Exploring the cooccurrence of behavioural phenotypes for avoidant/restrictive food intake disorder in a partial hospitalization sample

Abstract

Objective Literature providing clinical characterizations of avoidant/restrictive food intake disorder (ARFID) has proposed the occurrence of three functions for food refusal: fear of negative consequences, lack of hunger, or sensory sensitivity. Recent studies have suggested that these functions may be used to subtype patients presenting with ARFID; however, other work suggests that these categories are not mutually exclusive and instead represent neurobiological dimensions that can cooccur. The current study explored the potential cooccurrence of behavioural phenotypes in patients with ARFID presenting to a partial hospitalization program. Method Two raters conducted a retrospective chart review of patients with ARFID presenting to treatment from June 2014 to May 2018 (N = 59). Results Regarding cooccurrence of symptoms consistent with behavioural phenotypes, raters showed excellent agreement, and over 50% of the sample endorsed symptoms consistent with more than one phenotype. The sensory sensitivity phenotype was most common in the sample and frequently cooccurred with both other phenotypes. Discussion Results suggest that multiple functions for food avoidance may be present within one individual. Future work should aim to further characterize individuals presenting with singular versus multiple phenotype characteristics.

Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample

“…In contrast to AN, patients with ARFID lack shape concerns, body image preoccupation, and drive for thinness (Norris, Spettigue, & Katzman, 2016; Schmidt, Vogel, Hiemisch, Kiess, & Hilbert, 2018). Instead, they often have a narrow range of accepted foods based on taste, texture, colour, appearance, or odour, a fear of swallowing, choking or vomiting, and/or a lack of interest in food or disgust (Harris et al, 2019; Mammel & Ornstein, 2017; Norris et al, 2018; Reilly, Brown, Gray, Kaye, & Menzel, 2019; Zickgraf, Lane‐Loney, Essayli, & Ornstein, 2019). Generally, ARFID has a higher prevalence in younger children and boys than other eating disorders and is frequently associated with concurrent physical and psychological symptoms and lower quality of life (Fisher et al, 2014; Krom et al, 2019; Nicely, Lane‐Loney, Masciulli, Hollenbeak, & Ornstein, 2014).…”

Adapting treatment in an eating disorder program to meet the needs of patients with ARFID: Three case reports

“…; DSM-5) gives three examples of what might qualify as an eating or feeding disturbance: individuals who seem disinterested in eating, those who avoid certain foods because of a sensitivity to specific characteristics of the food, such as texture or color, and those who are concerned about an aversive experience associated with eating, such as choking or difficulty swallowing (APA, 2013). Empirical studies have supported the existence of these subtypes (Norris et al, 2018; Zickgraf, Lane-Loney, Essayli, & Ornstein, 2019), although they are not mutually exclusive, with one study finding that over 50% of patients endorsed symptoms characteristic of more than one subtype (Reilly, Brown, Gray, Kaye, & Menzel, 2019).…”

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

“…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, ). The other two ARFID presentations involve restrictive eating due to apparent lack of appetite or interest in eating, and restrictive eating due to fear of aversive consequences from eating, such as choking and vomiting.…”

“…The other two ARFID presentations involve restrictive eating due to apparent lack of appetite or interest in eating, and restrictive eating due to fear of aversive consequences from eating, such as choking and vomiting. Although the ARFID presentations show significant overlap in both nonclinical and diagnosed samples (e.g., Reilly et al, ; Zickgraf & Ellis, ), there is also evidence that they are phenomenologically and statistically distinct from one another. Therefore, it is likely that each presentation has its own etiological and maintenance mechanisms linked to severity of restrictive eating and likelihood of experiencing ARFID symptoms.…”

“…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.…”