have generally been developed in predominantly food-secure populations. The current study aims to test measurement invariance (MI) for a measure of appetitive traits and a measure of Avoidant Restrictive Food Intake Disorder (ARFID) symptomology across food security status. METHOD Data from a sample of mothers (n = 634) and two undergraduate samples (n = 945 and n = 442) were used to assess MI for the Adult Eating Behavior Questionnaire (AEBQ), which measures appetitive traits, and the Nine Item ARFID Screen (NIAS), which measures ARFID symptomology. Current food security was assessed using the 18-item USDA Household Food Security Survey Module, which was dichotomized into two groups: 1) the 'food insecure' group included marginal, low, and very low food security and 2) the 'food secure' group included high food security. Overall and multi-group confirmatory factor analyses were conducted separately for each measure in each sample. RESULTS Results demonstrated scalar (i.e., strong) MI for both measures across samples, indicating that these measures performed equivalently across food-secure and food-insecure individuals. CONCLUSION Findings suggest that differences in appetitive traits by food security status observed in prior research are not artifacts of measurement differences, but instead reflect true differences. Additionally, past mixed results regarding the relationship between food insecurity (FI) and ARFID symptomology are not likely driven by measurement error when using the NIAS.
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Affiliation(s)
- Kaoon Francois Ban
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - Vivienne M Hazzard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hana F Zickgraf
- Department of Psychology, University of South Alabama, Mobile, AL, USA; Research Center, Rogers Behavioral Health, Oconomowoc, WI, USA
| | - Shannon M O'Connor
- Department of Psychology, Montclair State University, Montclair, NJ, USA.
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Grassi G, Pampaloni I. Gut Microbiota and Gastrointestinal Symptoms in the Global Assessment of Obsessive-Compulsive Disorder: A Narrative Review of Current Evidence and Practical Implications. Brain Sci 2024; 14:539. [PMID: 38928539 PMCID: PMC11201482 DOI: 10.3390/brainsci14060539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
A growing body of literature suggests a link between bowel syndromes (e.g., irritable bowel syndrome and inflammatory bowel disease), gut microbiome alterations, and psychiatric disorders. This narrative review aims to explore the potential role of the gut microbiome in the pathogenesis and clinical presentation of obsessive-compulsive disorder (OCD) and to explore whether there is sufficient evidence to warrant considering gastrointestinal symptoms and their implication for the gut microbiome during the assessment and treatment of OCD. For this purpose, a PubMed search of studies focusing on OCD, gut microbiota, irritable bowel syndrome, and inflammatory bowel disease was conducted by two independent reviewers. While the current literature on gut microbiome and gastrointestinal issues in OCD remains limited, emerging evidence suggests gut microbiome alterations and high rates of bowel syndromes in this population. These findings emphasize the importance of incorporating comprehensive gastrointestinal assessments into the "global assessment of OCD". Such assessment should encompass various factors, including gastrointestinal physical comorbidities and symptoms, nutritional habits, bowel habits, fluid intake, exercise patterns, and potential microbiome dysfunctions and inflammation. Considering the treatment implications, interventions targeting gut health, such as probiotics and dietary modifications, may hold promise in improving symptoms in OCD patients with comorbid gastrointestinal problems. Further research in this area is warranted to better understand the interplay between gut health and OCD and to explore the effectiveness of targeted interventions in improving clinical outcomes.
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Affiliation(s)
| | - Ilenia Pampaloni
- National OCD and BDD Unit, South West London and St Georges NHS Trust, London SW17 7DJ, UK;
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Kaul I, Burton-Murray H, Musaad S, Mirabile Y, Czyzewski D, van Tilburg MAL, Sher AC, Chumpitazi BP, Shulman RJ. Avoidant/restrictive food intake disorder prevalence is high in children with gastroparesis and functional dyspepsia. Neurogastroenterol Motil 2024; 36:e14777. [PMID: 38454301 PMCID: PMC11149999 DOI: 10.1111/nmo.14777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) prevalence in children with gastroparesis (Gp) and/or functional dyspepsia (FD) is unknown. We aimed to identify ARFID prevalence and trajectory over 2 months in children with Gp, FD, and healthy children (HC) using two screening questionnaires. We also explored the frequency of a positive ARFID screen between those with/without delayed gastric emptying or abnormal fundic accommodation. METHODS In this prospective longitudinal study conducted at an urban tertiary care hospital, patients ages 10-17 years with Gp or FD and age- and gender-matched HC completed two validated ARFID screening tools at baseline and 2-month follow-up: the Nine Item ARFID Screen (NIAS) and the Pica, ARFID, and Rumination Disorder Interview-ARFID Questionnaire (PARDI-AR-Q). Gastric retention and fundic accommodation (for Gp and FD) were determined from gastric emptying scintigraphy. KEY RESULTS At baseline, the proportion of children screening positive for ARFID on the NIAS versus PARDI-AR-Q was Gp: 48.5% versus 63.6%, FD: 66.7% versus 65.2%, HC: 15.3% versus 9.7%, respectively; p < 0.0001 across groups. Of children who screened positive at baseline and participated in the follow-up, 71.9% and 53.3% were positive 2 months later (NIAS versus PARDI-AR-Q, respectively). A positive ARFID screen in Gp or FD was not related to the presence/absence of delayed gastric retention or abnormal fundic accommodation. CONCLUSIONS & INFERENCES ARFID detected from screening questionnaires is highly prevalent among children with Gp and FD and persists for at least 2 months in a substantial proportion of children. Children with these disorders should be screened for ARFID.
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Affiliation(s)
- Isha Kaul
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- USDA/ARS Children's Nutrition Research Center, Houston, Texas, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Helen Burton-Murray
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Salma Musaad
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- USDA/ARS Children's Nutrition Research Center, Houston, Texas, USA
| | - Yiming Mirabile
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- USDA/ARS Children's Nutrition Research Center, Houston, Texas, USA
| | - Danita Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Miranda A L van Tilburg
- Cape Fear Valley Health, Fayetteville, North Carolina, USA
- University of North Carolina, Chapel Hill, North Carolina, USA
- University of Washington, Seattle, Washington, USA
- Marshall University, Huntington, West Virginia, USA
- Campbell University, Lillington, North Carolina, USA
| | - Andrew C Sher
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Bruno P Chumpitazi
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert J Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- USDA/ARS Children's Nutrition Research Center, Houston, Texas, USA
- Texas Children's Hospital, Houston, Texas, USA
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Chaaya R, Hallit R, Malaeb D, Sakr F, Dabbous M, El Khatib S, Fekih-Romdhane F, Hallit S, Obeid S. Moderating effect of self-esteem between perfectionism and avoidant restrictive food intake disorder among Lebanese adults. BMC Psychiatry 2024; 24:325. [PMID: 38671387 PMCID: PMC11055237 DOI: 10.1186/s12888-024-05762-8] [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: 09/18/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis added to the DSM-5 characterized by pathological eating habits without body image disturbances. Previous findings demonstrated a general association between high levels of perfectionism and low levels of self-esteem in association with general eating disorders. However, research is scant when it comes to ARFID specifically. Subsequently, although self-esteem is seen to moderate the association between perfectionism and general eating disorders, this research study aims to explore the same moderation but with ARFID specifically. METHODS For this study, 515 Lebanese adults from the general Lebanese population were recruited from all over Lebanon, 60.1% of which were females. The Arabic version of the Big Three Perfectionism Scale- Short Form (BTPS-SF) was used to measure self-critical, rigid and narcissistic perfectionism; the Avoidant/Restrictive Food Intake Disorder screen (NIAS) was used to score the ARFID variable; the Arabic-Single Item Self-Esteem (A-SISE) was the scale used to measure self-esteem. RESULTS Across the different perfectionism types, self-esteem was seen to moderate the association between narcissistic perfectionism and ARFID (Beta = - 0.22; p =.006). At low (Beta = 0.77; p <.001), moderate (Beta = 0.56; p <.001) and high (Beta = 0.36; p =.001) levels of self-esteem, higher narcissistic perfectionism was significantly associated with higher ARFID scores. CONCLUSION This study brought to light some crucial clinical implications that highlight the need for interventions that help in the enhancement of self-esteem in patients with high perfectionism and ARFID. This study suggests that clinicians and healthcare professionals should focus more on risk factors influencing the development and maintenance of ARFID-like symptoms.
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Affiliation(s)
- Roni Chaaya
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, 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
- 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
| | - Sami El Khatib
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology (GUST), Hawally, Kuwait
| | - 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
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon.
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Öğütlü H, Kaşak M, Doğan U, Zickgraf HF, Türkçapar MH. Psychometric properties of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in Turkish children. J Eat Disord 2024; 12:30. [PMID: 38374128 PMCID: PMC10875749 DOI: 10.1186/s40337-024-00987-0] [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: 09/28/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The nine item avoidant/restrictive food intake disorder screen (NIAS) is a short and practical assessment tool specific to ARFID with three ARFID phenotypes such as "Picky eating," "Fear," and "Appetite". This study aimed to evaluate the psychometric properties of the Turkish translation of the NIAS parent form and to investigate the relationship between ARFID symptoms and anxiety, depression symptoms, and eating behaviors in a sample of Turkish children. METHOD Parents were asked to provide their children's sociodemographic data and to complete the NIAS, Eating Disorder Examination Questionnaire-Short (EDE-QS), Children's Eating Behavior Questionnaire (CEBQ), and Revised Child Anxiety and Depression Scale (RCADS) scales. RESULTS The sample included 440 participants between 6 and 12 ages. Turkish NIAS demonstrated good internal consistency. The three-factor model of the Turkish NIAS was in an acceptable structure. The Turkish NIAS scale was shown to be valid and reliable. NIAS scores were shown to be higher in underweight participants. The NIAS-parent version subscales showed expected convergent and divergent validity with the CEBQ, EDEQ-S, and RCADS scales in children, except CEBQ emotional overeating and desire to drink subscales were correlated with NIAS. CONCLUSION The Turkish version of the NIAS is valid and reliable in evaluating ARFID symptoms in children.
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Affiliation(s)
- Hakan Öğütlü
- Department of Child and Adolescent Psychiatry, Cognitive Behavioral Psychotherapies Association, Karum Is Merkezi Iran Caddesi No: 21 Gaziosmanpasa Mah., 06680, Cankaya, Ankara, Turkey.
| | - Meryem Kaşak
- Department of Child and Adolescent Psychiatry, Ankara City Hospital, Ankara, Turkey
| | - Uğur Doğan
- Departman of Guidance and Counseling, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Hana F Zickgraf
- Department of Psychology, University of South Alabama, Mobile, AL, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
- Rogers Behavioral Health, Oconomowoc, WI, USA
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Hollis E, Murray HB, Parkman HP. Relationships among symptoms of gastroparesis to those of avoidant/restrictive food intake disorder in patients with gastroparesis. Neurogastroenterol Motil 2024; 36:e14725. [PMID: 38062502 PMCID: PMC10842788 DOI: 10.1111/nmo.14725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Patients with symptoms of gastroparesis (Gp) often reduce food intake in attempt to manage their symptoms. Up to 40% of adults with Gp have been reported to have symptoms of a non-body image-based eating disorder, avoidant/restrictive food intake disorder (ARFID). However, whether ARFID symptoms precede or follow the diagnosis of Gp is unknown. METHODS From January 2021 to January 2022, consecutive adult patients with Gp at an academic center completed self-report surveys for Gp symptom severity (patient assessment of upper gastrointestinal symptoms; PAGI-SYM) and for ARFID (nine-item ARFID screen; NIAS). KEY RESULTS One hundred and seven patients (age 45.4 ± 17.2 yrs, 84.1% female, BMI 26.4 ± 7.3) with Gp (4-h gastric retention 33.5 ± 21.8%) were included. Eighty-two of the 107 Gp patients (77%) screened positive for ARFID. Positive ARFID screen was most often on the NIAS appetite subscale (84%) and fear subscale (76%), with a lower positive screen rate on the picky subscale (45%). Of the Gp who screened positive for ARFID, 38% reported that eating difficulties came after their Gp diagnosis, whereas 17% reported that eating difficulties preceded their Gp diagnosis, and 15% reported that both began at the same time. CONCLUSIONS Many (77%) patients with Gp screened positive for ARFID. In Gp patients with ARFID, the Gp diagnosis was more likely to precede the development of eating difficulties. Thus, a subset of patients with Gp may be at risk for developing ARFID. Further longitudinal research is needed to confirm findings and identify risk factors.
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Affiliation(s)
| | - Helen Burton Murray
- Department of Psychiatry, Eating Disorders Clinical Research Program, Massachusetts General Hospital, Boston, MA
| | - Henry P. Parkman
- Gastroenterology Division, Temple University Hospital, Philadelphia, PA
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Kamei M, Nishibe M, Araki R, Kohyama K, Kusakabe Y. Effect of texture preference on food texture perception: Exploring the role of matching food texture and preference. Appetite 2024; 192:107078. [PMID: 37898406 DOI: 10.1016/j.appet.2023.107078] [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: 08/02/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023]
Abstract
This study aimed to investigate the influence of smooth texture preference on smoothness perception. An online questionnaire (Study 1, n = 464) and a sensory evaluation test (Study 2, n = 65) were administered to Japanese elderly participants (65-74 years), with common Japanese confectionery (Daifuku) as test foods. Through the online questionnaire, four distinct texture preference groups were formed based on the factors of preference for smoothness and firmness of the inner bean paste layer. Analysis of the food preference scale for imbalanced diet (FPSID) revealed that smooth-texture likers were more likely to be picky eaters than firm-texture likers. Furthermore, high (HiSm) and low smoothness preference groups (LoSm) were selected for the food sensory evaluation test to compare perceived textures (smoothness and firmness). Only the HiSm group exhibited a positive association between perceived smoothness and overall texture liking, perceiving smoothness significantly more intense than the LoSm group in situations where overall texture liking was high. This finding indicates that smooth texture preference does not act independently but rather interacts with food texture matching to affect perception. Our findings suggest that when food texture aligns with individuals' preferences, it elicits hedonic emotions and dynamically enhances food texture perception. This preference-involved perceptual process may contribute to the development of more explicit texture preferences.
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Affiliation(s)
- Mio Kamei
- Food Research Institute, National Agricultural and Food Research Organization, Japan.
| | - Misaki Nishibe
- Food Research Institute, National Agricultural and Food Research Organization, Japan
| | - Risa Araki
- Food Research Institute, National Agricultural and Food Research Organization, Japan
| | - Kaoru Kohyama
- Food Research Institute, National Agricultural and Food Research Organization, Japan
| | - Yuko Kusakabe
- Food Research Institute, National Agricultural and Food Research Organization, Japan
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D'Adamo L, Smolar L, Balantekin KN, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: a cross-sectional study. J Eat Disord 2023; 11:214. [PMID: 38049869 PMCID: PMC10694964 DOI: 10.1186/s40337-023-00939-0] [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: 05/31/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen. METHODS Among 50,082 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined. RESULTS 2378 (4.7%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than most other diagnoses and higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%). CONCLUSIONS Findings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders, at risk for an eating disorder, or at low risk. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.
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Affiliation(s)
- Laura D'Adamo
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, NY, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA
- Center for m2Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA, 94022, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
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Vanzhula IA, Wang E, Martinelli MK, Schreyer C, Guarda AS. Inpatient hospital course and self-reported symptomatology in underweight adults with ARFID compared to age- and sex-matched controls with anorexia nervosa. J Eat Disord 2023; 11:206. [PMID: 37986115 PMCID: PMC10658840 DOI: 10.1186/s40337-023-00912-x] [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: 05/26/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE Avoidant restrictive food intake disorder (ARFID) has similar prevalence to anorexia nervosa (AN) in adults, but research in this population is lacking. Although inpatient or residential treatment involving nutritional rehabilitation is increasingly recommended for malnourished individuals with ARFID, best practices remain poorly defined. Existing studies on self-reported symptomatology and treatment course and outcome are primarily in child and adolescent cohorts and demonstrate inconsistent findings. This study aimed to compare hospital course and self-reported symptomatology of underweight adult inpatients with ARFID and sex- and age-matched patients with AN. METHOD Underweight adult patients with ARFID or AN admitted to a specialized, hospital-based behavioral treatment program completed measures of body dissatisfaction, drive for thinness, bulimic symptoms, anxiety, depression, and personality traits. Demographic and treatment course data were abstracted from electronic medical records. Patients with ARFID (n = 69) were matched to those with AN (n = 69) based on sex and age. RESULTS Adults with ARFID were closer to target weight at admission, but gained weight at a slower rate, were discharged at lower BMI, and were less likely to reach target weight by discharge than adults with AN. Patients with ARFID reported less weight and shape-related eating disorder, state anxiety, and depression symptoms and lower neuroticism. DISCUSSION Adults with ARFID progress through treatment more slowly and achieve less favorable weight outcomes by hospital discharge than patients with AN, but long-term outcomes are unclear. Describing clinical presentations and course of illness of adult ARFID may help inform treatment protocols.
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Affiliation(s)
- Irina A Vanzhula
- Johns Hopkins University School of Medicine, Meyer 101, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Erin Wang
- Johns Hopkins University School of Medicine, Meyer 101, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Mary K Martinelli
- Johns Hopkins University School of Medicine, Meyer 101, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Colleen Schreyer
- Johns Hopkins University School of Medicine, Meyer 101, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Angela S Guarda
- Johns Hopkins University School of Medicine, Meyer 101, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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12
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Barnhart WR, Dial LA, Jordan AK, Studer-Perez EI, Kalantzis MA, Musher-Eizenman DR. Higher meal disengagement and meal presentation are uniquely related to psychological distress and lower quality of life in undergraduate students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37713319 DOI: 10.1080/07448481.2023.2245912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/13/2023] [Accepted: 07/28/2023] [Indexed: 09/17/2023]
Abstract
Objective: Picky eating, which occurs in emerging adulthood and is associated with psychological distress and quality of life, has historically been conceptualized as unidimensional despite research suggesting it is a multifaceted construct. Participants: An undergraduate sample (N = 509; Mage = 19.96). Methods: A cross-sectional survey assessed picky eating facets (food variety, meal disengagement, meal presentation, and taste aversion), disordered eating, anxiety, depression, stress, obsessive compulsive disorder (OCD), and social phobia symptoms, and quality of life. Results: Meal disengagement was uniquely related to higher anxiety, depression, stress, and social phobia symptoms and lower quality of life, whereas meal presentation was uniquely related to higher anxiety, stress, and OCD symptoms, beyond covariates and disordered eating. Food variety and taste aversion were not uniquely related to outcomes. Conclusions: Considering picky eating multidimensionally may yield important insights beyond the broader construct in terms of its relationship with psychological well-being in undergraduates.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Lauren A Dial
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Amy K Jordan
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Emma I Studer-Perez
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Maria A Kalantzis
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
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13
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Wirth JM. Evaluation and management of avoidant/restrictive food intake disorder. JAAPA 2023; 36:1-5. [PMID: 37668492 DOI: 10.1097/01.jaa.0000947112.60744.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
ABSTRACT Avoidant/restrictive food intake disorder (ARFID) is an uncommon but complex eating disorder characterized by extreme picky eating without poor body image or fear of weight gain. Intake is limited by volume or variety of food, driven by fear of adverse consequences associated with ingestion, sensory sensitivities to food properties, or a lack of interest in eating. Avoidance or restriction of food intake can lead to low body weight or failure to thrive, nutritional deficiencies, reliance on enteral feeding, and psychosocial impairment. The presentation of ARFID varies depending on severity, variety, and volume of diet; therefore, medical evaluation should be comprehensive, should be tailored to patient needs, and should include screening for commonly co-occurring psychiatric conditions. Cognitive behavioral therapy and/or family-based therapy, in conjunction with pharmacotherapy and/or hospital refeeding, have demonstrated therapeutic benefit. Available literature is sparse and largely limited to children and adolescents. Additional studies are needed to evaluate therapeutic interventions, medical follow-up, and prognosis.
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Affiliation(s)
- Jessica M Wirth
- Jessica M. Wirth is an urgent care and occupational medicine PA and former assistant professor of PA studies at Dominican University of California in San Rafael, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise
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He J, Zhang X, Barnhart WR, Cui S, Liu Y, Zhao Y, Yin J, Tan C. Picky eating is associated with lower life satisfaction and elevated psychological distress and psychosocial impairment in Chinese pregnant women. Int J Eat Disord 2023; 56:1807-1813. [PMID: 37196058 DOI: 10.1002/eat.23993] [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: 01/05/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE This study assessed picky eating in pregnant women by exploring whether picky eating is associated with pregnant women's well-being, including life satisfaction, psychological distress, and psychosocial impairment. METHOD Data collected were from 345 Chinese pregnant women (M age = 29.95 years, SD = 5.58). Pearson correlation analyses were conducted to examine zero-order correlations between picky eating and well-being variables (i.e., life satisfaction, psychological distress, and psychosocial impairment). Hierarchical multiple regressions were conducted to examine the unique associations of picky eating with well-being variables, adjusting for demographic and pregnancy-related characteristics and thinness-oriented disordered eating. RESULTS Picky eating was significantly and negatively correlated with life satisfaction (r = -.24, p < .001) and positively correlated with psychological distress (r = .37, p < .001) and psychosocial impairment (r = .50, p < .001). When adjusting for covariates and thinness-oriented disordered eating, picky eating was still significantly associated with lower life satisfaction, higher psychological distress, and higher psychosocial impairment. DISCUSSION The findings suggest that picky eating may be a significant correlate of pregnant women's poorer well-being. Future research with longitudinal designs is warranted to further examine the temporal associations between picky eating and pregnant women's well-being. PUBLIC SIGNIFICANCE Picky eating behaviors are poorly understood in pregnant women. Our results revealed that higher picky eating behaviors were associated with lower life satisfaction and higher psychological distress and psychosocial impairment in Chinese pregnant women. Researchers and clinicians may consider picky eating in the assessment and treatment of mental health and disordered eating in pregnant women.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Xinyi Zhang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
- Teachers College, Columbia University, New York, New York, USA
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Yutian Liu
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Yumeng Zhao
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Junyu Yin
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Chuyi Tan
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
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15
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D'Adamo L, Smolar L, Balantekin K, Taylor CB, Wilfley D, Fitzsimmons-Craft E. Prevalence, Characteristics, and Correlates of Avoidant/Restrictive Food Intake Disorder among Adult Respondents to the National Eating Disorders Association Online Screen: A Cross-Sectional Study. RESEARCH SQUARE 2023:rs.3.rs-3007049. [PMID: 37333103 PMCID: PMC10274940 DOI: 10.21203/rs.3.rs-3007049/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Avoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association (NEDA) online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen compared to other probable eating disorder/risk categories. Methods Among 47,705 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined. Results 2,378 (5.0%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than all other diagnoses but higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%). Conclusions Findings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders or at risk for an eating disorder. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.
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16
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Nagao-Sato S, Kawasaki Y, Akamatsu R, Fujiwara Y, Omori M, Sugawara M, Yamazaki Y, Matsumoto S, Iwakabe S. Sensory profile of picky eaters among college female students. Appetite 2023; 185:106518. [PMID: 36863532 DOI: 10.1016/j.appet.2023.106518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023]
Abstract
Picky eaters are at risk of an unbalanced diet, which is critical for women of reproductive age. A sensory profile, which is a potential factor in picky eating, has not been well researched. This study assessed the differences in sensory profile and dietary intake according to the picky eating status among female Japanese undergraduate college students. Cross-sectional data were obtained from the Ochanomizu Health Study conducted in 2018. The questionnaire included items regarding demographic characteristics, picky eating status, sensory profile, and dietary intake. Sensory profile was assessed using the Adult/Adolescent Sensory Profile questionnaire, and dietary intakes were calculated using a brief-type self-administered diet history questionnaire. Among the 111 participants, 23% were picky eaters and 77% were non-picky eaters. The age, body mass index and household status did not differ between the picky eaters and non-picky eaters. Being a picky eater was associated with higher scores on sensory sensitivity and sensation avoiding, and lower thresholds for taste and smell, touch, and auditory stimuli than being a non-picky eater. Of the picky eaters, 58% and 100% were at a high risk for folate and iron deficiencies, respectively, compared to 35% and 81% of non-picky eaters. Nutrition education for picky eaters in reproductive age to increase vegetable dishes comfortably in their diet is suggested to prevent anemia during their future pregnancy.
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Affiliation(s)
- Sayaka Nagao-Sato
- Graduate School of Humanities and Sciences, Ochanomizu University, 2-1-1, Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan.
| | - Yui Kawasaki
- Institute for SDGs Promotion, Organization for Social Implementation of Sustainability, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan.
| | - Rie Akamatsu
- Natural Science Division, Faculty of Core Research, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan; Institute for Human Life Science, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan.
| | - Yoko Fujiwara
- Natural Science Division, Faculty of Core Research, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan; Institute for Human Life Science, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan.
| | - Mika Omori
- Human Science Division, Faculty of Core Research, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan; Institute for Education and Human Development, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan; Department of Psychology, Tohoku University, Aoba, Kawauchi 27-1, Sendai, 980-8576, Japan.
| | - Masumi Sugawara
- Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, 1-25, Midorigaoka, Chofu, Tokyo, 182-8525, Japan.
| | - Yoko Yamazaki
- Department of Social Education and Welfare, Tokyo Kasei University, 1-18-1, Kaga, Itabashi-ku, Tokyo, 173-8602, Japan.
| | - Satoko Matsumoto
- Institute for Education and Human Development, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan.
| | - Shigeru Iwakabe
- College of Comprehensive Psychology, Ritsumeikan University, 2-150, Iwakura-tyo, Ibaraki-shi, Osaka, 567-8570, Japan.
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17
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Fox G, Coulthard H, Williamson I, Aldridge V. How multiple threats to safety affects quality of life for picky eating adults: A new explanatory model. Appetite 2023; 181:106396. [PMID: 36436724 DOI: 10.1016/j.appet.2022.106396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022]
Abstract
Picky eating describes a pattern of eating characterised by a narrow dietary range with rejection of both novel and familiar foods. Research has suggested that picky eating in adulthood is associated with several negative psychosocial outcomes including impaired quality of life. This research aimed to build and test a model explaining the relationship between picky eating and quality of life. 230 participants were recruited via online support forums for picky eating, and an undergraduate research participation scheme. Participants completed self-report measures of picky eating, sensory sensitivity, disgust, anxiety, fear of negative evaluation and eating related quality of life. Regression analysis indicated that picky eating, disgust sensitivity, anxiety, and fear of negative evaluation were all associated with impaired eating-related quality of life. A theoretical model was then devised which aimed to explain the interactions between these factors, and Path Analysis indicated that this model was a good fit for the data. This Safety in Picky Eating and Quality of life (SPEQ) model suggests that threat perception and the drive for safety underlies the relationship between picky eating and impaired quality of life. The SPEQ model provides a preliminary basis for understanding how picky eating impacts quality of life in adulthood.
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Affiliation(s)
- Gemma Fox
- Division of Psychology, Faculty of Health & Life Sciences, Hawthorn Building, De Montfort University, Leicester, LE1 9BH, UK.
| | - Helen Coulthard
- Division of Psychology, Faculty of Health & Life Sciences, Hawthorn Building, De Montfort University, Leicester, LE1 9BH, UK
| | - Iain Williamson
- Division of Psychology, Faculty of Health & Life Sciences, Hawthorn Building, De Montfort University, Leicester, LE1 9BH, UK
| | - Victoria Aldridge
- Division of Psychology, Faculty of Health & Life Sciences, Hawthorn Building, De Montfort University, Leicester, LE1 9BH, UK
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18
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Nitsch A, Watters A, Manwaring J, Bauschka M, Hebert M, Mehler PS. Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study. Int J Eat Disord 2023; 56:978-990. [PMID: 36695305 DOI: 10.1002/eat.23897] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study is to describe the clinical features of adult patients with avoidant/restrictive food intake disorder (ARFID) to better understand the medical findings, psychological comorbidities, and laboratory abnormalities in this population. METHOD We completed a retrospective chart review of all adult patients with a diagnosis of ARFID, admitted for medical stabilization, between April 2016 and June 2021, to an inpatient hospital unit, which specializes in severe eating disorders. Information collected included anthropomorphic data, laboratory assessments, and medical history at time of admission. RESULTS One hundred and twenty-two adult patients with ARFID were identified as meeting inclusion criteria for the study. The most common ARFID presentation was "fear of adverse consequences." The majority were female (70%), with an average age of 32.7 ± 13.7 years and mean percent of ideal body weight (m%IBW) of 68.2 ± 10.9. The most common laboratory abnormalities were low serum prealbumin and vitamin D, hypokalemia, leukopenia, and elevated serum bicarbonate. The most common psychiatric diagnoses were anxiety and depressive disorders, and the most common medical diagnoses were disorders of gut-brain interaction (DGBI). DISCUSSION This is the largest study to the authors' knowledge of medical presentations in adult patients with ARFID. Our results reflect that the adult patient with ARFID may, in some aspects, present differently than pediatric and adolescent patients with ARFID, or from ARFID patients requiring less intensive care. This study highlights the need for further investigation of adult patients with ARFID. PUBLIC SIGNIFICANCE ARFID is a restrictive eating disorder first defined in 2013. This study explores the medical presentations of adult patients (>18 years old) with ARFID presenting for specialized eating disorder treatment and identifies unique features of the adult presentation for treatment, compared to pediatric and adolescent peers.
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Affiliation(s)
- Allison Nitsch
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jamie Manwaring
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Melanie Hebert
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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19
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Robison M, Rogers ML, Robertson L, Duffy ME, Manwaring J, Riddle M, Rienecke RD, Le Grange D, Duffy A, Plotkin M, Blalock DV, Mehler PS, Joiner TE. Avoidant restrictive food intake disorder and suicidal ideation. Psychiatry Res 2022; 317:114925. [PMID: 37732866 DOI: 10.1016/j.psychres.2022.114925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022]
Abstract
Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.
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Affiliation(s)
- Morgan Robison
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Jamie Manwaring
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Megan Riddle
- ACUTE at Denver Health, Denver, CO, USA; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL (Emeritus), USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Philip S Mehler
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Internal Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
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20
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How Colour Influences Taste Perception in Adult Picky Eaters. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Menghi L, Endrizzi I, Cliceri D, Zampini M, Giacalone D, Gasperi F. Validating the Italian version of the Adult Picky Eating Questionnaire. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Body Dissatisfaction, Eating Styles, Weight-Related Behaviors, and Health among Young Women in the United States. Nutrients 2022; 14:nu14183876. [PMID: 36145252 PMCID: PMC9505776 DOI: 10.3390/nu14183876] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Body dissatisfaction is a common condition that poses health behavior risks, such as the use of maladaptive eating styles instead of adaptive eating styles. Few studies have simultaneously examined both adaptive and maladaptive eating styles and their association with body dissatisfaction in a comprehensive manner. To address this gap, this study examined how body dissatisfaction is related to an array of adaptive and maladaptive eating styles, weight-related behaviors, and health status as well as the associations of health status, BMI, and weight-related behaviors with body dissatisfaction in 261 young adult women. Maladaptive eating styles, such as emotional eating, tended to rise in tandem with body dissatisfaction, differing significantly among body-dissatisfaction levels with medium to large effect sizes. For adaptive eating styles, as body dissatisfaction increased, compensatory restraint increased, intuitive eating declined, and mindful eating did not differ. Weight-related dietary, physical activity, and sleep behaviors did not differ by body dissatisfaction level. BMI increased and health status decreased as body dissatisfaction increased. Binary logistic regression revealed those who were body-dissatisfied had significantly lower health status, higher BMIs, and did not differ on weight-related behaviors. Study findings suggest strategies to improve health-promotion interventions aiming to increase body satisfaction.
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The Polish Version of the Avoidant/Restrictive Food Intake Disorder Questionnaire—Parents Report (ARFID-Q-PR) and the Nine Items Avoidant/Restrictive Food Intake Disorder Screen—Parents Report (NIAS-PR): Maternal Perspective. Nutrients 2022; 14:nu14153175. [PMID: 35956354 PMCID: PMC9370130 DOI: 10.3390/nu14153175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
The aim of the present study was to develop and validate the Avoidant/Restrictive Food Intake Disorder Questionnaire—Parents Report (ARFID-Q-PR), a new tool to diagnose ARFID, based on a report submitted by Polish mothers of children aged 2 to 10 years. In total, 167 mothers of boys and girls aged 2 to 10 participated in the study. We used the ARFID-Q-PR and the Nine Items Avoidant/Restrictive Food Intake Disorder Screen—Parents Report (NIAS-PR). In addition, all mothers were asked to provide information on age, sex, height and weight, chronic somatic diseases, neurodevelopmental and mental disorders as well as intellectual disability of their children. Results of the reliability analysis demonstrated that the ARFID-Q-PR had adequate internal consistency (Cronbach’s alpha of 0.84). The stability of the ARFID-Q-PR factorial structure was confirmed. It is composed of three subscales: (1) attitudes to food; (2) justification for restrictions; (3) somatic symptoms. Our findings demonstrated that the ARFID-Q-PR total score was positively associated with the NIAS-PR total score. In addition, children with developmental and mental disorders substantially demonstrated more ARFID symptoms than did the children in the general population. The Polish version ARFID-Q-PR can be used to recognize the ARFID symptoms in young children by the main feeder in the family—mother or father.
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Coulthard H, Abdullahi N, Bell K, Noon E. Understanding disgust-based food rejection in picky and non-picky eaters: Willingness to touch and taste familiar foods with changes. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2021.104442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Brown TA, Menzel JE, Reilly EE, Luo T, Zickgraf H. Exploring the role of disgust sensitivity and propensity in selective eating. Appetite 2022; 174:106018. [PMID: 35364112 DOI: 10.1016/j.appet.2022.106018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/15/2022] [Accepted: 03/22/2022] [Indexed: 11/02/2022]
Abstract
While disgust is a clinically and theoretically relevant construct for selective eating, limited research has examined how different aspects of disgust relate to selective eating severity in adults. Thus, the present study sought to 1) compare disgust propensity (how easily people are disgusted) and disgust sensitivity (how unpleasant disgust is) across a spectrum of selective eaters, 2) explore the specificity of the associations between disgust sensitivity/propensity and selective eating across selective eating and related phenotypes, and 3) explore whether the relationship between selective eating and disgust is food-specific. Participants were 554 adults recruited on Amazon's Mechanical Turk who completed cross-sectional surveys on study constructs. The sample was recruited to over-represent individuals with high levels of selective eating. Results support that disgust propensity, but not sensitivity, was elevated in the impaired selective eating group compared to non-impaired selective eaters and non-selective eaters. Only the selective eating phenotype was independently associated with both disgust sensitivity and propensity. Correlation results supported that the associations between selective eating and disgust were specific to the disgust elicited by food (i.e., animal protein, fruits, vegetables). Overall, results support that disgust propensity and disgust sensitivity play a role in selective eating. Results imply that disgust sensitivity associated with selective eating appears limited to the food domain and may be more specific to disgust eliciting food itself, rather than signs of food contamination or spoilage.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychological Sciences, 226 Thach Hall, Auburn University, AL, 36849, USA; Department of Psychiatry, 4510 Executive Drive, Suite 330, San Diego, CA, 92121, USA.
| | - Jessie E Menzel
- Department of Psychiatry, 4510 Executive Drive, Suite 330, San Diego, CA, 92121, USA.
| | - Erin E Reilly
- Department of Psychology, 210 Hauser Hall, Hofstra University, Hempstead, NY, 11549, USA.
| | | | - Hana Zickgraf
- Department of Psychology, 75 South University Blvd., University of South Alabama, Mobile, AL, 36688, USA.
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26
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Kim YK, Di Martino JM, Nicholas J, Rivera-Cancel A, Wildes JE, Marcus MD, Sapiro G, Zucker N. Parent strategies for expanding food variety: Reflections of 19,239 adults with symptoms of Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2022; 55:108-119. [PMID: 34761436 PMCID: PMC8841112 DOI: 10.1002/eat.23639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize helpful parent feeding strategies using reflections on childhood eating experiences of adults with symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID). METHOD We explored a unique text-based dataset gathered from a population of N = 19,239 self-identified adult "picky eaters." The sample included adults with symptoms of ARFID as evidenced by marked interference in psychosocial functioning, weight loss/sustained low weight, and/or nutritional deficiency (likely ARFID), and non-ARFID participants. We leveraged state-of-the-art natural language processing (NLP) methods to classify feeding strategies that were perceived as helpful or not helpful. The best classifiers that distinguished helpful approaches were further analyzed using qualitative coding according to a grounded theory approach. RESULTS NLP reliably and accurately classified the perceived helpfulness of caregivers' feeding strategies (82%) and provided information about features of helpful parent strategies using recollections of adults with varying degrees of food avoidance. Strategies perceived as forceful were regarded as not helpful. Positive and encouraging strategies were perceived as helpful in improving attitudes toward food and minimizing social discomfort around eating. Although food variety improved, adults still struggled with a degree of avoidance/restriction. DISCUSSION Adults perceived that positive parent feeding strategies were helpful even though they continued to experience some degree of food avoidance. Creating a positive emotional context surrounding food and eating with others may help to eliminate psychosocial impairment and increase food approach in those with severe food avoidance. Nevertheless, additional tools to optimize parent strategies and improve individuals' capacity to incorporate avoided foods and cope with challenging eating situations are needed.
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Affiliation(s)
| | | | - Julia Nicholas
- Psychiatry and Behavioral Sciences, Duke University, USA
| | | | | | | | - Guillermo Sapiro
- Electrical and Computer Engineering, Duke University, USA,Computer Sciences, Duke University, USA,Biomedical Engineering, Duke University, USA,Mathematics, Duke University, USA
| | - Nancy Zucker
- Psychiatry and Behavioral Sciences, Duke University, USA,Psychology and Neuroscience, Duke University, USA
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27
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Zickgraf HF, Loftus P, Gibbons B, Cohen LC, Hunt MG. "If I could survive without eating, it would be a huge relief": Development and initial validation of the Fear of Food Questionnaire. Appetite 2021; 169:105808. [PMID: 34798226 DOI: 10.1016/j.appet.2021.105808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fear of food and behavioral avoidance of specific foods, food groups, and food related social situations can substantially reduce health related quality of life in individuals with a wide range of conditions that affect appetite, eating behavior, and digestion, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), vomit and choking phobias, and food allergies/sensitivities. When this avoidance leads to weight/nutritional and/or psychosocial impairment, the diagnostic criteria for Avoidant/restrictive food intake disorder (ARFID) are met. Fear of food is an important target for interventions designed to improve psychosocial functioning and quality of life in such individuals. The purpose of this research was to develop and validate a novel measure of fear of food. METHODS Participants (n = 1138) were recruited from ongoing clinical trials for both IBD and IBS, from Amazon's Mechanical Turk, from Reddit support forums for IBS, IBD, and vomit phobia, and from an undergraduate subject pool. Exploratory and confirmatory factor analysis, Pearson's correlations, one-way ANOVA, and intraclass correlation coefficients were used to assess the validity and reliability of the Fear of Food Questionnaire. RESULTS The final 18 item questionnaire showed excellent internal consistency, test-retest reliability, convergent validity, discriminative (known groups) validity, as well as good factor structure. Fear of food was highly correlated with visceral hypersensitivity, catastrophizing, GI symptom severity and health related quality of life, as well as with self-reported Fear-ARFID symptoms. Individuals meeting study criteria for Fear-ARFID reported the highest scores relative to control and other analogue clinical groups. CONCLUSION The Fear of Food Questionnaire appears to be reliable and valid across populations and may be a valuable tool in the assessment and treatment of Fear-ARFID.
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Affiliation(s)
- Hana F Zickgraf
- University of South Alabama, Department of Psychology, USA; University of Pennsylvania, Department of Psychology, USA; Penn State Hershey Medical Center, Department of Psychiatry & Department of Surgery, USA.
| | - Patrick Loftus
- University of Pennsylvania, Department of Psychology, USA
| | | | - Lauren C Cohen
- University of Pennsylvania, Department of Psychology, USA
| | - Melissa G Hunt
- University of Pennsylvania, Department of Psychology, USA
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28
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Dial LA, Jordan A, Emley E, Angoff HD, Varga AV, Musher-Eizenman DR. Consequences of Picky Eating in College Students. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:822-831. [PMID: 34629162 DOI: 10.1016/j.jneb.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine the relation between young adult picky eating (PE) and psychosocial outcomes (eg, social phobia, quality of life) and dietary intake. DESIGN Cross-sectional study including demographic, quantitative, and qualitative measures. PARTICIPANTS Midwestern undergraduate convenience sample (n = 488) recruited early 2020. MAIN OUTCOME MEASURES Picky eating identity and bias internalization, social phobia, quality of life, and dietary intake. ANALYSES Pearson correlations were conducted among study variables. Independent t tests compared picky eaters and nonpicky eaters on key variables. Qualitative data were coded using content analysis. RESULTS Picky eaters reported eating less fiber (t[445] = -3.51; P < 0.001; d = 0.34) and vegetables (t[464] = -3.57; P < 0.001; d = 0.33), and reported more social phobia (t[336.84] = 4.04; P < 0.001; d = 0.39) than nonpicky eaters. Picky eating behaviors were positively correlated with PE identity (r[190] = 0.48; P < 0.001; R2 = 0.23) and bias internalization (r[190] = 0.44; P < 0.001; R2 = 0.19). CONCLUSIONS AND IMPLICATIONS Future research might explore additional factors that theoretically overlap with PE behavior (eg, other eating styles, disordered eating patterns) or play a role in PE (eg, anxiety, obsessive-compulsive difficulties). A greater understanding of these factors may lead to intervention to reduce PE in adults. In addition, validation of the PE identity and PE distress measures is essential for future use and to replicate this study's findings.
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Affiliation(s)
- Lauren A Dial
- Department of Psychology, Bowling Green State University, Bowling Green, OH.
| | - Amy Jordan
- Department of Psychology, Bowling Green State University, Bowling Green, OH
| | - Elizabeth Emley
- Department of Psychology, Bowling Green State University, Bowling Green, OH
| | - Harrison D Angoff
- Department of Psychology, Bowling Green State University, Bowling Green, OH
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29
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Thomas JJ, Becker KR, Breithaupt L, Murray HB, Jo JH, Kuhnle MC, Dreier MJ, Harshman S, Kahn DL, Hauser K, Slattery M, Misra M, Lawson EA, Eddy KT. Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder. ACTA ACUST UNITED AC 2021; 31:47-55. [PMID: 34423319 PMCID: PMC8375627 DOI: 10.1016/j.jbct.2020.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
There are currently no evidence-based treatments for adults with avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the acceptability, feasibility, and proof-of-concept of cognitive-behavioral therapy for ARFID (CBT-AR) for adults. Males and females (ages 18–55 years) were offered 20–30 outpatient sessions of CBT-AR delivered by one of five therapists. Of 18 eligible adults offered CBT-AR, 15 chose to participate and 14 completed treatment. All patients endorsed high ratings of treatment credibility and expected improvement after the first session, and 93% of completers provided high ratings of satisfaction at the conclusion of treatment. Therapists rated the majority (80%) of patients as “much improved” or “very much improved.” Based on intent-to-treat analyses, ARFID severity on the Pica, ARFID, and Rumination Disorder Interview (PARDI) showed a large and significant decrease from pre- to post-treatment; and patients incorporated a mean of 18.0 novel foods. The underweight subgroup (n = 4) gained an average of 11.38 pounds, showing a large and significant increase in mean BMI from the underweight to the normal-weight range. At post-treatment, 47% of patients no longer met criteria for ARFID. To our knowledge, this is the first prospective treatment study of ARFID in adults. The findings of this study provide preliminary evidence of feasibility, acceptability, and proof-of-concept of CBT-AR for heterogeneous presentations of ARFID in adults. Randomized controlled trials are needed to confirm these findings. ClinicalTrials.gov Identifier: NCT02963220.
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Affiliation(s)
- 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, 401 Park Drive, Boston, MA 02215, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
| | - Helen Burton Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Jenny H Jo
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, Boston, MA 02114, USA
| | - Megan C Kuhnle
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, 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
| | - Stephanie Harshman
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA.,Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, Boston, MA 02114, USA
| | - Danielle L Kahn
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, Boston, MA 02114, USA
| | - Kristine Hauser
- Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, Boston, MA 02114, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, Boston, MA 02114, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, Boston, MA 02114, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital, 175 Cambridge Street, Boston, MA 02114, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457-B, Boston, MA 02114, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
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30
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Bliznashki S, Hristova V. The imputation of structure in random patterns as a cognitive factor predicting adult picky eating behavior. Appetite 2021; 167:105645. [PMID: 34391841 DOI: 10.1016/j.appet.2021.105645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/07/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
We raise the hypothesis that adult picky eating behavior may be related to subjects' tendency to impute structure in random stimuli. We test said hypothesis in an empirical study which operationalizes subjects' objective abilities and subjective decision criteria in discriminating between correlated and independent signals in terms of the classic Signal Detection Theory. A robust regularized Bayesian multiple regression analysis indicates that liberal subjective decision criteria which indicate a tendency to over-impute structure when trying to discriminate between random and correlated patterns are associated with elevated scores of picky eating while controlling for several other variables. The predictive power of our discriminating procedure appears comparable to that of related eating dispositions. Our results strongly suggest that cognitive factors might indeed have substantial and meaningful relationships with certain eating behaviors.
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Affiliation(s)
- Svetoslav Bliznashki
- Department of General, Experimental, Developmental and Health Psychology, Sofia University "St. Kliment Ohridski", Bul. "Tsar Osvoboditel" 15, 1504, Sofia Center, Sofia, Bulgaria.
| | - Velina Hristova
- Department of General, Experimental, Developmental and Health Psychology, Sofia University "St. Kliment Ohridski", Bul. "Tsar Osvoboditel" 15, 1504, Sofia Center, Sofia, Bulgaria.
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31
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Weight Gain in Adults with Avoidant/Restrictive Food Intake Disorder Compared to Restrictive Anorexia Nervosa-Pilot Findings from a Longitudinal Study. Nutrients 2021; 13:nu13030871. [PMID: 33799928 PMCID: PMC8001165 DOI: 10.3390/nu13030871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by persistent failure to meet nutritional needs, absence of body image distortion and often low body weight. Weight restorative treatment in ARFID-adults is provided for as in Anorexia Nervosa (AN), while the effect is unknown. The aim was to compare weight gain between ARFID and restrictive subtype of AN (AN-R), including exploring impact of medical factors and psychopathology. METHODS Individuals with ARFID (n = 7; all cases enrolled over 5 years) and AN-R (n = 80) were recruited from the Prospective Longitudinal All-comers inclusion study in Eating Disorders (PROLED) during 5 years. All underwent weight restorative inpatient treatment. Clinical characteristics at baseline and weekly weight gain were recorded and compared. RESULTS There were no significant differences at baseline weight, nor in weight gain between groups. Anxiety was statistically significantly higher in AN-R at baseline. CONCLUSIONS Although there were differences in several clinical measures at baseline (Autism Quotient, symptom checklist, mood scores and Morgan Russel Outcome Scale), only anxiety was higher in AN-R. No differences in weight gain were observed, although mean values indicate a faster weight gain in the ARFID group. Standard weight restorative treatment in this study in adults with ARFID has similar weight gaining effect as in AN-R.
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32
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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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33
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Koomar T, Thomas TR, Pottschmidt NR, Lutter M, Michaelson JJ. Estimating the Prevalence and Genetic Risk Mechanisms of ARFID in a Large Autism Cohort. Front Psychiatry 2021; 12:668297. [PMID: 34177659 PMCID: PMC8221394 DOI: 10.3389/fpsyt.2021.668297] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/07/2021] [Indexed: 12/27/2022] Open
Abstract
This study is the first genetically-informed investigation of avoidant/restrictive food intake disorder (ARFID), an eating disorder that profoundly impacts quality of life for those affected. ARFID is highly comorbid with autism, and we provide the first estimate of its prevalence in a large and phenotypically diverse autism cohort (a subsample of the SPARK study, N = 5,157 probands). This estimate, 21% (at a balanced accuracy 80%), is at the upper end of previous estimates from studies based on clinical samples, suggesting under-diagnosis and potentially lack of awareness among caretakers and clinicians. Although some studies suggest a decrease of disordered eating symptoms by age 6, our estimates indicate that up to 17% (at a balanced accuracy 87%) of parents of autistic children are also at heightened risk for ARFID, suggesting a lifelong risk for disordered eating. We were also able to provide the first estimates of narrow-sense heritability (h2) for ARFID risk, at 0.45. Genome-wide association revealed a single hit near ZSWIM6, a gene previously implicated in neurodevelopmental conditions. While, the current sample was not well-powered for GWAS, effect size and heritability estimates allowed us to project the sample sizes necessary to more robustly discover ARFID-linked loci via common variants. Further genetic analysis using polygenic risk scores (PRS) affirmed genetic links to autism as well as neuroticism and metabolic syndrome.
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Affiliation(s)
- Tanner Koomar
- Department of Psychiatry, The University of Iowa, Iowa City, IA, United States
| | - Taylor R Thomas
- Department of Psychiatry, The University of Iowa, Iowa City, IA, United States
| | - Natalie R Pottschmidt
- Department of Psychology, Pennsylvania State University, State College, PA, United States
| | - Michael Lutter
- Eating Recovery Center of San Antonio, San Antonio, TX, United States
| | - Jacob J Michaelson
- Department of Psychiatry, The University of Iowa, Iowa City, IA, United States
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34
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Barnhart WR, Hamilton L, Jordan AK, Pratt M, Musher-Eizenman DR. The interaction of negative psychological well-being and picky eating in relation to disordered eating in undergraduate students. Eat Behav 2021; 40:101476. [PMID: 33581480 DOI: 10.1016/j.eatbeh.2021.101476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/29/2022]
Abstract
The extant literature on picky eating focuses on children, leaving adults understudied. A sparse and mixed evidence base suggests relationships exist between picky eating and disordered eating in adults. The present study furthered this research by examining shared negative psychological correlates as moderators that may strengthen relationships between picky eating and disordered eating in undergraduate students. Participants (N = 509; 76.3% female) completed a cross-sectional survey assessing picky eating (Adult Picky Eating Questionnaire), disordered eating (Binge Eating Scale and Eating Disorder Examination-Questionnaire), and negative psychological correlates including anxiety, depression, and stress (Depression, Anxiety and Stress Scale - 21 Items), inflexible eating (Inflexible Eating Questionnaire), obsessive compulsive disorder (Short Obsessive Compulsive Disorder Screener), and social eating anxiety (adapted Social Phobia Scale) symptoms. Positive relationships were observed between picky eating and binge eating, dietary restraint, eating concerns, overall eating pathology, and all negative psychological correlates. Moderation analyses examined if negative psychological correlates strengthened relationships between picky eating and disordered eating. Higher inflexible eating and anxiety and stress symptoms interacted with higher picky eating in relation to disordered eating, specifically eating concerns. Interactions between picky eating and negative psychological correlates did not explain variance in binge eating, dietary restraint, and overall eating pathology. Findings complement research demonstrating overlap between picky eating and disordered eating and highlight specific negative psychological correlates that may strengthen relationships between picky eating and disordered eating. Researchers and clinicians interested in concurrent picky eating and disordered eating should consider these negative psychological correlates given their potential to worsen disordered eating.
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Affiliation(s)
| | | | - Amy K Jordan
- Department of Psychology, Bowling Green State University, USA
| | - Mercedes Pratt
- Department of Psychology, Bowling Green State University, USA
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35
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He J, Zickgraf HF, Essayli JH, Fan X. Classifying and characterizing Chinese young adults reporting picky eating: A latent profile analysis. Int J Eat Disord 2020; 53:883-893. [PMID: 31998999 PMCID: PMC7282959 DOI: 10.1002/eat.23231] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Picky eating (PE) is common across the lifespan and related to psychosocial impairment and limited dietary variety. However, research about PE in non-Western countries is limited. Because eating behaviors may differ by culture, operationalizing PE in non-Western countries (e.g., China) is needed. The present study aimed to replicate two previous studies identifying PE profiles in Western countries by using latent profile analysis (LPA) to classify and characterize adults reporting picky eating in a Chinese sample. METHOD A sample of 1,068 Chinese young adults completed a battery of questionnaires including the adult eating behavior questionnaire (AEBQ). LPA was utilized to identify eating profiles. The three-step approach was used to examine predictors of latent memberships and profile differences on various self-reported measures. RESULTS The best fit was a four-profile solution, with two picky eating profiles emerging: picky eating and severe picky eating. Compared to those in the other two profiles, participants in the picky eating profile (19.4%) and severe picky eating profile (3.3%) had significantly higher scores on self-reported eating disorder symptoms and psychological distress, and lower scores on self-reported food-related life satisfaction. Relative to the picky eating profile, participants in the severe picky eating profile reported significantly greater self-reported eating disorder symptoms, psychological distress, and food-related dissatisfaction. DISCUSSION Characterizing PE profiles is an important step toward understanding eating behaviors among Chinese young adults. Identifying various eating profiles has implications for future research related to PE, including the development of diagnostic tools and interventions to address PE in a Chinese context.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Hana F. Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Jamal H. Essayli
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Xitao Fan
- School of Humanities and Social Science, Chinese University of Hong Kong (Shenzhen), Shenzhen, China
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Zickgraf HF, Richard E, Zucker NL, Wallace GL. Rigidity and Sensory Sensitivity: Independent Contributions to Selective Eating in Children, Adolescents, and Young Adults. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:675-687. [DOI: 10.1080/15374416.2020.1738236] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Hana F. Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago
| | - Emily Richard
- Department of Speech, Language and Hearing Sciences, The George Washington University
| | - Nancy L. Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - Gregory L. Wallace
- Department of Speech, Language and Hearing Sciences, The George Washington University
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Abstract
Eating disorders (EDs) are a group of prevalent psychiatric illnesses with an onset in early to late adolescence-a time of significant neural development, physical and psychologic growth, and self-exploration. The etiology and neurobiology of EDs are not well understood, but EDs are recognized as brain-based illnesses with serious acute and long-term consequences if undertreated or ignored. Two EDs, anorexia nervosa (AN) and bulimia nervosa (BN), have historically been the primary EDs of focus. The DSM-5 updated diagnostic criteria for these disorders added two more: binge-eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). EDs severely impact males as well as females across the weight spectrum. Comorbidity is high; mortality rates for AN and BN are the highest in psychiatric conditions and higher than many medical conditions. Several treatment options are available to treat an ED ranging from inpatient hospitalization to outpatient services and different psychotherapy options. This chapter reviews the diagnostic criteria, clinical presentation, and treatment for these disorders. Where available, sex differences and developmental considerations will be noted. For all EDs, early recognition and swift treatment are necessary to avoid a chronic course.
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Abstract
OBJECTIVE To identify whether picky eating during childhood is associated with dietary intake, weight status and disordered eating behaviour during young adulthood. DESIGN A population-based study using data from young adults who responded online or by mail to the third wave of the Project EAT (Eating and Activity in Teens and Young Adults) study in 2008-2009. Participants retrospectively reported the extent to which they were a picky eater in childhood, sociodemographic characteristics, disordered eating behaviours, usual dietary intake, and weight and height. SETTING Participants were initially recruited in the Minneapolis/St. Paul metropolitan area of Minnesota, USA, in 1998-1999. PARTICIPANTS The analytic sample included 2275 young adults (55 % female, 48 % non-Hispanic White, mean age 25·3 (sd 1·6) years). RESULTS Young adults who reported picky eating in childhood were found to currently have lower intakes of fruit, vegetables and whole grains, and more frequent intakes of snack foods, sugar-sweetened beverages and foods from fast-food restaurants. No associations were observed between picky eating in childhood and young adults' weight status, use of weight-control strategies or report of binge eating. CONCLUSIONS While young adults who report picky eating during childhood are not at higher risk for disordered eating, those who were picky eaters tend to have less healthy dietary intake. Food preferences and dietary habits established by picky eaters during childhood may persist into adulthood.
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Harshman SG, Wons O, Rogers MS, Izquierdo AM, Holmes TM, Pulumo RL, Asanza E, Eddy KT, Misra M, Micali N, Lawson EA, Thomas JJ. A Diet High in Processed Foods, Total Carbohydrates and Added Sugars, and Low in Vegetables and Protein Is Characteristic of Youth with Avoidant/Restrictive Food Intake Disorder. Nutrients 2019; 11:E2013. [PMID: 31461865 PMCID: PMC6770555 DOI: 10.3390/nu11092013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/27/2022] Open
Abstract
Avoidant/restrictive food intake disorder (ARFID) is characterized in part by limited dietary variety, but dietary characteristics of this disorder have not yet been systematically studied. Our objective was to examine dietary intake defined by diet variety, macronutrient intake, and micronutrient intake in children and adolescents with full or subthreshold ARFID in comparison to healthy controls. We collected and analyzed four-day food record data for 52 participants with full or subthreshold ARFID, and 52 healthy controls, aged 9-22 years. We examined frequency of commonly reported foods by logistic regression and intake by food groups, macronutrients, and micronutrients between groups with repeated-measures ANOVA. Participants with full or subthreshold ARFID did not report any fruit or vegetable category in their top five most commonly reported food categories, whereas these food groups occupied three of the top five groups for healthy controls. Vegetable and protein intake were significantly lower in full or subthreshold ARFID compared to healthy controls. Intakes of added sugars and total carbohydrates were significantly higher in full or subthreshold ARFID compared to healthy controls. Individuals with full or subthreshold ARFID had lower intake of vitamins K and B12, consistent with limited vegetable and protein intake compared to healthy controls. Our results support the need for diet diversification as part of therapeutic interventions for ARFID to reduce risk for nutrient insufficiencies and related complications.
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Affiliation(s)
- Stephanie G Harshman
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Olivia Wons
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Madeline S Rogers
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alyssa M Izquierdo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Tara M Holmes
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Reitumetse L Pulumo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elisa Asanza
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02114, USA
| | - Nadia Micali
- Département universitaire de psychiatrie, Université de Genève, 1211 Genève, Switzerland
- Service de psychiatrie de l'enfant et de l'adolescent, Département de l'enfant et de l'adolescent, HUG, 1211 Genève, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, 1211 Geneva, Switzerland
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, Holborn, London WC1N 1EH, UK
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02114, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA.
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He J, Sun S, Zickgraf HF, Ellis JM, Fan X. Assessing Appetitive Traits Among Chinese Young Adults Using the Adult Eating Behavior Questionnaire: Factor Structure, Gender Invariance and Latent Mean Differences, and Associations With BMI. Assessment 2019; 28:877-889. [PMID: 31328547 DOI: 10.1177/1073191119864642] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The current study examined the factor structure, measurement reliability, measurement invariance across genders, and latent gender mean differences, of a new Chinese translation of the Adult Eating Behavior Questionnaire (C-AEBQ) in a Chinese young adult sample (n = 1,068, 52.57% women). The associations between the appetitive traits assessed by the AEBQ and body mass index were also explored. The previously established eight-factor model of the AEBQ was supported in the present sample. The C-AEBQ had strong measurement invariance between genders. Cronbach's alpha estimates of the eight subscales of the C-AEBQ ranged from 0.76 to 0.97, and the test-retest reliability coefficients of the subscales ranged from 0.50 to 0.77. The C-AEBQ had adequate convergent and divergent validity, as supported by the theoretically expected correlations between C-AEBQ and the Three-Factor Eating Questionnaire. Furthermore, Satiety Responsiveness, Slowness in Eating, and Food Fussiness were inversely associated with body mass index. Overall, the C-AEBQ appears to be a psychometrically sound instrument as a comprehensive measure for appetitive traits for Chinese young adults.
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Affiliation(s)
- Jinbo He
- Chinese University of Hong Kong, Shenzhen, China
| | - Shengyan Sun
- Huzhou University, Huzhou, Zhejiang Province, China
| | | | | | - Xitao Fan
- Chinese University of Hong Kong, Shenzhen, China
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Dovey TM, Kumari V, Blissett J. Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), autistic spectrum disorders or picky eating: Same or different? Eur Psychiatry 2019; 61:56-62. [PMID: 31310945 DOI: 10.1016/j.eurpsy.2019.06.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Not much is known at present about the behavioural and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), the newest addition to the eating disorder diagnostic category in DSM-V. Our aims were to examine eating difficulties, behavioural problems and sensory hypersensitivity in ARFID children, relative to typically developing children with no reported feeding, mental or physical health problems, as well as children with autistic spectrum disorders (ASD; typically associated with a high prevalence of eating problems) or Picky Eating (PE). METHODS Four hundred and eighty-six parents of children with ARFID (n = 29), ASD (n = 56), PE (n = 143) or no reported difficulties (n = 259) completed (online) the Behavioral Pediatric Feeding Assessment Scale, the Child Eating Behaviour Questionnaire, Strengths and Difficulties Questionnaire, and the Sensory Experiences Questionnaire about the children. RESULTS The ARFID, ASD and PE groups had eating difficulties, behavioural problems and sensory hypersensitivity, relative to the typically developing group, and differed significantly on only some of the dimensions assessed. Specifically, the ARFID group had the lowest food-responsiveness and differed significantly from the PE and typically developing (but not from ASD) groups while the ASD group had significantly greater behavioural problems and social and non-social sensitivity than all other groups. CONCLUSIONS Notable overlap in eating difficulties, behavioural problems and sensory profiles of children with ARFID, ASD or PE, with more severe aberrations in ARFID (food-responsiveness) and ASD (hypersensitivity and social problems) on specific dimensions, argue for a dimensional approach to improve therapy and management of children with these disorders.
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Affiliation(s)
- Terence M Dovey
- Department of Life Sciences, Division of Psychology, Brunel University London, Uxbridge UB8 3PH, United Kingdom.
| | - Veena Kumari
- Department of Life Sciences, Division of Psychology, Brunel University London, Uxbridge UB8 3PH, United Kingdom; Centre for Cognitive Neuroscience, College of Health and Life Sciences, Brunel University London, Uxbridge UB8 3PH, United Kingdom
| | - Jackie Blissett
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham B4 7ET, United Kingdom
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Strand M, von Hausswolff-Juhlin Y, Welch E. A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder. Int J Eat Disord 2019; 52:331-360. [PMID: 30489647 DOI: 10.1002/eat.22962] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Avoidant/restrictive food intake disorder (ARFID) was introduced as a new diagnosis in the DSM-5. This systematic scoping review explores how ARFID as a diagnostic entity is conceptualized in the research literature and evaluates the diagnostic validity according to the Feighner criteria. METHOD A systematic scoping review of papers on ARFID in PubMed/MEDLINE and Web of Science was undertaken, following PRISMA and Joanna Briggs Institute guidelines. RESULTS Fifty-one original research publications, 23 reviews and commentaries, and 20 case reports were identified. The use of ARFID as a conceptual category varies significantly within this literature. At this time, the ARFID diagnosis does not fulfil the Feighner criteria for evaluating the validity of diagnostic constructs, the most urgent problem being the demarcation toward other disorders. A three-dimensional model-lack of interest in food, selectivity based on sensory sensitivity, and fear of aversive consequences-is gaining support in the research literature. DISCUSSION The introduction of the ARFID diagnosis has undoubtedly increased the recognition of a previously largely neglected group of patients. However, this article points to an inability of the current DSM-5 diagnostic criteria to ensure optimal diagnostic validity, which risks making them less useful in clinical practice and in epidemiological research. To increase the conceptual validity of the ARFID construct, several possible alterations to the current diagnostic criteria are suggested, including a stronger emphasis of the three identified subdomains and further clarifying the boundaries of ARFID.
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Affiliation(s)
- Mattias Strand
- Stockholm Centre for Eating Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Yvonne von Hausswolff-Juhlin
- Stockholm Centre for Eating Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Elisabeth Welch
- Stockholm Centre for Eating Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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43
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Zickgraf HF, Murray HB, Kratz HE, Franklin ME. Characteristics of outpatients diagnosed with the selective/neophobic presentation of avoidant/restrictive food intake disorder. Int J Eat Disord 2019; 52:367-377. [PMID: 30636013 PMCID: PMC8056744 DOI: 10.1002/eat.23013] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/10/2018] [Accepted: 12/16/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although Avoidant/Restrictive Food Intake Disorder (ARFID) has existed since the publication of DSM-5 in 2013, research on the descriptive psychopathology of treatment-seeking patients with formal ARFID diagnoses is sparse, and limited to tertiary eating disorder-focused treatment settings where most patients present with weight loss/malnutrition. In these settings, the selective/neophobic symptom presentation is rare compared to other primary eating restrictions. We aimed provide initial descriptive psychopathology of ARFID primary selective/neophobic symptom presentation in an outpatient setting, and to explore the prevalence of the core ARFID symptoms and clinical differences among patients meeting criteria based on weight/nutritional symptoms versus psychosocial impairment only. METHOD We reviewed the charts of 22 consecutive outpatients diagnosed with ARFID caused by selective/neophobic eating, and describe symptoms, impairment, illness trajectory, and demographic features. Patients who met ARFID criteria because of weight loss/nutritional problems were compared to those who met for psychosocial impairment only on demographic and clinical characteristics. RESULTS Patients were predominantly male (81.8%) and school-aged (4-11 years). 81.8% had no weight/nutritional symptoms documented by a medical provider. All met criteria for significant psychosocial impairment. There were few differences between patients who did versus did not meet weight loss/nutritional criteria for ARFID; they differed only in age and in the presence of appetite disturbances consistent with another proposed presentation of ARFID. DISCUSSION These results provide novel data on the clinical characteristics of individuals who present with a primary presentation of selective/neophobic ARFID, including support for psychosocial impairment as sufficient for fulfilling ARFID criterion A.
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Affiliation(s)
- Hana F. Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois,Child and Adolescent OCD, Tic, Trich, and Anxiety Group (COTTAGe), Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen B. Murray
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Hilary E. Kratz
- Department of Psychology, La Salle University, Philadelphia, Pennsylvania
| | - Martin E. Franklin
- Child and Adolescent OCD, Tic, Trich, and Anxiety Group (COTTAGe), Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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44
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Katzman DK, Norris ML, Zucker N. Avoidant restrictive food intake disorder: First do no harm. Int J Eat Disord 2019; 52:459-461. [PMID: 30676659 DOI: 10.1002/eat.23021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This opinion piece offers some considerations, both medical and psychological, for the use of nasogastric tube (NGT) feedings in the treatment of avoidant restrictive food intake disorder (ARFID) in children and adolescents. METHOD Although there is empirical support for the use of NGT feedings in the treatment of anorexia nervosa, this evidence base does not exist for the treatment of ARFID. As such, there is need to delineate pragmatic considerations in the use of this procedure. RESULTS Issues of medical necessity notwithstanding, we advise that the use of this procedure be considered more cautiously due to the oral sensitivities inherent in many individuals with ARFID and the potential psychological consequences. These sensitivities may make the experience of NGT feedings particularly aversive, with the potential of creating iatrogenic conditioned food aversions. DISCUSSION This article encourages clinicians to give careful thought and attention when considering NGT feedings in children and adolescents with ARFID.
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Affiliation(s)
- Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark L Norris
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Eastern Ontario (CHEO) and University of Ottawa, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada
| | - Nancy Zucker
- Division of Child and Family Mental Health and Developmental Neuroscience, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
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45
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He J, Ellis JM, Zickgraf HF, Fan X. Translating, modifying, and validating the Adult Picky Eating Questionnaire for use in China. Eat Behav 2019; 33:78-84. [PMID: 31005684 PMCID: PMC7061871 DOI: 10.1016/j.eatbeh.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/01/2019] [Accepted: 04/10/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study was to translate, modify, and validate the Adult Picky Eating Questionnaire (APEQ) for use in China. METHODS Based on standard procedures, the APEQ was translated into Chinese. Four items were added in the final Chinese version of the APEQ (C-APEQ). For testing the psychometric properties of the C-APEQ, a total of 1069 participants (17-24 years; 52.57% women) were recruited from two universities in mainland China. RESULTS Exploratory factor analysis and confirmatory factor analysis supported the previous four-factor structure of the APEQ. Findings also showed that the C-APEQ had adequate internal consistency (α = 0.874) and test-retest reliability (ICC = 0.778). The C-APEQ demonstrated strong measurement invariance across gender. Furthermore, the C-APEQ composite score presented positive and significant correlations with eating disturbance, psychological distress, and psychological inflexibility. It also showed a negative and significant correlation with food-related life satisfaction. CONCLUSION Findings suggested that the Chinese version of the APEQ demonstrated sound psychometric properties. Thus, the C-APEQ can be a useful tool in future studies to accurately assess picky eating among adult population and explore the relationships between picky eating and other physical and psychological outcomes in a Chinese context.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, Chinese University of Hong Kong (Shenzhen), Shenzhen, Guangdong, China.
| | - Jordan M. Ellis
- Psychology Department, East Carolina University, Greenville, NC, United States
| | - Hana F. Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Xitao Fan
- School of Humanities and Social Science, Chinese University of Hong Kong (Shenzhen), Shenzhen, Guangdong, China.
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Ikemoto T, Hayashi K, Arai YC, Nishihara M, Inoue S, Inoue M, Shiro Y, Ushida T. The Relationship Between Musculoskeletal Pain and Picky Eating: The Role of Negative Self-Labeling. Pain Ther 2019; 8:101-110. [PMID: 30868476 PMCID: PMC6513938 DOI: 10.1007/s40122-019-0116-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction Picky eating appears to be associated with poor health outcomes and thus it might have a role in musculoskeletal pain in adults. However, this relationship has not been investigated yet. The aim of the present study was to determine whether the number of musculoskeletal pain regions was associated with picky eating, which was characterized by food intake balance of familiar products or self-identification. Methods A total of 4660 adult subjects were enrolled in this study. Picky eating was assessed in two ways; a countable score and self-identification of picky eating. For the countable score, the number of food items, which the subjects usually did not consume among a list of 11 familiar products was measured. Self-identification as a picky eater was defined through a single question. The presence of musculoskeletal pain; in the neck, low back, knee, back, or arm, within 2 months of the survey was also identified. Results Of all subjects, 2654 (56%) had musculoskeletal pain in at least one region. The prevalence of musculoskeletal pain in every region was seen as consistently higher in subjects who self-identified as picky eaters than those who were non-picky eaters. In multiple linear regression analysis, the number of pain regions was significantly associated with older age, females, self-identification as a picky eater, and low body weight, not but the countable score. Conclusions There may be an association between musculoskeletal pain and negative beliefs about one’s own eating behaviors. Electronic supplementary material The online version of this article (10.1007/s40122-019-0116-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tatsunori Ikemoto
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Japan.,Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Nagakute, Japan.,Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Kazuhiro Hayashi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan. .,Department of Rehabilitation, Aichi Medical University Hospital, Nagakute, Japan.
| | - Young-Chang Arai
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Nagakute, Japan.,Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Makoto Nishihara
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Shinsuke Inoue
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Masayuki Inoue
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Nagakute, Japan
| | - Yukiko Shiro
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.,Department of Physical Therapy, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan
| | - Takahiro Ushida
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Nagakute, Japan.,Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
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Becker KR, Keshishian AC, Liebman RE, Coniglio KA, Wang SB, Franko DL, Eddy KT, Thomas JJ. Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa. Int J Eat Disord 2019; 52:230-238. [PMID: 30578644 PMCID: PMC7191972 DOI: 10.1002/eat.22988] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are restrictive eating disorders. There is a proposal before the American Psychiatric Association to broaden the current DSM-5 criteria for ARFID, which currently require dietary intake that is inadequate to support energy or nutritional needs. We compared the clinical presentations of ARFID and AN in an outpatient sample to determine how a more inclusive definition of ARFID, heterogeneous for age and weight status, is distinct from AN. METHODS As part of standard care, 138 individuals with AN or ARFID completed an online assessment battery and agreed to include their responses in research. RESULTS Individuals with ARFID were younger, reported earlier age of onset, and had higher percent median BMI (%mBMI) than those with AN (all ps < .001). Individuals with ARFID scored lower on measures of eating pathology, depression, anxiety, and clinical impairment (all ps < .05), but did not differ from those with AN on restrictive eating (p = .52), and scored higher on food neophobia (p < .001). DISCUSSION Allowing psychosocial impairment to be sufficient for an ARFID diagnosis resulted in a clinical picture of ARFID such that %mBMI was higher (and in the normal range) compared with AN. Differences in gender distribution, age, and age of onset remained consistent with previous research. Both groups reported similar levels of dietary restriction, although ARFID can be distinguished by relatively higher levels of food neophobia. Currently available measures of eating pathology may capture certain ARFID symptoms, but highlight the need for measures of impairment relative to ARFID.
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Affiliation(s)
- Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ani C. Keshishian
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital
| | - Rachel E. Liebman
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | - Shirley B. Wang
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychology, Harvard University, Boston, Massachusetts
| | - Debra L. Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Northeastern University, Boston, Massachusetts
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Bozzini AB, Malzyner G, Maximino P, Machado RHV, Ramos CDC, Ribeiro L, Fisberg M. O PEDIATRA DEVE INVESTIGAR SINTOMAS DE TRANSTORNOS OBSESSIVOS COMPULSIVOS EM CRIANÇAS COM DIFICULDADES ALIMENTARES? REVISTA PAULISTA DE PEDIATRIA 2019; 37:104-109. [PMID: 30379278 PMCID: PMC6362373 DOI: 10.1590/1984-0462/;2019;37;1;00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/24/2017] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação “transtorno obsessivo compulsivo” e “picky eating/dificuldade alimentar”. Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas.
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Kurotori I, Shioda K, Abe T, Kato R, Ishikawa S, Suda S. An Inpatient Observational Study: Characteristics And Outcomes Of Avoidant/Restrictive Food Intake Disorder (ARFID) In Children And Adolescents In Japan. Neuropsychiatr Dis Treat 2019; 15:3313-3321. [PMID: 31819456 PMCID: PMC6886540 DOI: 10.2147/ndt.s218354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the clinical characteristics and course of severe avoidant/restrictive food intake disorder (ARFID) in hospitalized children and adolescents and compare them with those of patients with restricting-type anorexia nervosa (R-AN). PATIENTS AND METHODS We conducted a retrospective chart review of inpatients diagnosed with ARFID or R-AN based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at Jichi Children's Medical Center Tochigi between April 1, 2007 and March 31, 2017. We compared the characteristics of the ARFID and R-AN patients at admission, during hospitalization, and after discharge. RESULTS Both the ARFID (n=13) and R-AN (n=79) patients required hospitalization for their medically unstable state. The features of ARFID group included concern about the aversive consequences of eating and avoidance of eating due to sensory concerns. Significant differences were found at admission between ARFID and R-AN groups in age (10.7 vs 12.7 years), family history of mental disorders (46.2% vs 17.7%), comorbid developmental disorders (6 vs 3 cases), and the time from onset to admission (3.9 vs 6.3 months). The body weight status, % ideal body weight (%IBW), % expected body weight (%EBW), <75% IBW rate, and <75% EBW rate did not differ significantly between the two groups at admission or discharge. The duration of post-discharge outpatient follow-up treatment did not differ significantly between ARFID and R-AN groups (15.3 vs 18.4 months); however, ARFID group recovery rate was significantly higher than that of R-AN group (77% vs 43%). The reasons that the patients with ARFID had significantly better outcomes than the R-AN patients remain unclear. Compared to those in previous studies, the present patients were younger and demonstrated better outcomes. Our results indicate that the body weight status is similar between ARFID and R-AN patients, but the ARFID patients achieved better outcomes. CONCLUSION These findings suggest that early onset in childhood, early disease recognition, and early intervention are important factors for achieving better outcomes for patients with ARFID.
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Affiliation(s)
| | | | | | | | - Shizukiyo Ishikawa
- Department of Medical Education Center, Jichi Medical University, Tochigi, Japan
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Ellis JM, Zickgraf HF, Galloway AT, Essayli JH, Whited MC. A functional description of adult picky eating using latent profile analysis. Int J Behav Nutr Phys Act 2018; 15:109. [PMID: 30400944 PMCID: PMC6220498 DOI: 10.1186/s12966-018-0743-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Research has indicated that adult picky eating (PE) is associated with elevated psychosocial impairment and limited dietary variety and fruit and vegetable intake; however, research operationalizing PE behaviors is limited. Previous research identified a PE profile in children, marked by high food avoidance (satiety responsiveness, fussiness, and slow eating) and low food approach (food enjoyment and responsiveness) appetitive traits. The present study aimed to replicate a similar latent eating behavior profile in an adult sample. METHODS A sample of 1339 US adults recruited through Amazon's MTurk completed an online survey that included a modified self-report version of the Child Eating Behavior Questionnaire (CEBQ-A). Latent profile analysis was employed to identify eating profiles using the CEBQ-A subscales, ANCOVAs were employed to examine profile differences on various self-report measures, and eating profiles were compared across BMI classifications. RESULTS Analyses converged on a four-profile solution, and a picky eater profile that closely resembled the past child profile emerged. Participants in the picky eater profile (18.1%) scored higher on measures of adult PE and social eating anxiety compared to all other profiles, scored higher on eating-related impairment and depression than moderate eating profiles, and were more likely to be of normal weight. DISCUSSION A distinct adult PE profile was observed, indicating childhood PE and appetitive behaviors may carry over into adulthood. Research identifying meaningful groups of picky eaters will help to shed light on the conditions under which picky eating is a risk factor for significant psychosocial impairment or distress, or weight-related problems.
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Affiliation(s)
- Jordan M Ellis
- Department of Psychology, East Carolina University, East Fifth Street, 104 Rawl Building, Greenville, NC, 27858-4353, USA.
| | - Hana F Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Amy T Galloway
- Department of Psychology, Appalachian State University, 222 Joyce Lawrence Ln, P.O. Box 32109, Boone, NC, 28608, USA
| | - Jamal H Essayli
- Department of Psychiatry, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Matthew C Whited
- Department of Psychology, East Carolina University, East Fifth Street, 104 Rawl Building, Greenville, NC, 27858-4353, USA
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