Further support for diagnostically meaningful ARFID symptom presentations in an adolescent medicine partial hospitalization program

• Published in: The International journal of eating disorders 2019-04, Vol.52 (4), p.402-409
• Main Authors: Zickgraf, Hana F., Lane‐Loney, Susan, Essayli, Jamal H., Ornstein, Rollyn M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Medicine - methods; appetite; ARFID; avoidant/restrictive food intake disorder; Child; choking phobia; Comorbidity; Eating disorders; Feeding and Eating Disorders - psychology; Feeding and Eating Disorders - therapy; Female; Hospitalization - statistics & numerical data; Humans; Male; partial hospitalization; picky eating; Psychopathology; Restrictions; Retrospective Studies; selective eating; Teenagers; vomit phobia
• ISSN: 0276-3478; 1098-108X
• DOI: 10.1002/eat.23016

Objective To identify potential presentations of avoidant/restrictive food intake disorder (ARFID) in a pediatric eating disorder partial hospitalization program (PHP) based on the nature of the eating restriction leading to core symptoms of ARFID. Method A retrospective chart review of 83 patients ages 8–17 admitted to a PHP and diagnosed with ARFID. Charts were independently reviewed by two coders, with high inter‐rater agreement (κ = 0.77). Distinct categories were identified and groups were compared on demographics, anthropometrics, comorbid psychopathology, and core ARFID symptoms. Results We identified cases characterized by predominantly selective eating based on aversions to the sensory properties of foods, lack of interest in eating/low appetite, and fear of aversive consequences from eating. We also distinguished a subset of patients with eating restrictions consistent with both selectivity and limited interest/appetite. The four primary ARFID presentation groups differed on core ARFID criteria, symptom trajectory and illness duration, mood and medical comorbidities, age, gender, and parent‐reported symptoms of psychopathology. Discussion The present findings suggest that there are diagnostically meaningful ARFID subtypes that can be differentiated based on the nature of their eating restrictions, as well as other demographic, illness history features, and psychiatric comorbidity. As treatments for youth with ARFID are developed and refined, it will be important to take into consideration not only demographic differences, but also the variability in symptoms, as this might require distinct interventions and levels of care. Additionally, differing mechanisms that maintain different types of eating restrictions might necessitate unique psychological and psychiatric interventions.