Avoidant/restrictive food intake disorder (ARFID)

Last edited 11/2020 and last reviewed 11/2020

Avoidant/restrictive food intake disorder (ARFID) (1) was defined in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5)

• DSM-5 criteria
• to be diagnosed with ARFID, an individual must have problematic eating habits, which may be due to an inability to tolerate certain sensory properties of food (e.g., texture, taste, appearance); a fear of potential adverse consequences of eating (e.g., choking, vomiting); and/or an overall lack of interest in food or eating
• these "alterations must be significant enough to cause either weight loss or failure to gain appropriate weight in growing children; nutritional deficiencies; dependence on nutritional supplements (e.g., energy-dense drinks or tube-feeding); or psychosocial dysfunction" (2)
  
  
• ARFID behaviours:
• cannot be due to food insecurity or culturally accepted practices;
• are not motivated by fear of weight gain or weight/shape overvaluation as in anorexia nervosa (AN) or bulimia nervosa (BN)
• cannot better be explained by another medical or psychological disorder
  
  
• if another medical or psychiatric disorder present
• food avoidance or restriction must be more extreme than what would typically be expected for the co-occurring condition
  
  
• ARFID can be diagnosed in individuals of all ages (2,3)


• evidence suggests that youth with ARFID are significantly more likely to develop this disorder at a younger age, experience a longer duration of symptoms, are more likely to be male, have longer inpatient stays for medical stabilization, and present with weights higher than those with AN but lower than those with BN (4)


• ARFID aetiology is unknown
• probable that both biological and environmental factors—and their interplay—contribute to pathogenesis
• has been hypothesized that that there may be biological bases that underlie sensory sensitivity, trait anxiety, and both homeostatic and hedonic appetites, which may increase vulnerability to ARFID (2)
• environmental factors such as family meal milieu, availability of fruits and vegetables in the local environment, and exposure to models of healthy eating and/or diverse foods may also play a role (2)

Reference:

• (1). American Psychiatric Association, American Psychiatric Association DSM-5 Task Force. Diagnostic and statistical manual of mental disorders : DSM-5. 5th ed. ed. Arlington, VA; 2013
• (2) Brigham KS et al. Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents.Curr Pediatr Rep. 2018 June ; 6(2): 107–113. doi:10.1007/s40124-018-0162-y.
• (3) Becker KR et al. Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa. Int J Eat Disord. 2019 March ; 52(3): 230–238. doi:10.1002/eat.22988.
• (4) Duncombe Lowe K et al. Youth with Avoidant/Restrictive Food IntakeDisorder: Examining Differences by Age, WeightStatus, and Symptom Duration.Nutrients2019,11, 1955; doi:10.3390/nu11081955