Avoidant/restrictive food intake disorder or ARFID is a feeding and eating disorder that is characterized by patterns of avoidant or restrictive eating. ARFID, previously called “Selective Eating Disorder”, is similar to anorexia nervosa in that individuals with both of these disorders limit the amount and/or type of foods they consume; however, unlike anorexia, eating behaviors associated with ARFID are not driven by concerns related to body shape or size or fears of gaining weight.
While ARFID is considered to be a disorder that primarily affects children and adolescents, ARFID also affects adults. Exactly how adults with ARFID come to the attention of treaters is not well understood. Patients with ARVID and those with disorders of the gut–brain interaction (DGBI, formerly called “functional gastrointestinal disorders”) both present with specific eating patterns in response to gastrointestinal complaints; it is unclear, however, how commonly ARFID occurs among adults with DGBI symptoms.
In a retrospective review of charts from referrals of adults (ages, 18–90 years; 73.0% female) to a tertiary care center for neurogastroenterology examination. Blinded coders reviewed a total of 410 referrals, applying Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria for ARFID.
In this cohort, 26 individuals (6.3%) met the full criteria for ARFID and 71 (17.3%) had clinically significant avoidant or restrictive eating behaviors but insufficient data to make a definitive diagnosis of ARFID. Among the patients with ARFID symptoms (n = 97), 90 patients (92.8%) reported fear of gastrointestinal symptoms as the motivation for their avoidant or restrictive eating, most commonly nausea (n = 34), bloating (n = 30), generalized abdominal pain/discomfort (n = 26), and vomiting (n = 21).
ARFID was more common in patients with eating or weight-related complaints, such as low weight, weight loss, poor appetite, and food aversion (odds ratio [OR], 5.09; 95% CI, 2.54–10.21). ARFID was also more common in those with stomach complaints (OR, 1.82; 95% CI, 1.04–3.20). The following stomach complaints were more frequent in those with versus those without ARFID symptoms, respectively: postprandial fullness (12.4% vs 3.5%), early satiety (20.6% vs 6.1%), and epigastric pain (28.9% vs 15.7%).
With regard to diagnosis, ARFID symptoms were more commonly observed in individuals given the following diagnoses: dyspepsia/nausea/vomiting diagnosis (OR, 3.59; 95% CI, 2.04–6.32; P < .001), chronic abdominal pain diagnosis (OR, 4.72; 95% CI, 1.89–11.81; P = .001), and lower gastrointestinal diagnoses (OR, 2.04; 95% CI, 1.34–4.32; P = .003).
Determining whether patients have ARFID, a gastrointestinal disorder, or both has significant clinical implications with regard to treatment choices. For example, the treatment prescribed for some DGBI may recommend avoidance of certain foods to prevent gastrointestinal symptoms; however, this approach would not be recommended in exposure-based treatment for ARFID (e.g., cognitive-behavioral therapy for ARFID). The findings of this study indicate that among adults seeking neurogastroenterology evaluation, ARFID symptoms were common, occurring in about 24% of the referred patients. Although ARFID symptoms were common, only one case was formally diagnosed with ARFID. These findings suggest that certain presenting complaints and diagnoses are more commonly present in patients with ARFID, which may help clinicians identify patients with ARVID and treatment approaches.
Murray HB, Bailey AP, Keshishian AC, Silvernale CJ, Staller K, Eddy KT, Thomas JJ, Kuo B. Prevalence and Characteristics of Avoidant/Restrictive Food Intake Disorder in Adult Neurogastroenterology Patients. Clin Gastroenterol Hepatol. 2020 Aug;18(9):1995-2002.
Helen Burton Murray, MS is a Clinical Fellow in Psychology in the MGH Department of Psychiatry.
Kamryn Eddy, PhD is co-director of the Eating Disorders Clinical and Research Program at MGH and is an Associate Professor of Psychology in the Harvard Medical School. Dr. Eddy specializes in assessing and treating children, adolescents and young adults with eating disorders.
Jennifer J. Thomas, PhD is the Co-Director of the Eating Disorders Clinical and Research Program at MGH and an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School. Dr. Thomas’s research focuses on atypical eating disorders, as described in her co-authored books: Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem? and Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. She is currently principal investigator on several studies investigating the neurobiology and treatment of avoidant/restrictive food intake disorder.
