Treatment Needs and Rates of Mental Health Comorbidity in Adolescent Patients With ARFID

Abstract

The purpose of this paper is to provide a descriptive overview of a single-center ARFID-specific pilot clinic that sought to better understand the specific needs of patients with ARFID including rates of comorbidities, and to gain insight into treatment requirements. A retrospective cohort study was completed on patients meeting criteria for ARFID admitted to a specialized pilot clinic within a tertiary care hospital. Over an 18 month period, a total of 26 patients were assessed and had follow-up data for a 12 month period. Patients presented with heterogeneous manifestations of ARFID and high rates of comorbid mood and anxiety disorders were noted. Treatment plans were tailored to meet individual needs at assessment and over the treatment period. A multidisciplinary approach was most often administered, including a combination of individual therapy, family therapy, medical monitoring, and prescribed medications. Only 30% of patients were treated exclusively by therapists on the eating disorder team. The experiences gained from this pilot study highlight the need for specialized resources for assessment and treatment of patients with ARFID, the importance of a multidisciplinary approach to treatment, and the necessity of utilization of ARFID-specific measures for program evaluation purposes.

How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (ARFID)

“…Preliminary evidence for diagnostic transition from ARFID to AN [ 21 , 28 , 29 ] also suggests shared aetiology. Furthermore, there is considerable phenotypic overlap, and comorbidity, between ARFID and neurodevelopmental disorders such as ASD or ADHD [ 15 , 16 , 30 ], and other psychiatric conditions including anxiety and OCD [ 14 , 15 ]. This is in contrast to AN, for example, where comorbid neurodevelopmental disorders are less frequent, and depression is more prevalent than anxiety [ 14 , 15 , 30 – 32 ].…”

“…Although these proposed presentations are not officially recognised in classification systems, they are commonly used in the literature and we have referred to them as ‘limited intake’, ‘limited variety’, and ‘aversive’ presentations in the following text. Although individual case reports demonstrate each of the three proposed presentations, a mixed clinical presentation is often observed in ARFID patients [ 30 , 33 ] and Thomas et al [ 34 ] propose that individuals with ARFID can present with any degree of features.…”

“…An aversive outcome ARFID presentation is characterised by food avoidance or restriction based on a fear of undesired consequences such as choking, allergic reaction, nausea or vomiting, illness etc. For many, this occurs acutely following exposure to a traumatic event, and individuals frequently display a concurrent anxiety disorder [ 13 , 30 , 35 ]. Patients with this presentation are reported to have a shorter length of illness and are more frequently hospitalised (associated with more acute weight loss and associated health concerns) than the other two presentations [ 13 , 30 , 33 , 35 ].…”

“…For many, this occurs acutely following exposure to a traumatic event, and individuals frequently display a concurrent anxiety disorder [ 13 , 30 , 35 ]. Patients with this presentation are reported to have a shorter length of illness and are more frequently hospitalised (associated with more acute weight loss and associated health concerns) than the other two presentations [ 13 , 30 , 33 , 35 ].…”

“…Generalized anxiety disorder, social anxiety disorder, and obsessive–compulsive disorder (OCD) are commonly reported to co-occur with ARFID. Compared to comorbidity patterns in other EDs, those with ARFID have relatively higher prevalence of anxiety disorders (35–73%), but lower prevalence of depression (15–35%) [ 14 , 15 , 30 – 32 ]. The latter may be an age dependent factor [ 46 ].…”