Radcliffe ARFID Workgroup: Toward operationalization of research diagnostic criteria and directions for the field

Abstract

Objective Since its introduction to the psychiatric nomenclature in 2013, research on avoidant/restrictive food intake disorder (ARFID) has proliferated highlighting lack of clarity in how ARFID is defined. Method In September 2018, a small multi‐disciplinary pool of international experts in feeding disorder and eating disorder clinical practice and research convened as the Radcliffe ARFID workgroup to consider operationalization of DSM‐5 ARFID diagnostic criteria to guide research in this disorder. Results By consensus of the Radcliffe ARFID workgroup, ARFID eating is characterized by food avoidance and/or restriction, involving limited volume and/or variety associated with one or more of the following: weight loss or faltering growth (e.g., defined as in anorexia nervosa, or by crossing weight/growth percentiles); nutritional deficiencies (defined by laboratory assay or dietary recall); dependence on tube feeding or nutritional supplements (≥50% of daily caloric intake or any tube feeding not required by a concurrent medical condition); and/or psychosocial impairment. Conclusions This article offers definitions on how best to operationalize ARFID criteria and assessment thereof to be tested in existing clinical populations and to guide future study to advance understanding and treatment of this heterogeneous disorder.

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

“…Bringing together FEDs in a single grouping represents an expanded appreciation for the clinical significance of feeding problems during infancy and childhood [75,76]. The guidelines for pica and rumination-regurgitation disorder have not changed substantially from the ICD-…”

Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

“…1,3,5,14 ARFID is distinguished from these symptoms alone, though by avoidant/restrictive eating that leads to weight loss, nutritional deficiencies, dependence on supplemental feedings, and/or psychosocial impairment. 12,15 There is increased interest in the gastroenterology field to identify underlying or comorbid FED symptoms to inform treatment decision-making. 16,17 In patients with gastroparesis/ dyspepsia, FED symptoms could be causing or contributing to gastroparesis symptoms.…”

“…Interestingly, symptoms of gastroparesis/dyspepsia overlap with those described in patients with FEDs, including abdominal pain, early satiety, postprandial fullness, nausea, bloating/distension, and vomiting (non‐self‐induced) 1,3,5,14 . ARFID is distinguished from these symptoms alone, though by avoidant/restrictive eating that leads to weight loss, nutritional deficiencies, dependence on supplemental feedings, and/or psychosocial impairment 12,15 …”

Introduction to a special issue on child and adolescent feeding and eating disorders and avoidant/restrictive food intake disorder

“…Both are welcome additions to the literature as they will enable clinicians and researchers to more rigorously establish the prevalence of ARFID in epidemiological studies, separate individuals with ARFID from healthy controls in biological studies, and evaluate outcomes from novel treatments. Indeed, application of the concepts and tools from Eddy et al (), Bryant‐Waugh et al (), and Schmidt et al () may solve many of the diagnostic problems raised by Strand's (2019) comprehensive review.…”

“…For independence of the review process, Ruth Striegel Weissman served as the editor for three manuscripts included in this Special Issue (Bryant‐Waugh et al, ; Eddy et al, ; Izquierdo et al, ).…”