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Avoidant restrictive food intake disorder (ARFID)

Author/s
Josephine Neale, Javier Sanchez-Cerezo, Nikita Julius, Richard M. Lynn, Lee D. Hudson, Dasha Nicholls
Citation
Focus Issue 6: Eating disorders
CEPiP.2024.1.72-76
Abstract

Avoidant restrictive food intake disorder (ARFID) was introduced in DSM-5 and has more recently been included in ICD-11. It presents with restrictive eating patterns but the diagnosis hinges on the subsequent health problems and functional impairment, either physical or psychological, related to the restriction. Critically, the restricted eating is not associated with concerns about body image, weight or shape, in contrast to other restrictive eating disorders. This article provides an educational overview of ARFID, its presentation and subtypes, known comorbidities, and assessment and treatment options. ARFID-specific cognitive behavioural therapy and family therapy approaches have been developed but no randomised intervention studies have yet been undertaken. Case scenarios demonstrate how the diagnostic criteria may apply in clinical practice.

Keywords: ARFID, avoidant restrictive food intake disorder, eating disorders, assessment, therapy

Cite as: Cutting Edge Psychiatry in Practice 2025, 6(1):72-76; https://doi.org/10.65031/khrj6698

References

  1. Kurz S, Van Dyck Z, Dremmel D, Munsch S, Hilbert A. Early-onset restrictive eating disturbances in primary school boys and girls. European Child and Adolescent Psychiatry. 2015;24:779-85. https://doi.org/10.1007/s00787-014-0622-z
  2. Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including avoidant/restrictive food intake disorder (ARFID), in the Australian population. Journal of Eating Disorders. 2017;5(1):1-10. https://doi.org/10.1186/s40337-017-0149-z
  3. Eddy KT, Thomas JJ, Hastings E, Edkins K, Lamont E, Nevins CM, et al. Prevalence of DSM‐5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. International Journal of Eating Disorders. 2015;48(5):464-70. https://doi.org/10.1002/eat.22350
  4. Katzman DK, Spettigue W, Agostino H, Couturier J, Dominic A, Findlay SM, et al. Incidence and age-and sex-specific differences in the clinical presentation of children and adolescents with avoidant restrictive food intake disorder. JAMA Pediatrics. 2021;175(12):e213861. https://doi.org/10.1001/jamapediatrics.2021.3861
  5. Sanchez-Cerezo J, Neale J, Hudson L, Lynn RM, Julius N, Nicholls D. 731 A national surveillance study of ARFID in the UK and Ireland. Archives of Disease in Childhood. 2023;108:A372. https://doi.org/10.1136/archdischild-2023-rcpch.587
  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Arlington VA. American Psychiatric Association (2013). https://doi.org/10.1007/springerreference_179660
  7. National Institute for Health and Care Excellence (NICE). Eating disorders: recognition and treatment. NICE guideline [NG69] 2017. Updated 16 December 2020. Accessed 16 November 2023. Available from: https://www.nice.org.uk/guidance/ng69/chapter/ Recommendations#identification-and-assessment. https://doi.org/10.24292/01.mf.0120.14
  8. Sanchez-Cerezo J, Neale J, Julius N, Croudace T, Lynn RM, Hudson LD, et al. Subtypes of avoidant/restrictive food intake disorder in children and adolescents: a latent class analysis. eClinicalMedicine 2024;68:102440. https://doi.org/10.1016/j.eclinm.2024.102440
  9. Neale J, Pais SM, Nicholls D, Chapman S, Hudson LD. What are the effects of restrictive eating disorders on growth and puberty and are effects permanent? A systematic review and meta-analysis. Journal of Adolescent Health. 2020;66(2):144-56. https://doi.org/10.1016/j.jadohealth.2019.08.032
  10. Sanchez‐Cerezo J, Nagularaj L, Gledhill J, Nicholls D. What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature. European Eating Disorders Review. 2023;31(2):226-46. https://doi.org/10.1002/erv.2964
  11. Emmett PM, Hays NP, Taylor CM. Antecedents of picky eating behaviour in young children. Appetite. 2018;130:163-73.      
  12. Harris HA, Derks IP, Prinzie P, Louwerse A, Hillegers MH, Jansen PW. Interrelated development of autism spectrum disorder symptoms and eating problems in childhood: a population-based cohort. Frontiers in Pediatrics. 2023;11:1062012. https://doi.org/10.3389/fped.2023.1062012
  13. Bryant‐Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ. Development of the Pica, ARFID, and Rumination Disorder Interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: a pilot study for ages 10–22. International Journal of Eating Disorders. 2019;52(4):378-87. https://doi.org/10.1002/eat.22958
  14. Archibald T, Bryant‐Waugh R. Current evidence for avoidant restrictive food intake disorder: implications for clinical practice and future directions. JCPP Advances. 2023:e12160. https://doi.org/10.1002/jcv2.12160
  15. Kambanis PE, Thomas JJ. Assessment and treatment of avoidant/restrictive food intake disorder. Current Psychiatry Reports. 2023;25(2):53- 64. https://doi.org/10.1007/s11920-022-01404-6
  16. Harrison ME, Norris ML, Robinson A, Spettigue W, Morrissey M, Isserlin L. Use of cyproheptadine to stimulate appetite and body weight gain: a systematic review. Appetite. 2019;137:62-72. https://doi.org/10.1016/j.appet.2019.02.012
  17. Gray E, Chen T, Menzel J, Schwartz T, Kaye WH. Mirtazapine and weight gain in avoidant and restrictive food intake disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2018;57(4):288-9. https://doi.org/10.1016/j.jaac.2018.01.011