Avoidant/Restrictive Food Intake Disorder

We often see patients with feeding difficulties that don’t fit with anorexia nervosa, but are more attributable to food aversion/sensory issues. This is known as ARFID or avoidant/restrictive food intake disorder. Here is some background info.

• Overview:
  • Dx created in 2013 with DSM5. Very recent, so there’s not a lot of data about it.
  • Occurs across the lifespan, including adults
  • More common in males than females

• DSM criteria:
  • All must be met:
  • Avoidant/restrictive intake due to:
    • Low appetite
    • Sensory aversion
    • Or Conditioned fear/anxiety after aversive eating experiences
  • Results in ≥1:
    • Weight loss or poor growth
    • Nutritional deficiency
    • Dependence on supplements/enteral feeding
    • Psychosocial impairment
  • Not due to:
    • Food unavailability or cultural practice
    • Anorexia or bulimia (no weight/shape distortion)
    • Another medical or psychiatric condition(unless severity is disproportionate and clinically significant)
• Causes
  • Genetic vulnerabilities
  • Altered brain function/neurotransmitters/circuits
  • Medical illnesses (GI disorders, allergies/intolerances, oral-motor dysfunction, metabolic abnormalities)
  • Anxiety and fear
  • Way to gain control over chaotic circumstances
  • Dysfunctional beliefs about food
  • Early feeding experiences/parenting styles/mealtime routines
  • Family conflict, pressure to eat
  • Cultural norms and societal pressure about “healthy eating”
• Key distinguishing features
  • Not driven by weight/body image concerns
  • Often first presents in pediatrics/GI clinics, not psychiatry
• Drivers of food avoidance:
  • Low appetite/lack of interest in food
  • Sensory aversion (taste, texture, smell, temperature, appearance)
  • Fear of aversive consequences of eating
    • GI distress, vomiting, choking
• Psychiatric comorbidity
  • Anxiety disorders common (GAD)
  • Also:
    • Panic disorder
    • Social anxiety disorder
    • Autism spectrum disorder
    • ADHD
    • Mood disorders
    • Internet gaming disorder
• Medical complications
  • Similar to anorexia nervosa when underweight
    • Cardiac, endocrine, GI
  • Stunted growth in children
  • Vomiting prominent: electrolyte abnormalities
• Treatment
  • Psychotherapy
    • CBT, exposure, family-based treatment
  • Medications
    • Appetite stimulants, antidepressants, meds to treat GI symptoms