Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents

  • Kathryn S. Brigham
  • Laurie D. Manzo
  • Kamryn T. Eddy
  • Jennifer J. Thomas
Adolescent Medicine (M Goldstein and L Johnson, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Adolescent Medicine

Abstract

Purpose of Review

Avoidant/restrictive food intake disorder (ARFID) was added to the psychiatric nomenclature in 2013. However, youth with ARFID often present first to medical—rather than psychiatric—settings, making its evaluation and treatment relevant to pediatricians.

Recent Findings

ARFID is defined by limited volume or variety of food intake motivated by sensory sensitivity, fear of aversive consequences, or lack of interest in food or eating; and associated with medical, nutritional, and/or psychosocial impairment. It appears to be as common as anorexia nervosa and bulimia nervosa and can occur in individuals of all ages. ARFID is heterogeneous in presentation and may require both medical and psychological management.

Summary

Pediatricians should be aware of the diagnostic criteria for ARFID and the possibility that these patients may require medical intervention and referral for psychological treatment. The neurobiology underlying ARFID is unknown, and novel treatments are currently being tested.

Keywords

Avoidant/restrictive food intake disorder ARFID Eating disorder Nutrition deficiencies Cognitive-behavioral therapy CBT-AR 

Notes

Compliance with Ethical Standards

Conflict of Interest

Kathryn S. Brigham and Laurie D. Manzo each declare no potential conflicts of interest. Kamryn T. Eddy and Jennifer J. Thomas declare future book royalties from Cambridge University Press.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    American Psychiatric Association, American Psychiatric Association DSM-5 Task Force. Diagnostic and statistical manual of mental disorders : DSM-5. 5th ed. Arlington; 2013.Google Scholar
  2. 2.
    American Psychiatric Association, American Psychiatric Association Task Force on DSM. Diagnostic and statistical manual of mental disorders : DSM-IV. 4th ed. Washington; 1994.Google Scholar
  3. 3.
    •• Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Curr Psychiatry Rep. 2017;19(8):54. -017-0795-5.Theoretical conceptualization of ARFID and review. CrossRefPubMedGoogle Scholar
  4. 4.
    Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, Rome ES, et al. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. J Adolesc Health. 2014;55(1):49–52.CrossRefPubMedGoogle Scholar
  5. 5.
    • Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatr Dis Treat. 2016;12:213–8. Review article about ARFID. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Eddy KT, Thomas JJ, Hastings E, Edkins K, Lamont E, Nevins CM, et al. Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord. 2015;48(5):464–70.CrossRefPubMedGoogle Scholar
  7. 7.
    Hay P, Mitchison D, Collado AEL, Gonzalez-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including avoidant/restrictive food intake disorder (ARFID), in the Australian population. J Eat Disord. 2017;5:21-017-0149-z. eCollection 2017CrossRefGoogle Scholar
  8. 8.
    Kurz S, van Dyck Z, Dremmel D, Munsch S, Hilbert A. Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry. 2015;24(7):779–85.CrossRefPubMedGoogle Scholar
  9. 9.
    Forman SF, McKenzie N, Hehn R, Monge MC, Kapphahn CJ, Mammel KA, et al. Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the national eating disorders quality improvement collaborative. J Adolesc Health. 2014;55(6):750–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Norris ML, Robinson A, Obeid N, Harrison M, Spettigue W, Henderson K. Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord. 2014;47(5):495–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Ornstein RM, Rosen DS, Mammel KA, Callahan ST, Forman S, Jay MS, et al. Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders. J Adolesc Health. 2013;53(2):303–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord. 2014;2(1):21. -014-0021-3. eCollection 2014.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    •• Ornstein RM, Essayli JH, Nicely TA, Masciulli E, Lane-Loney S. Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders. Int J Eat Disord. 2017;50(9):1067–74. Study showing patients with ARFID can be successfully treated in eating disorder programs. CrossRefPubMedGoogle Scholar
  14. 14.
    • Mammel KA, Ornstein RM. Avoidant/restrictive food intake disorder: a new eating disorder diagnosis in the diagnostic and statistical manual 5. Curr Opin Pediatr. 2017;29(4):407–13. Review article about ARFID. CrossRefPubMedGoogle Scholar
  15. 15.
    Mueller C, editor. The ASPEN adult nutrition support core curriculum. 3rd ed. Silver Spring: American Society for Parenteral and Enteral Nutrition; 2017.Google Scholar
  16. 16.
    Office of Dietary Supplements, National Institutes of Health (US). Folate. 2016 Apr 20; Available at: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/. Accessed 6 Feb 2018.
  17. 17.
    Office of Dietary Supplements, National Institutes of Health (US). Calcium. 2016 Nov 17; Available at: https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional. Accessed 6 Feb 2018.
  18. 18.
    Office of Dietary Supplements, National Institutes of Health (US). Iron. 2016 Feb 11; Available at: https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed 6 Feb 2018.
  19. 19.
    Office of Dietary Supplements, National Institutes of Health (US). Vitamin A. 2016 Aug 31; Available at: https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/. Accessed 6 Feb 2018.
  20. 20.
    Office of Dietary Supplements, National Institutes of Health (US). Vitamin B12. 2016 Feb 11; Available at: https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/. Accessed 6 Feb 2018.
  21. 21.
    Office of Dietary Supplements, National Institutes of Health (US). Vitamin C. 2016 Feb 11; Available at: https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/. Accessed 6 Feb 2018.
  22. 22.
    Office of Dietary Supplements, National Institutes of Health (US). Vitamin D. 2016 Feb 11; Available at: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed 6 Feb 2018.
  23. 23.
    Office of Dietary Supplements, National Institutes of Health (US). Vitamin K. 2016 Feb 11; Available at: https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/. Accessed 6 Feb 2018.
  24. 24.
    Office of Dietary Supplements, National Institutes of Health (US). Zinc. 2016 Feb 11; Available at: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/. Accessed 6 Feb 2018.
  25. 25.
    Office of Dietary Supplements, National Institutes of Health (US). Riboflavin. 2016 Feb 11; Available at: https://ods.od.nih.gov/factsheets/Riboflavin-HealthProfessional/. Accessed 1 Mar 2018.
  26. 26.
    •• Thomas JJ, Brigham KS, Sally ST, Hazen EP, Eddy KT. Case 18-2017—an 11-year-old girl with difficulty eating after a choking incident. N Engl J Med. 2017;376(24):2377–86. Clinical case example demonstrating evaluation, differential diagnosis, medical management, and psychological treatment. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    •• Marild K, Stordal K, Bulik CM, Rewers M, Ekbom A, Liu E, et al. Celiac disease and anorexia nervosa: a nationwide study. Pediatrics. 2017;139(5):e20164367.  https://doi.org/10.1542/peds.2016-4367. An important study showing a bidirectional association between celiac disease and AN. CrossRefPubMedGoogle Scholar
  28. 28.
    De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. Female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med. 2014;48(4):289. –2013-093218CrossRefPubMedGoogle Scholar
  29. 29.
    Setnick J. Micronutrient deficiencies and supplementation in anorexia and bulimia nervosa: a review of literature. Nutr Clin Pract. 2010;25(2):137–42.CrossRefPubMedGoogle Scholar
  30. 30.
    •• Society for Adolescent Health and Medicine, Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, et al. Position paper of the society for adolescent health and medicine: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2015;56(1):121–5. Guidelines for medical providers for the treatment of restrictive eating disorders. CrossRefGoogle Scholar
  31. 31.
    Bryant-Waugh R, Micali N, Cooke L, et al. The Pica, ARFID, and Rumination Disorder Interview: development of a multi-informant, semi-structured interview of feeding disorders across the lifespan. In preparation .Google Scholar
  32. 32.
    Hilbert A, van Dyck Z. Eating disorders in youth-questionnaire. English version. 2016 June 21; Available at: http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-197246. Accessed Feb 28, 2018.
  33. 33.
    Zickgraf HF, Ellis JM. Initial validation of the nine item avoidant/restrictive food intake disorder screen (NIAS): a measure of three restrictive eating patterns. Appetite. 2018;123:32–42.CrossRefPubMedGoogle Scholar
  34. 34.
    •• Strandjord SE, Sieke EH, Richmond M, Rome ES. Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency. J Adolesc Health. 2015;57(6):673–8. Study comparing hospitalization and 1-year follow-up of patients with either AN or ARFID. CrossRefPubMedGoogle Scholar
  35. 35.
    Brown J, Kim C, Lim A, Brown S, Desai H, Volker L, et al. Successful gastrostomy tube weaning program using an intensive multidisciplinary team approach. J Pediatr Gastroenterol Nutr. 2014;58(6):743–9.PubMedGoogle Scholar
  36. 36.
    Sharp WG, Stubbs KH, Adams H, Wells BM, Lesack RS, Criado KK, et al. Intensive, manual-based intervention for pediatric feeding disorders: results from a randomized pilot trial. J Pediatr Gastroenterol Nutr. 2016;62(4):658–63.CrossRefPubMedGoogle Scholar
  37. 37.
    Sant'Anna AM, Hammes PS, Porporino M, Martel C, Zygmuntowicz C, Ramsay M. Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program. J Pediatr Gastroenterol Nutr. 2014;59(5):674–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Thomas J, Eddy K. Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: children, adolescents, and adults. Cambridge: Cambridge University Press; In press 2018.Google Scholar
  39. 39.
    Kardas M, Cermik BB, Ekmekci S, Uzuner S, Gokce S. Lorazepam in the treatment of posttraumatic feeding disorder. J Child Adolesc Psychopharmacol. 2014;24(5):296–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Brewerton TD, D'Agostino M. Adjunctive use of olanzapine in the treatment of avoidant restrictive food intake disorder in children and adolescents in an eating disorders program. J Child Adolesc Psychopharmacol. 2017;27(10):920–2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kathryn S. Brigham
    • 1
    • 2
  • Laurie D. Manzo
    • 1
    • 3
  • Kamryn T. Eddy
    • 3
    • 4
  • Jennifer J. Thomas
    • 3
    • 4
  1. 1.Division of Adolescent and Young Adult MedicineMassachusetts General HospitalBostonUSA
  2. 2.Department of PediatricsHarvard Medical SchoolBostonUSA
  3. 3.Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonUSA
  4. 4.Department of PsychiatryHarvard Medical SchoolBostonUSA

Personalised recommendations