Avoidant/Restrictive Food Intake Disorder

Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder that is characterized by restrictive nutrient intake. Although it may seem similar to Anorexia Nervosa or Bulimia Nervosa, ARFID is different in that the restrictive eating patterns are not motivated by a distorted body image or a fear of gaining weight (Bourne, 2020). Because it fails to meet the criteria for AN or BN, it was an unclassified disorder until 2013, when it was defined in the publication of DSM-5 (Zimmerman, 2017). To meet the criteria for ARFID, the restrictive eating must not be a result of a cultural practice (like religious fasting), shortage of food, or a distorted body image. ARFID may be due to a variety of reasons such as a lack of interest in food, avoidance of certain sensory characteristics of food, or fear or eating due to past aversive experiences like choking or gastrointestinal distress (Coglan, 2019). It is easy to confuse ARFID with “picky eating” but ARFID necessarily involves a clinically significant nutrient deficiency that requires proper diagnosis and treatment.
ARFID is most common amongst older children and young adolescents, but spans across all ages. ARFID has several comorbidities, including OCD, generalized anxiety disorder, autism spectrum disorder, and learning disorder. Compared to AN or BN, ARFID has a lower hospitalization rate (Norris, 2013), a higher percentage of males, and a younger age of onset (Fisher, 2014). Because it is most common among younger children, it is often diagnosed and treated by pediatricians. However, there is currently very little empirical data on proper treatment and prevention. Also, as the disorder can be due to such a variety of reasons, an individualized approach to treatment is warranted with a focus on behavioral and nutritional intervention (Zimmerman, 2017). For instance, for ARFID patients that have had an aversive or traumatic experience with food, systematic desensitization and management of anxiety may be the best course of treatment. For patients whose disorder is not motivated by psychological factors, a treatment with a focus on nutritional and dietary supplement may be more appropriate (Zimmerman, 2017). All in all, more research is warranted to explore risk factors, prognosis, and treatment of ARFID.


References
Bourne, L., Bryant-Waugh, R., Cook, J., & Mandy, W. (2020). Avoidant/Restrictive Food Intake disorder: A systematic scoping review of the current literature. Psychiatry Research, 288, 112961. https://doi.org/10.1016/j.psychres.2020.112961 
Coglan, L., & Otasowie, J. (2019). Avoidant/restrictive food intake disorder: What do we know so far? BJPsych Advances, 25(2), 90–98. https://doi.org/10.1192/bja.2018.48 
Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A “New disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49–52. https://doi.org/10.1016/j.jadohealth.2013.11.013 
Norris, M. L., Robinson, A., Obeid, N., Harrison, M., Spettigue, W., & Henderson, K. (2013). Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study. International Journal of Eating Disorders, 47(5), 495–499. https://doi.org/10.1002/eat.22217 
Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake disorder (ARFID). Current Problems in Pediatric and Adolescent Health Care, 47(4), 95–103. https://doi.org/10.1016/j.cppeds.2017.02.005