A Scoping Review of Psychological Interventions and Outcomes for Avoidant and Restrictive Food Intake Disorder (ARFID)

Abstract

ObjectiveThis systematic scoping review examined available studies reporting on psychological interventions for Avoidant Restrictive Food Intake Disorder (ARFID) and synthesised how outcomes are measured during such interventions.Method Five databases (Cochrane, Embase, Medline, PsychInfo and Web of Science) were searched on 9th May and 22nd December 2022. Studies were included if they reported on psychological interventions for patients with a diagnosis of ARFID. Studies were excluded if patients did not have ARFID and if psychological interventions were not provided or detailed. Overall, fifty studies were included and synthesised. Results The most common psychological interventions for ARFID were behavioural therapy (17 studies), followed by cognitive-behavioural therapy (16 studies), and family-based therapy (14 studies). Most studies reported on psychological interventions for children and adolescents with ARFID (42 studies), The majority of included studies were from Western samples (including 33 from the US or Canada). Almost half of studies were single-case study designs (22 studies). compared to adult samples. Outcomes were generally favourable and were most commonly measured via physical health metrics (33 studies). Discussion This review highlights the advances in psychological interventions for ARFID over the past 10 years. The most common psychological interventions for ARFID were behavioural approaches, CBT, and FBT, with common themes across these interventions such as food exposure, psychoeducation, family involvement, and anxiety management. Several areas for future research and implications for clinical practice are discussed, including the need for individualised formulation to guide interventions, more rigorous treatment studies, and more research for adults with ARFID.

Traits of Autism Spectrum Disorder and Anxiety as Correlates of Picky Eating and Disordered Eating in an Adult Non-Clinical Population

“…Given that this study identi ed that anxiety was associated with both picky eating and disordered eating, anxiety management may be an important component in supporting adults with these eating disturbances. Further, this may suggest support for anxiety may be important in the prevention and/or early intervention of eating disorders including ARFID and AN, corroborating previous ndings that anxiety management is important in the treatment of these eating disorders (11,47).…”

“…Therefore, the current study focussed on young adults, and the ndings may not be representative of older adults. Given that recent research has highlighted that more older adults are receiving late diagnoses of autism (60), that eating disturbances can present across the lifespan (10, 61) and that adults with ARFID are under-researched (11), improved understanding of autistic traits and eating pathology in older adults is necessary.…”

Importance of Distinguishing Avoidant/Restrictive Food Intake Disorder From Other Eating Disorders in Patients With Disorders of Gut-brain Interaction

“…When considering eating disorder differential diagnoses in patients being seen for a DGBI, it is important to distinguish ARFID from other weight and/or body image-motivated eating disorders, as treatments for these conditions vary [3][4][5] and effectively engaging patients in seeking treatment may be hindered by incorrectly describing their restrictive eating patterns as the more stereotypical eating disorders of anorexia nervosa or BN, given varying attitudes and stigma associated with the different conditions 6 and the stigma of psychiatric blame for DGBI conditions more generally. 7,8 Nausea and vomiting disorders, in particular, may be easily confused with BN, which is characterized by episodes of binge eating and inappropriate compensatory behaviors, including vomiting.…”

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

“…Yet, research on ARFID has almost exclusively focused on children and adolescents, with little investigation in adult populations overall and existing adult studies limited to patients in treatment settings (10). Despite evidence that ARFID is a prevalent and impairing condition, research suggests that it often goes undetected, and no evidence-based treatment recommendations for ARFID currently exist (11,12). Thus, additional study into ARFID's prevalence and characteristics is urgently needed, particularly in under-researched groups including adults and individuals who are not currently in treatment.…”