Avoidant/Restrictive Food Intake Disorder

What is Avoidant/Restrictive Food Intake Disorder (ARFID)?

Persistent failure to meet nutritional/energy needs due to avoidance or restriction of food intake.

What are some reasons individuals may restrict eating in ARFID?

Lack of interest in eating, sensory sensitivities, fear of choking, vomiting, or illness.

What are the potential consequences of ARFID?

Significant weight loss, nutritional deficiency, dependence on supplements/enteral feeding, or psychosocial impairment.

What distinguishes ARFID from typical picky eating?

ARFID is more severe, persistent, and clinically impairing.

What was the DSM-IV diagnosis that ARFID replaces and extends?

Feeding disorder of infancy or early childhood.

What is the core feature of Avoidant/Restrictive Food Intake Disorder (ARFID)?

What is the core feature of Avoidant/Restrictive Food Intake Disorder (ARFID)?

List the consequences of food avoidance/restriction as per Criterion A.

Significant weight loss, nutritional deficiency, dependence on feeding, interference with psychosocial functioning.

What are some examples of sensory-based avoidance in ARFID?

Extreme sensitivity to appearance, color, smell, texture, temperature, or taste of food.

What are some terms used to describe sensory-based avoidance?

Restrictive/selective eating, choosey eating, perseverant eating, chronic food refusal, food neophobia.

What are some traumatic or uncomfortable events that can lead to food avoidance?

Choking, GI procedures (e.g., esophagoscopy), repeated vomiting.

What are some related terms for avoidance due to aversive experiences?

Functional dysphagia, globus hystericus.

What are some signs of nutritional deficiency that can be observed in ARFID?

Hypothermia, bradycardia, anemia

How is significant weight loss/growth failure determined in ARFID?

Through clinical judgment.

What are some examples of dependence on supplements/tube feeding in ARFID?

Infants needing NG tubes, children relying on supplements, individuals dependent on gastrostomy tubes.

What is a key characteristic of ARFID in relation to weight/shape concerns?

ARFID involves no fear of weight gain.

What are the potential consequences of ARFID?

Medical, nutritional, or psychosocial consequences.

When should ARFID be diagnosed in individuals with ASD?

Only if avoidance leads to significant impairment beyond ASD expectations.

What is the primary reason for food avoidance in ARFID compared to GI disorders?

ARFID causes avoidance despite normal physiology, unlike GI disorders.

What is the main focus of food avoidance in ARFID versus anxiety disorders?

ARFID relates to food properties or fear of GI events, not contamination or social fear.

What are some potential biological factors in the etiology of ARFID?

Genetic predisposition for sensory sensitivity and low appetite regulation.

What is a potential cognitive factor in the etiology of ARFID?

Cognitive expectations of harm (e.g., “I will choke if I eat this”).

What is the role of overaccommodating caregivers in the etiology of ARFID?

They reinforce the child's eating of only preferred foods, providing comfort.

What are the nutritional/medical management strategies for ARFID?

Weight restoration, correcting micronutrient deficiencies, and gradual food variety expansion.

What psychological interventions are used in the treatment of ARFID?

CBT-AR, exposure therapy, family-based treatment, and motivational interviewing.

What adjunct medications may be used in ARFID treatment?

SSRIs for anxiety, cyproheptadine for appetite, and mirtazapine to increase appetite/reduce anxiety.