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DSM-5 differentiates avoidant/restrictive food intake disorder (ARFID) from other eating disorders (EDs) by a lack of overvaluation of body weight/shape driving restrictive eating. However, clinical observations and research demonstrate ARFID and shape/weight motivations sometimes co-occur. To inform classification, we: (1) derived profiles underlying restriction motivation and examined their validity and (2) described diagnostic characterizations of individuals in each profile to explore whether findings support current diagnostic schemes. We expected, consistent with DSM-5, that profiles would comprise individuals endorsing solely ARFID or restraint (i.e. trying to eat less to control shape/weight) motivations.
Methods
We applied latent profile analysis to 202 treatment-seeking individuals (ages 10–79 years [M = 26, s.d. = 14], 76% female) with ARFID or a non-ARFID ED, using the Nine-Item ARFID Screen (Picky, Appetite, and Fear subscales) and the Eating Disorder Examination-Questionnaire Restraint subscale as indicators.
Results
A 5-profile solution emerged: Restraint/ARFID-Mixed (n = 24; 8% [n = 2] with ARFID diagnosis); ARFID-2 (with Picky/Appetite; n = 56; 82% ARFID); ARFID-3 (with Picky/Appetite/Fear; n = 40; 68% ARFID); Restraint (n = 45; 11% ARFID); and Non-Endorsers (n = 37; 2% ARFID). Two profiles comprised individuals endorsing solely ARFID motivations (ARFID-2, ARFID-3) and one comprising solely restraint motivations (Restraint), consistent with DSM-5. However, Restraint/ARFID-Mixed (92% non-ARFID ED diagnoses, comprising 18% of those with non-ARFID ED diagnoses in the full sample) endorsed ARFID and restraint motivations.
Conclusions
The heterogeneous profiles identified suggest ARFID and restraint motivations for dietary restriction may overlap somewhat and that individuals with non-ARFID EDs can also endorse high ARFID symptoms. Future research should clarify diagnostic boundaries between ARFID and non-ARFID EDs.
Are you a picky eater? Do you worry that food will make you vomit or choke? Do you find eating to be a chore? If yes, this book is for you! Your struggles could be caused by Avoidant Restrictive Food Intake Disorder (ARFID); a disorder characterized by eating a limited variety or volume of food. You may have been told that you eat like a child, but ARFID affects people right across the lifespan, and this book is the first specifically written to support adults. Join Drs. Jennifer Thomas, Kendra Becker, and Kamryn Eddy - three ARFID experts at Harvard Medical School - to learn how to beat your ARFID at home and unlock a healthier relationship with food. Real-life examples show that you are not alone, while practical tips, quizzes, worksheets, and structured activities, take you step-by-step through the latest evidence-based treatment techniques to support your recovery.
This chapter describes the primary interventions for the lack of interest presentation of ARFID, including:
Step-by-step instructions for interoceptive exposures to habituate to feelings of nausea, fullness, or bloating to support eating enough for adequate nutritional intake
Self-monitoring to increase awareness of hunger cues
Reconnecting to the pleasure of eating by using the five steps with highly preferred foods
This chapter provides a basic introduction to the relationship between thoughts, feelings, and behaviors, and introduces our cognitive-behavioral model of ARFID.Wereturn to the case examples from Chapter 1 to illustrate a cognitive-behavioral understanding of sensory sensitivity, fear of aversive consequences, and lack of interest in eating or food.
This chapter explains what avoidant/restrictive food intake disorder (ARFID) is and provides diverse and relatable case examples of each of the three prototypical ARFID presentations, including sensory sensitivity, fear of aversive consequences, and lack of interest in eating or food.
This chapter describes the evidence for cognitive-behavioral therapy for ARFID and highlights exciting future directions in ARFID treatment and research.
This chapter will help the reader assess the adequacy of his of her current diet and determine which module(s) (described in chapters 6, 7, and 8) is/are most appropriate to complete as next steps. Key components of this chapter will include:
Information about common nutrition deficiencies observed in ARFID
The five basic food groups (from US MyPlate schematic) and the importance of eating a varied diet
Strategically selecting fruits, vegetables, proteins, dairy, and grains to learn about that will support resolution of nutrition deficiencies, encourage further weight gain (if needed), and/or reduce psychosocial impairment
Selecting whether to tackle sensory sensitivity, fear of aversive consequences, and/or lack of interest in eating or food, and in what order