Case 18-2017 — An 11-Year-Old Girl with Difficulty Eating after a Choking Incident

Thomas, Jennifer J.; Brigham, Kathryn S.; Sally, Sarah T.; Hazen, Eric P.; Eddy, Kamryn T.

doi:10.1056/nejmcpc1616394

Cited by 54 publications

(28 citation statements)

References 21 publications

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“…45 A typical example would be a young person with longstanding selective eating (i.e., sensory sensitivity) and chronic low appetite (i.e., lack of interest in eating) who loses weight precipitously following an acute choking episode (thus developing fear of aversive consequences). 43 Consistent with the National Institute of Mental Health’s Research Domain Criteria (RDoC) approach, we hypothesize that abnormalities in taste perception, homeostatic appetite, and fear responsiveness underlie the three primary ARFID presentations of sensory sensitivity, lack of interest in eating or food, and fear of aversive consequences, respectively. We are currently testing our hypotheses in a study funded by the National Institute of Mental Health (1R01MH108595: “Neurobiological and Behavioral Risk Mechanisms of Youth Avoidant/Restrictive Eating Trajectories,” https://projectreporter.nih.gov/project_info_description.cfm?aid=9244073&icde=34034868&ddparam=&ddvalue=&ddsub=&cr=4&csb=default&cs=ASC&pball=).…”

Section: Directions For Future Researchmentioning

confidence: 87%

“…A recent non-randomized case record review from a pediatric feeding clinic found that patients who were given cyproheptadine gained significant weight over a 6.5-month period, but remained in the underweight range at the end of the study and did not significantly surpass weight gain in a control group who did not take appetite-stimulating medication. 42 Similarly, while a recent recent case report describes the use of mirtazapine—an antidepressant medication with appetite-stimulating properties–to reduce barriers to eating in ARFID with fear of aversive consequences, 43 further research is needed on the efficacy of antidepressant and anti-anxiety medications for the treatment of ARFID across the age span.…”

Section: What Is Currently Known?mentioning

confidence: 99%

“…Indeed, DSM-5 describes three primary ARFID presentations including sensory sensitivity, lack of interest in food or eating, and fear of aversive consequences, 1 which generally coincide with the Great Ormond Street criteria for feeding disorders (i.e., selective eating, food avoidance emotional disorder, and functional dysphagia, respectively). 44 While more research is needed to evaluate the accuracy of this putative ARFID nosology, these three primary presentations are commonly seen in clinical settings 9,43,44 and a recent epidemiological study confirmed that all three were present among the 8–13-year-olds who met criteria for ARFID. 3,14 …”

Section: Directions For Future Researchmentioning

confidence: 99%

“…A recent case report describes the successful application of CBT-AR to an 11-year-old girl with low weight, sensory sensitivity, lack of interest in eating, and fear of aversive consequences. 43 …”

Section: Directions For Future Researchmentioning

confidence: 99%

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Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

Thomas

Lawson

Micali

et al. 2017

Curr Psychiatry Rep

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256

233

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Purpose of review: DSM-5 defined Avoidant/Restrictive Food Intake Disorder (ARFID) as a failure to meet nutritional needs leading to low weight, nutritional deficiency, dependence on supplemental feedings, and/or psychosocial impairment. We summarize what is known about ARFID and introduce a three-dimensional model to inform research. Recent findings: Because ARFID prevalence, risk factors, and maintaining mechanisms are not known, prevailing treatment approaches are based on clinical experience rather than data. Furthermore, most ARFID research has focused on children, rather than adolescents or adults. We hypothesize a three-dimensional model wherein neurobiological abnormalities in sensory perception, homeostatic appetite, and negative valence systems underlie the three primary ARFID presentations of sensory sensitivity, lack of interest in eating, and fear of aversive consequences, respectively. Summary: Now that ARFID has been defined, studies investigating risk factors, prevalence, and pathophysiology are needed. Our model suggests testable hypotheses about etiology and highlights cognitive-behavioral therapy as one possible treatment.

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Section: Directions For Future Researchmentioning

confidence: 87%

Section: What Is Currently Known?mentioning

confidence: 99%

Section: Directions For Future Researchmentioning

confidence: 99%

Section: Directions For Future Researchmentioning

confidence: 99%

See 2 more Smart Citations

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

Thomas

Lawson

Micali

et al. 2017

Curr Psychiatry Rep

Self Cite

256

233

View full text Add to dashboard Cite

show abstract

“…tuberculosis or human immunodeficiency virus), or conditions that hinder chewing or swallowing of boluses of food (e.g. tonsillar hypertrophy, oromotor dysfunction, achalasia) (15). …”

Section: Discussionmentioning

confidence: 99%

Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents

et al. 2018

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Purpose of review: Avoidant/restrictive food intake disorder (ARFID) was added to the psychiatric nomenclature in 2013. However, youth with ARFID often present first to medical— rather than psychiatric—settings, making its evaluation and treatment relevant to pediatricians. Recent findings: ARFID is defined by limited volume or variety of food intake motivated by sensory sensitivity, fear of aversive consequences, or lack of interest in food or eating, and associated with medical, nutritional, and/or psychosocial impairment. It appears to be as common as anorexia nervosa and bulimia nervosa and can occur in individuals of all ages. ARFID is heterogeneous in presentation and may require both medical and psychological management. Summary: Pediatricians should be aware of the diagnostic criteria for ARFID and the possibility that these patients may require medical intervention and referral for psychological treatment. The neurobiology underlying ARFID is unknown, and novel treatments are currently being tested.

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A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder

Strand

Hausswolff-Juhlin

Welch

2018

Intl J Eating Disorders

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Objective Avoidant/restrictive food intake disorder (ARFID) was introduced as a new diagnosis in the DSM‐5. This systematic scoping review explores how ARFID as a diagnostic entity is conceptualized in the research literature and evaluates the diagnostic validity according to the Feighner criteria. Method A systematic scoping review of papers on ARFID in PubMed/MEDLINE and Web of Science was undertaken, following PRISMA and Joanna Briggs Institute guidelines. Results Fifty‐one original research publications, 23 reviews and commentaries, and 20 case reports were identified. The use of ARFID as a conceptual category varies significantly within this literature. At this time, the ARFID diagnosis does not fulfil the Feighner criteria for evaluating the validity of diagnostic constructs, the most urgent problem being the demarcation toward other disorders. A three‐dimensional model—lack of interest in food, selectivity based on sensory sensitivity, and fear of aversive consequences—is gaining support in the research literature. Discussion The introduction of the ARFID diagnosis has undoubtedly increased the recognition of a previously largely neglected group of patients. However, this article points to an inability of the current DSM‐5 diagnostic criteria to ensure optimal diagnostic validity, which risks making them less useful in clinical practice and in epidemiological research. To increase the conceptual validity of the ARFID construct, several possible alterations to the current diagnostic criteria are suggested, including a stronger emphasis of the three identified subdomains and further clarifying the boundaries of ARFID.

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Case 18-2017 — An 11-Year-Old Girl with Difficulty Eating after a Choking Incident

Cited by 54 publications

References 21 publications

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents

A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder

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