The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder

Abstract

High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.

Translation of the nine item avoidant/restrictive food intake disorder screen (NIAS) questionnaire in French (NIAS‐Fr)

“…Up to 40% of DGBI patients meet criteria for symptoms of ARFID, 9 particularly those with a history of restrictive diets 10 . While ARFID‐like symptoms are common among DGBI patients, we found only eight papers that meet keywords for both ARFID and DGBI on PubMed to date 9,11–17 . In addition, since ARFID has been first described by the DSM‐5 in 2013, the current literature on this eating disorder among adult population is very limited.…”

Latent profile analysis reveals the central role of psychological symptoms in driving disease severity in chronic constipation

“…While our study included a well‐validated measure of ED symptoms, 42 our study lacked inclusion of a measure specific to avoidant/restrictive food intake disorder (ARFID), an ED with high comorbidity in DGBI 43,44 . It is possible that the Oral Control subscale may capture some ARFID symptoms, as shown in studies with children and adolescents 45,46 .…”

Importance of Distinguishing Avoidant/Restrictive Food Intake Disorder From Other Eating Disorders in Patients With Disorders of Gut-brain Interaction

“…Increasing awareness of the comorbidity between disorders of gutbrain interaction (DGBI) and avoidant/ restrictive food intake disorder (ARFID) provided by Weeks et al 1 is incredibly important and helpful to improve care in these populations. This psychiatric disorder is distinguished from other eating disorders in that it does not involve underlying weight, shape, or body image concerns.…”

“…This psychiatric disorder is distinguished from other eating disorders in that it does not involve underlying weight, shape, or body image concerns. 2 The visual comparison provided in Table 1 of the clinical review by Weeks et al 1 is misleading in understanding this distinction by failing to include "body image concerns" as a required symptom in bulimia nervosa (BN) and as a potential symptom in other specified feeding or eating disorder diagnoses.…”

“…In addition to the screening questions and questionnaires recommended by Weeks et al, 1 appropriate screening for weight and shape-based eating disorders is necessary to differentiate education and treatment. The Nine Item ARFID Screen 10 is not validated to differentiate ARFID from other eating disorders, and additional measures, such as the EDE-Q, 11 are recommended for this purpose.…”