Avoidant/restrictive Food Intake Disorder

Contributor: Joan K. Orrell-Valente, PhD, LP, Linsey Utzinger, PhD and Julie Lesser, MD at
Center for the Treatment of Eating Disorders of Children’s Hospital, Minneapolis, MN

Avoidant/Restrictive Food Intake Disorder (ARFID) is a new diagnostic category in the feeding and eating disorders section of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5, 2013).

The ARFID diagnosis was developed to subsume and extend the DSM 4th edition (DSM IV-TR, 2000) diagnoses of Eating Disorder Not Otherwise Specified (EDNOS) and Feeding Disorder of Infancy or Early Childhood, with the aim of capturing and better defining the range of disordered eating symptoms that can occur across the lifespan.

Diagnostic criteria include restrictive caloric intake, weight loss, malnutrition, dependence on enteral feeding or nutritional supplements, and psychosocial impairment, without the body image concerns or fears of weight gain that are characteristic of anorexia nervosa and bulimia nervosa.

ARFID Can Be Varied

ARFID is recognized to be varied in its clinical presentation.

A diagnosis of ARFID may include:

• Avoidance of oral intake associated with a medical condition (e.g., gastrointestinal disease);
• Developmental disorder (e.g., autism spectrum with sensory concerns);
• Anxiety disorder (e.g., vomiting or choking phobia or obsessive compulsive disorder); or
• History of selective (picky) eating

Although little empirical data exist about effective treatment interventions for individuals diagnosed with ARFID, there are several prominent characteristics of ARFID, such as avoidance behaviors and caloric restriction, which may respond to known treatment approaches and strategies.

Because patients may experience abdominal pain and other aversive consequences when they eat, they can also exhibit symptoms of anxiety that further exacerbate food avoidance. These primary disturbances frequently have negative physiological and psychosocial sequelae.

The range of symptoms with which patients present often demands multidisciplinary care which can include pediatric medicine, integrative medicine, psychiatry, psychotherapy, nursing, and nutrition.

Treatment Approaches for ARFID

Though formally diagnosed as EDNOS or as a Feeding Disorder prior to DSM 5, and as ARFID since then, patients with the ARFID clinical profile have been treated at the Center for the Treatment of Eating Disorders (CTED) since CTED was established in October 2011.

At CTED, we have developed and implemented a combined treatment approach that includes elements of:

• Family-Based Treatment (e.g., family meal, early-stage parent involvement in refeeding; Lock & LeGrange, 2005, 2013)
• The Unified Protocol for the Treatment of Emotional Disorders (e.g., psychoeducation on the cognitive triad and emotional processing, graduated exposures; Barlow et al., 2010)
• Food chaining (e.g., flavor mapping)
• Nutrition counseling (e.g., nutritional needs, strategies to facilitate weight regain)
• Behavior modification (e.g., positive reinforcement)
• Parent skills enhancement (e.g., establishing a pattern of regular eating, contingent reinforcement)

A minority of patients may require hospitalization for medical stabilization, and certain patients may be prescribed psychiatric medications (e.g., hydroxyzine) to help with nausea or sensations of abdominal fullness.

Because clinical presentations vary, treatment strategies may need to vary as well. Selected treatment components are implemented based on the ARFID sub-type.

Community Discussion – Share your thoughts here!

Have you or someone you love had experience with Avoidant/Restrictive Food Intake Disorder? What advise do you have to give others that may be struggling with this disorder?

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References:

1. Barlow, D.H., Ellard, K.K., Fairholme, C.P, Farchione, T.J., Boisseau, C.L., Allen, L.B. & Ehrenreich-May, J. (2011). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. Oxford/New York: Oxford University Press.
2. Diagnostic American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC/London, England: American Psychiatric Publishing.
3. Lock, J. & Le Grange, D. (2013). Treatment manual for anorexia nervosa: A family-based approach. New York/London: Guilford Press.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 1st, 2014
Published on EatingDisorderHope.com