A new category of eating disorder, known as Avoidant/Restrictive Food Intake Disorder (ARFID), emerged in May of 2013 in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.
ARFID is found in children who self-impose significant restrictions on their own eating. It is associated with weight loss or lack of expected weight gain and often manifests with severe physiological and/or psychosocial distress.
Now, two years later, a new commentary by experts from the Hospital for Sick Children (SickKids) and the Children’s Hospital of Eastern Ontario (CHEO) reflects on the clinical impact of the diagnosis of ARFID, and the work that remains in terms of treatments and improved outcomes. The paper is published in the Journal of Adolescent Health.
“ARFID is not just about picky eating — it’s a very challenging diagnostic category in the DSM-5,” says coauthor Dr. Debra Katzman, a Staff Physician in the Eating Disorders program and Senior Associate Scientist at SickKids.
“These kids have complexity, and this condition persists for long periods of time and requires treatment to address both the medical and psychosocial aspects of the condition. If left untreated, children and teens may be left with serious, long-term complications.”
The classification of ARFID expanded upon a previous diagnostic category of Feeding Disorder of Infancy or Early Childhood, which was rarely used or studied.
In addition to the physiological problems caused by the disorder, there are serious social implications, especially for teens, whose social interactions are often centred around food.
“For those teens who are unable to go out to eat pizza with their friends, the condition can be socially limiting,” says Katzman, who is also Professor of Paediatrics at the University of Toronto.
Coauthor Dr. Mark Norris adds that “Parents have a significant role in identifying unhealthy patterns in their child. Concerned parents should talk to their child’s pediatrician or family doctor early on, rather than letting the problem persist for months or even years.” Norris is an Adolescent Health Physician and Associate Professor of Paediatrics within the Department of Pediatrics at CHEO.
It is also vital, adds Norris, that clinicians on the front-lines and in eating disorders programs become more familiar with the diagnosis, so that the depth and range of eating difficulties among children, teens, and adults can be further studied. As of now, eating disorders specialists are working to assess outcomes and evaluate the effectiveness of different interventions.