Characteristics of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: A “New Disorder” in DSM-5

TLDR

The study aimed to assess the DSM‑5 diagnostic criteria for Avoidant/Restrictive Food Intake Disorder (ARFID) in children and adolescents whose poor eating is unrelated to body image concerns. Researchers conducted a retrospective case‑control study of 8–18‑year‑olds, applying a diagnostic algorithm to compare 98 ARFID cases identified in seven adolescent‑medicine eating disorder programs with randomly selected anorexia nervosa and bulimia nervosa controls. ARFID patients were younger, more often male, had longer illness duration, intermediate body‑weight percentiles, and higher rates of comorbid medical and anxiety disorders, distinguishing them from anorexia and bulimia patients and underscoring their unique clinical profile.

Abstract

PurposeTo evaluate the DSM-5 diagnosis of Avoidant/Restrictive Food Intake Disorder (ARFID) in children and adolescents with poor eating not associated with body image concerns.MethodsA retrospective case-control study of 8–18-year-olds, using a diagnostic algorithm, compared all cases with ARFID presenting to seven adolescent-medicine eating disorder programs in 2010 to a randomly selected sample with anorexia nervosa (AN) and bulimia nervosa (BN). Demographic and clinical information were recorded.ResultsOf 712 individuals studied, 98 (13.8%) met ARFID criteria. Patients with ARFID were younger than those with AN (n = 98) or BN (n = 66), (12.9 vs. 15.6 vs. 16.5 years), had longer durations of illness (33.3 vs. 14.5 vs. 23.5 months), were more likely to be male (29% vs. 15% vs. 6%), and had a percent median body weight intermediate between those with AN or BN (86.5 vs. 81.0 and 107.5). Patients with ARFID included those with selective (picky) eating since early childhood (28.7%); generalized anxiety (21.4%); gastrointestinal symptoms (19.4%); a history of vomiting/choking (13.2%); and food allergies (4.1%). Patients with ARFID were more likely to have a comorbid medical condition (55% vs. 10% vs. 11%) or anxiety disorder (58% vs. 35% vs. 33%) and were less likely to have a mood disorder (19% vs. 31% vs. 58%).ConclusionsPatients with ARFID were demographically and clinically distinct from those with AN or BN. They were significantly underweight with a longer duration of illness and had a greater likelihood of comorbid medical and/or psychiatric symptoms.