Avoidant/Restrictive Food Intake Disorder

This new DSM-5 category involves younger, significantly underweight patients who are distinctly different from those with AN and BN.

One of the new diagnostic categories in the DSM-5 is (ARFID). These individuals have disordered eating symptoms that don’t match the criteria of traditional eating disorders. Instead, they have clinically significant struggles with eating and food, and very young children have problems with feeding. As a result, the individual’s diet does not provide enough calories or adequate nutrition. Adults with ARFID lose weight; younger children may not lose weight but can’t gain weight and may not grow as expected.

The problems caused by ARFID go far beyond issues with food. The effects of the eating problems can affect adults at work and in their social lives. For example, at work they avoid working lunches and avoid family and friends at social events, where food is often present. Children have similar problems at school, for example, problems with schoolwork because of the extra time needed to eat their school lunch.

A case-control study attempts to better define ARFID

To clarify differences between children and adolescents with ARFID and patients with anorexia nervosa (AN) and bulimia nervosa (BN), Dr. M.M. Fisher and colleagues conducted a retrospective case-control study of 8 to 18-year-olds by using a diagnostic algorithm. The researchers compared all students with ARFID presenting at seven adolescent medicine-eating disorders programs in 2010 with a randomly selected sample of adolescent patients with AN and BN. The final group included 712 individuals.

Ninety-eight (13.8%) of the teens met the DSM-5 criteria for ARFID. The ARFID group had a number of distinct characteristics; for example, they were younger than the patients with AN (n=98) and those with BN (n=66) (12.9 years of age vs. 15.6 years of age, vs. 16.5 years of age, respectively). The group with a diagnosis of ARFID also had been ill longer than had the AN and BN groups (33.3, 14.5, and 16.5 months, respectively. In addition, those diagnosed with ARFID were more likely to be male (29%, 15%, and 6%, respectively) and had median body weights that fell between those of patients with AN or BN (86.5, 81.0, and 107.5 lb, respectively).

As the researchers further evaluated the ARFID patients, they found that more than a fourth had histories of selective (“picky”) eating dating back to early childhood. They also had generalized anxiety (21.4%), gastrointestinal symptoms (19.4%), and a history of fear of vomiting or choking on food (13.1%), and food allergies (4.1%). Teens with ARFID were more likely to have comorbid medical conditions or anxiety disorder (58%, 35%, and 33%, respectively), but were less likely to have mood disorders (19%, 31%, and 58%, respectively).

Thus, the authors found clear clinical distinctions between teens with ARFID and those with AN or BN. As in an earlier study by Norris et al. (Int J Eat Disord. 2013; Dec. 16 doi:10.1002/eat.22217), Dr. Fisher and colleagues found that those diagnosed with ARFID were significantly underweight and had a greater likelihood of having comorbid medical and/or psychiatric symptoms. The earlier study results also suggested that a proportion of these patients develop AN as treatment progresses.