![]() ![]() A small study of treatment-seekers completing the Eating Pathology Symptoms Inventory (EPSI 12) found that while individuals with AN endorsed higher scores than those with ARFID on EPSI Restraint (a self-report measure of purposeful dieting), the two groups scored similarly on EPSI Restriction (a self-report measure of actual deficits in calorie intake). Prior research suggests that ARFID can be differentiated from anorexia nervosa (AN) based on the rationale for food restriction. This gap impacts identification of the condition in clinical settings, evaluation of treatment efficacy, and ascertainment of epidemiology and natural course. There are currently no validated assessment tools for the specific psychopathology of ARFID. Further studies are needed to investigate the epidemiology of ARFID in children, adults, and the elderly. 10 These studies suggest that despite variation in estimates, ARFID is commonly seen in clinical settings and might be common among children in the general population. 9 A recent latent class analysis of three pediatric surveillance studies (in which pediatricians and child psychiatrists were asked to report on any children < 12 years with a newly diagnosed restrictive type eating disorder) performed across Canada, the United Kingdom, and Australia suggested that one of two identified clusters representing between 25–34% of children with incident restrictive type eating disorders mapped onto symptoms consistent with ARFID. 8 By contrast, a retrospective review of 2,231 consecutive referrals (aged 8–18 years) to pediatric gastrointestinal clinics in the Boston area showed an ARFID prevalence of only 1.5%. 7 Further, ARFID was even more common (22.5%) among youth in a day treatment program for eating disorders. For example, a series of case reviews and clinical studies across eating disorder treatment programs in North America found that between 7.2% and 17.4% of patients across sites had ARFID 4, 5, 6 In a similar retrospective chart review of individuals seeking treatment for eating disorders in Japan, 11% met criteria for ARFID. ![]() 3 The prevalence of ARFID in healthcare settings is generally higher. A questionnaire-based study recently investigated the prevalence of ARFID in a primary school setting among 8–13 year olds in Switzerland, and found that 3.2% met criteria for ARFID via self-reported symptoms. Therefore, its incidence and prevalence in the general population are unknown. Given its status as a recently defined disorder, ARFID has not been included in any large-scale epidemiological studies. ![]() Below we summarize what is currently known about ARFID and highlight future research directions including our new three-dimensional model of neurobiology with implications for etiology and treatment. Examples of ARFID sequelae that would meet diagnostic criteria include poor growth and/or low weight, vitamin deficiencies, dependence on tube feeding or high-energy supplements to meet calorie needs, and psychosocial impairment (e.g., avoidance of eating opportunities at work or school difficulty eating with others). In all cases, to warrant an ARFID diagnosis, the avoidant and restrictive eating must lead to significant medical or psychosocial problems that require independent clinical attention. Still others may avoid specific foods or stop eating entirely following a traumatic experience with eating, such as choking, vomiting, or other forms of gastroenterological distress. ![]() Others with ARFID may restrict the amount they eat due to lack of interest in eating or low appetite. Specifically, individuals with sensory sensitivity may avoid eating specific foods-often meats, vegetables, and/or fruits-due to aversions to specific tastes, textures, or smells. DSM-5 provides three example presentations of ARFID, which can occur independently or in combination. 2 ARFID expanded upon Feeding Disorder of Infancy and Early Childhood to acknowledge that avoidant and restrictive eating symptoms can occur across the lifespan. Avoidant/Restrictive Food Intake Disorder (ARFID) was introduced to the psychiatric nomenclature four years ago 1 as a reformulation of Feeding Disorder of Infancy and Early Childhood. ![]()
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