Children with avoidant/restrictive food intake disorder and anorexia nervosa in a tertiary care pediatric eating disorder program: A comparative study

Abstract

Objective The purpose of this study was to examine the medical and psychological characteristics of children under the age of 13 years with avoidant restrictive food intake disorder (ARFID) and anorexia nervosa (AN) from a Canadian tertiary care pediatric eating disorders program. Method Participants included 106 children assessed between 2013 and 2017 using the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM‐5). Data were collected through clinical interviews, psychometric questionnaires, and chart review. Information collected included medical variables (e.g., weight, heart rate, need for inpatient admission, and duration of illness from symptom onset); medical comorbidities (e.g., history of food allergies, infection, and abdominal pain preceding the eating disorder); and psychological variables (e.g., psychiatric comorbidity, self‐reported depression and anxiety, and eating disorder related behaviors and cognitions). Results Children with ARFID had a longer length of illness, while those with AN had lower heart rates and were more likely to be admitted as inpatients. Children with ARFID had a history of abdominal pain and infections preceding their diagnoses and were more likely to be diagnosed with a comorbid anxiety disorder. Children with AN had a higher drive for thinness, lower self‐esteem, and scored higher on depression. Discussion This is the first study to look at DSM‐5 diagnosis at assessment and include psychometric and interview data with younger children with AN and ARFID. Understanding the medical and psychological profiles of children with AN and ARFID can result in a more timely and accurate diagnosis of eating disorders in younger children.

Youth with Avoidant/Restrictive Food Intake Disorder: Examining Differences by Age, Weight Status, and Symptom Duration

“…There is a growing literature examining the clinical differences between individuals presenting with ARFID in comparison to other eating disorders (e.g., anorexia nervosa [AN], bulimia nervosa [BN]). Findings suggest that youth with ARFID are significantly more likely to develop this disorder at a younger age, experience a longer duration of symptoms, are more likely to be male, have longer inpatient stays for medical stabilization, and present with weights higher than those with AN but lower than those with BN [2,3,4,6,7]. Previous research in the eating disorder literature suggests that clinical and medical presentations differ depending on eating disorder diagnosis, age, weight status, and symptom duration and frequency [6,8,9,10].…”

“…Findings suggest that youth with ARFID are significantly more likely to develop this disorder at a younger age, experience a longer duration of symptoms, are more likely to be male, have longer inpatient stays for medical stabilization, and present with weights higher than those with AN but lower than those with BN [2,3,4,6,7]. Previous research in the eating disorder literature suggests that clinical and medical presentations differ depending on eating disorder diagnosis, age, weight status, and symptom duration and frequency [6,8,9,10]. Given that ARFID is a recent addition to the DSM-5, research efforts to describe the heterogeneity within ARFID are still underway [2,11,12,13,14].…”

“…Research in this area is difficult due to the complexities inherent to ARFID, including lack of consensus over clear categorization methods, small sample sizes, and overlapping clinical presentations. Studies have looked at group differences between DSM-5-designated ARFID presentations across clinical characteristics, including psychiatric and medical comorbidities, as well as treatment trajectories [6,12,14]; however, there are limitations to the generalizability of findings due to small sample sizes. Given the current state of the literature, the present study aimed to explore group differences within ARFID defined by age, weight status, and symptom duration, as these variables have been identified as significant correlates for other eating disorders, although their impact within ARFID remains poorly understood [6,9].…”

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

“…Despite evidence that suicidality is common among individuals with other eating disorders (Wang et al, n.d.;Franko et al, 2004), only one study (Duncombe Lowe et al, 2019) to date has assessed suicidality among individuals with ARFID and did not report the overall prevalence in the sample. Prevalence of neurodevelopmental disorders was 10% in one study (Lieberman et al, 2019). Specifically, co-occurring rates of attention deficit/hyperactivity disorder (ADHD) have ranged from 4% (Nicely et al, 2014) to 26% (Duncombe Lowe et al, 2019) and cooccurring rates of autism spectrum disorder (ASD) have ranged from 3% (Lieberman et al, 2019) to 13% (Nicely et al, 2014).…”

“…Prevalence of neurodevelopmental disorders was 10% in one study (Lieberman et al, 2019). Specifically, co-occurring rates of attention deficit/hyperactivity disorder (ADHD) have ranged from 4% (Nicely et al, 2014) to 26% (Duncombe Lowe et al, 2019) and cooccurring rates of autism spectrum disorder (ASD) have ranged from 3% (Lieberman et al, 2019) to 13% (Nicely et al, 2014).…”