Characteristics of outpatients diagnosed with the selective/neophobic presentation of avoidant/restrictive food intake disorder

Abstract

Objective Although Avoidant/Restrictive Food Intake Disorder (ARFID) has existed since the publication of DSM‐5 in 2013, research on the descriptive psychopathology of treatment‐seeking patients with formal ARFID diagnoses is sparse, and limited to tertiary eating disorder‐focused treatment settings where most patients present with weight loss/malnutrition. In these settings, the selective/neophobic symptom presentation is rare compared to other primary eating restrictions. We aimed provide initial descriptive psychopathology of ARFID primary selective/neophobic symptom presentation in an outpatient setting, and to explore the prevalence of the core ARFID symptoms and clinical differences among patients meeting criteria based on weight/nutritional symptoms versus psychosocial impairment only. Method We reviewed the charts of 22 consecutive outpatients diagnosed with ARFID caused by selective/neophobic eating, and describe symptoms, impairment, illness trajectory, and demographic features. Patients who met ARFID criteria because of weight loss/nutritional problems were compared to those who met for psychosocial impairment only on demographic and clinical characteristics. Results Patients were predominantly male (81.8%) and school‐aged (4–11 years). 81.8% had no weight/nutritional symptoms documented by a medical provider. All met criteria for significant psychosocial impairment. There were few differences between patients who did versus did not meet weight loss/nutritional criteria for ARFID; they differed only in age and in the presence of appetite disturbances consistent with another proposed presentation of ARFID. Discussion These results provide novel data on the clinical characteristics of individuals who present with a primary presentation of selective/neophobic ARFID, including support for psychosocial impairment as sufficient for fulfilling ARFID criterion A.

Classifying and characterizing Chinese young adults reporting picky eating: A latent profile analysis

“…Picky eating appears to be most strongly related to eating‐related social anxiety and social impairment (e.g., Ellis, Galloway, et al, ), and the psychosocial impacts of PE may best be captured by the Personal and Social subscales of the CIA. As PE can be associated with increased, decreased, or appropriate caloric intake (Zickgraf, Murray, et al, ), a substantial proportion of individuals with PE are unlikely to experience impairment related to starvation. There is a need for further research exploring the relationship between PE and ARFID symptoms, particularly those related to weight and psychosocial impairment.…”

“…Yet, in some cases, PE is not benign. Clinically significant PE, also referred to as “selective” or “selective/neophobic” eating, can lead to a diagnosis of avoidant/restrictive food intake disorder (ARFID), an eating/feeding disorder characterized by restrictive eating not attributed to weight or shape concerns that leads to weight loss, nutritional insufficiencies, dependence on nutritional supplements, and/or psychosocial impairment (American Psychiatric Association, ; Fisher et al, ; Kennedy, Wick, & Keel, ; Reilly, Brown, Gray, Kaye, & Menzel, ; Thomas et al, ; Zickgraf, Lane‐Loney, Essayli, & Ornstein, ; Zickgraf, Murray, Kratz, & Franklin, ). PE is one of three patterns of restrictive eating that have been linked to ARFID symptoms in both nonclinical samples (e.g., Zickgraf & Ellis, ) and in treatment‐seeking patients diagnosed with ARFID (e.g., Reilly et al, ; Zickgraf, Lane‐Loney, et al, ).…”

“…Although it is clear that a subset of clinically diagnosed ARFID patients have symptoms that are attributable to PE (e.g., Reilly et al, ; Zickgraf, Lane‐Loney, et al, ; Zickgraf, Murray, et al, ), given the high prevalence of PE, and its normal distribution in the general population, there is a need for more understanding of how, and under what conditions, PE can cause nutritional deficiencies, weight loss, and psychosocial impairment. This is an emerging body of literature, almost entirely based on data collected in Western countries.…”

Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder

“…Much like those with ARFID, individuals with ADHD are often hyper‐sensitive and display exaggerated responses to sensory stimuli (Baranek, David, Poe, Stone, & Watson, ), which may include the taste and texture of food. Indeed, the prevalence of ADHD among individuals presenting with the “selective eating” profile of ARFID ranged from 24% to 25% in one study that utilized two raters (Reilly et al, ), and from 16% (Zickgraf, Lane‐Loney, et al, ) to 20% (Zickgraf, Murray, et al, ) in two studies. Exposure to sensory stimuli that produce an exaggerated response may be a relevant treatment target for those with co‐occurring ARFID and neurodevelopmental disorders.…”

“…to 25% in one study that utilized two raters (Reilly et al, 2019), and from 16% (Zickgraf, Lane-Loney, et al, 2019) to 20% (Zickgraf, Murray, et al, 2019) in two studies. Exposure to sensory stimuli that produce an exaggerated response may be a relevant treatment target for those with co-occurring ARFID and neurodevelopmental disorders.…”