At EDAC we are committed to making research accessible. Our Plain Speaking Summaries include plain language text on published papers and an interview with the authors. In this Plain Speaking Summary, Dr Michelle Sader introduced and discussed the current evidence base in relation to avoidant restrictive food intake disorder (ARFID) and is interviewed by Ellen Maloney, EDAC peer researcher. This review was compiled in collaboration with Dr Emy Nimbley and Dr Samuel Chawner (Cardiff University) for BEAT, the UK's leading eating disorder charity, and was written in preparation for Eating Disorder Awareness Week (EDAW) 2024.
Paper Synopsis
BEAT's website in relation to ARFID and eating disorder research can be found here, and the full review may be read here.
AIMS:
This review aims to explore and synthesise the existing evidence-base in relation to avoidant restrictive food intake disorder (ARFID) by investigating various factors associated with the feeding and eating disorder. This includes its prevalence, common presenting symptoms, potential causes and risk factors, co-occurrence with neurodivergence, typical age of onset and duration, impact on quality of life, available evidence-based treatments, barriers to treatment, and long-term outcomes.
KEY FINDINGS:
ARFID is a relatively novel feeding and eating disorder (included within the DSM-5 in 2013) characterised by severe food avoidance or restricted food intake, resulting in significant physical and mental health consequences. Prevalence rates vary globally and are higher than other eating disorders such as anorexia nervosa (AN) or bulimia nervosa (BN), particularly in clinical populations. ARFID onset tends to be younger, with a higher prevalence in male and Autistic individuals. ARFID significantly impacts physical health, mental health, social relationships, academic or occupational performance, and overall well-being. Existing ARFID profiles include lack of interest in food, sensory sensitivities/aversions, and fear of adverse consequences. While research is in its infancy, some potential causes of ARFID may include traumatic events, poor mental health, and genetic/neurobiological aspects. However, it is important to note the extensive lack of evidence in relation to potential neurobiological factors associated with ARFID.
There is a significant overlap between ARFID and neurodiversity, with ARFID prevalence rates significantly elevated in the Autistic community and in those with attention-deficit hyperactivity disorder (ADHD). Evidence-based treatments, though limited, include cognitive-behavioral therapy (CBT), family-based treatment (FBT), food exposure, psychological intervention, and anxiety management. Barriers to treatment include lack of awareness/knowledge, stigma, and limited access to specialised care. Long-term outcomes vary, with recovery rates similar to AN, but with higher rates of co-occurring psychiatric and developmental disorders seen in ARFID.
METHOD:
This review employed a comprehensive review of existing literature on ARFID, encompassing prevalence rates, presenting symptoms, potential causes and risk factors, connection with neurodivergence, age of onset and duration, impact on quality of life, available treatments, barriers to treatment, and long-term outcomes. Evidence was collected from various sources, including peer-reviewed journals and clinical studies.
RESULTS:
Prevalence rates for ARFID vary widely, ranging from 0.3% to 17.9% in global populations and 0.9% to 32% in clinical eating disorder populations. Many of these studies note that ARFID rates appear higher than those with AN or BN. Evidence suggests ARFID more common in younger individuals and shows a higher prevalence in males, though recent reports suggest a more equal distribution between male and female individuals. Autistic individuals often have a co-occurring ARFID diagnosis, with heightened prevalence rates seen ranging from 3% to 55%.
Common symptoms include a persistent lack of dietary needs
fulfillment, driven by factors like lack of interest in food, sensory
aversions, or fear of adverse consequences. These behaviors significantly
impact physical health, leading to weight loss, malnutrition, and vitamin
deficiencies. While ARFID tends to lead to underweight states, those who are within a health weight range or overweight can also be impacted by ARFID. ARFID also affects mental health, with evidence suggesting high rates of comorbidity with anxiety, depression and obsessive-compulsive disorder (OCD).
ARFID typically manifests at a younger age than other eating
disorders, but it is important to note that ARFID can also occur across adolescence and adulthood. The duration of illness (DOI) varies, with some
studies indicating longer DOI compared to other eating disorders.
ARFID significantly impacts quality of life,
affecting social relationships, academic or occupational performance, and
overall well-being. Treatment options can include CBT, FBT, food exposure, and psychological interventions.
However, evidence-based recovery programs are limited, and there are significant barriers to
accessing specialized care, including stigma about the perceived dangers associated with ARFID, and lack of awareness and knowledge on ARFID.
Long-term outcomes for ARFID are still being researched, but
individuals often experience similar outcomes to those with AN, with varying
rates of recovery, relapse, and co-occurring mental or physical health
conditions. Further research is needed to better understand and address the
complexities of ARFID.
IMPACT:
This study sheds light on the significant burden associated with ARFID and underscores the need for increased awareness, specialized care, and evidence-based support/treatments to improve outcomes for individuals affected by this disorder. This review highlights areas of ARFID research requiring significantly more attention and resources, such as neurobiological/neuroimaging research and avenues towards specialised or individual recovery paradigms tailored towards ARFID.
We
think the findings have so far have provided a good opportunity for anyone not
associated or properly informed on ARFID to learn more about the negative
experiences and outcome associated with this feeding and eating disorder.
DISSEMINATION:
Existing findings associated with this work have been disseminated for EDAW 2024, and we intend to provide more specific research drawn from this review for future EDAC-associated events and eating disorder-related conferences. This research is also publicly available within our research gallery, as well as on the BEAT website.
When thinking about our aims at EDAC, and focusing on the
unique experiences that autistic individuals have with an eating disorder, we
are currently focusing on conducting a systematic review looking at the
co-occurrence of ARFID and Autism. Many resources
have focused on the overlap between Autism and AN, and it is important to
highlight the unique experiences outside of this eating disorder.
SUMMARY:
ARFID is a severe feeding and eating disorder characterized by food avoidance or restricted food intake, resulting in significant physical and mental health consequences. Common presenting symptoms include lack of interest in food, sensory aversions, and fear of adverse consequences. Prevalence rates vary globally, with higher rates observed in clinical populations and in Autistic individuals. Potential causes may include traumatic events in relation to food, issues with mental health, traumatic events, mental health issues, as well as possible factors associated with genetics and neurobiology. Evidence-based treatments are lacking, which is why neither the National Institute of Health and Care Excellence (NICE) nor the Scottish Collegiate Guidelines Network (SIGN) are able to provide recommendations on treatment or recovery from ARFID. Many suggested recovery paradigms (e.g., CBT, FBT, anxiety management) have only been assessed in children and adolescents, and further research is needed to explore ARFID recovery in adulthood. There are significant barriers to treatment, such as lack of awareness and stigma, which hinder access to specialized care. Long-term outcomes can vary in ARFID, with recovery rates similar to AN, but with higher rates of co-occurring psychiatric and developmental disorders.
Overall, ARFID requires a dedicated body of resources, support and attention. Increased awareness, specialised care, and evidence-based treatments are essential to improve outcomes for affected individuals. A personal opinion from collating this evidence is that while it benefits the public to
continue bringing awareness to ARFID, that specified and
targeted research needs to be conducted in order to genuinely help and support people suffering from ARFID.
