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October 11, 2021

Avoidant Restrictive Food Intake Disorder—What Are We Missing? What Are We Waiting for?

Author Affiliations
  • 1Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Tufts Children’s Hospital, Boston, Massachusetts
  • 2Department of Pediatrics, Public Health and Community Medicine, Boston, Massachusetts
JAMA Pediatr. 2021;175(12):e213858. doi:10.1001/jamapediatrics.2021.3858

The diagnosis of avoidant restrictive food intake disorder (ARFID) materialized with the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) by the American Psychiatric Association.1 Simply stated, ARFID is an eating or feeding disturbance characterized by lack of interest in or avoidance of food that results in inadequate weight or weight loss, significant nutritional deficiency, dependence on supplemental nutrition or alternative feeding methods, and marked interference with psychosocial functioning. Avoidant restrictive food intake disorder is aversion or phobia that may have a triggering event. It is not picky eating, adherence to a culturally sanctioned practice, or lack of available nutritious food sources, and it is not about weight or body image. The weight and body image omission is an important feature that distinguishes it from other eating disorders (EDs) and their treatments. The DSM-5 does not provide a greater context of the scope of the problem, other epidemiologic information, or treatment options. Before the DSM-5 criteria, practitioners attempted to recognize and develop treatments for EDs that did not fit neatly into other diagnostic categories. With new diagnoses, practitioners may recognize more individuals with ARFID; however, they may struggle to screen for or treat these individuals because little evidence is available on ARFID-specific methods. Because ARFID is distinct from other EDs, we cannot simply apply clinical practices from other EDs. With the increase in ARFID diagnoses, it has become imperative that we develop a body of ARFID-specific data and evidence-based methods of screening and treatment for early detection, treatment, and optimization of health outcomes.

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