A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID)

Abstract

ObjectiveThis scoping review identifies and describes psychological interventions for avoidant restrictive food intake disorder (ARFID) and summarizes how outcomes are measured across such interventions.MethodFive databases (Cochrane, Embase, Medline, PsycInfo, Web of Science) were searched up to December 22, 2022. Studies were included if they reported on psychological interventions for ARFID. Studies were excluded if participants did not have an ARFID diagnosis and if psychological interventions were not delivered or detailed.ResultsFifty studies met inclusion criteria; almost half were single‐case study designs (23 studies) and most studies reported on psychological interventions for children and adolescents with ARFID (42 studies). Behavioral interventions (16 studies), cognitive‐behavioral therapy (10 studies), and family therapy (5 studies), or combinations of these therapeutic approaches (19 studies) were delivered to support patients with ARFID. Many studies lacked validated measures, with outcomes most commonly assessed via physical health metrics such as weight.DiscussionThis review provides a comprehensive summary of psychological interventions for ARFID since its introduction to the DSM‐5. Across a range of psychological interventions and modalities for ARFID, there were common treatment components such as food exposure, psychoeducation, anxiety management, and family involvement. Currently, studies reporting on psychological interventions for ARFID are characterized by small samples and high levels of heterogeneity, including in how outcomes are measured. Based on reviewed studies, we outline suggestions for clinical practice and future research.Public SignificanceAvoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by avoidance or restriction of food due to fear, sensory sensitivities, and/or a lack of interest in food. We reviewed the literature on psychological interventions for ARFID and the outcomes used to measure change. Several psychological interventions have been developed and applied to patients with ARFID. Outcome measurement varies widely and requires further development and greater consensus.

Case report: Avoidant/restrictive food intake disorder after tonsillectomy

“…Involving the family in an integrated treatment plan and psychoeducation is considered essential for therapeutic success, particularly with children and adolescents ( 34 ). A recent review examined the existing research on psychological interventions for ARFID and the criteria used to assess the outcome improvement ( 35 ). The treatment options provided to the current case which included CBT, and family therapy interventions followed the proposed approach described in this previous review ( 35 ).…”

“…A recent review examined the existing research on psychological interventions for ARFID and the criteria used to assess the outcome improvement ( 35 ). The treatment options provided to the current case which included CBT, and family therapy interventions followed the proposed approach described in this previous review ( 35 ).…”

Clinical characteristics, treatment course and outcome of adults treated for avoidant/restrictive food intake disorder (ARFID) at a tertiary care eating disorders program

“…Gastrointestinal disorders and complaints are the most frequently reported co-occurring medical concern among patients with ARFID [ 6 ]. Importantly, most of the research on ARFID has been conducted on children and adolescents, and the extant research focused on adults is extremely limited [ 3 , 4 , 7 , 8 ].…”

Avoidant Restrictive Food Intake Disorder (ARFID)—Looking beyond the eating disorder lens?

“…Positively, this increases awareness of this presentation and enables advocacy for more research and the development of treatments in the field. However, this stance also leads to expectations of existing eating disorder services providing effective care and treatment in the context of, at present, a vastly heterogeneous and weak evidence-base regarding possible treatments (Willmott, et al, 2024) and a lack of clear care pathways in the absence of robust clinical guidelines.…”