Avoidant/Restrictive Food Intake Disorder

Sujatha Seetharaman; Errol L. Fields

doi:10.1542/pir.2019-0133

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Sujatha Seetharaman, MD, MPH*
Errol L. Fields, MD, PhD, MPH, FAAP*

^*Johns Hopkins School of Medicine, Baltimore, MD

AUTHOR DISCLOSURE
Drs Seetharaman and Fields have disclosed no financial relationships relevant to this article. This commentary includes a discussion of investigative use of olanzapine and fluoxetine for treatment of AFRID.

Abbreviations:

AN:: anorexia nervosa
ARFID:: avoidant/restrictive food intake disorder
BN:: bulimia nervosa
CBT:: cognitive behavior therapy
DSM-5:: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition
FBT:: family-based therapy

Practice Gap

In 2013, revised guidelines were published on eating disorders with the introduction of a newly classified eating disorder diagnosis called “avoidant/restrictive food intake disorder” (ARFID) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Objectives

After completing this article, readers should be able to:

Recognize the diagnostic criteria for avoidant/restrictive food intake disorder (ARFID).
Distinguish how patients with ARFID lack fear of weight gain or body image disturbances that are evident in other eating disorders, such as anorexia nervosa.
Recognize how ARFID is more often seen in males and younger patients compared with other eating disorders.
Recognize that ARFID is associated with comorbid psychiatric diagnoses such as anxiety or obsessive-compulsive disorder and developmental disorders such as autism.
Understand that patients with ARFID can have significant disordered eating, resulting in impaired growth, pubertal delay, and malnutrition that might require medical stabilization in a hospital.
Identify how ARFID management requires a multidisciplinary approach.

Summary of Cases

We present three cases to introduce and exemplify the clinical characteristics of ARFID.

Case 1: A 15-year-old Boy with Poor Appetite, Lack of Interest in Food

A 15-year-old boy presents to an adolescent medicine eating disorder clinic after referral from his gastroenterologist for long-standing malnutrition and a BMI less than the 5th percentile for all of his life. He has a diagnosis of autism spectrum disorder and learning disability.

Case 2: A 9-year-old Girl with Restrictive Eating Due to Fear of Choking

A 9-year-old girl presents to the eating disorder clinic with a history of restrictive eating due to a “fear of choking.” The parents and the child said that 4 months ago she had an episode of choking while eating ice cream. Since then, the child started to obsessively worry that she would choke if she ate any food.