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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Avoidant Restrictive Food Intake Disorder - StatPearls - NCBI Bookshelf</title>
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<meta name="citation_title" content="Avoidant Restrictive Food Intake Disorder">
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<meta name="citation_date" content="2024/05/01">
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<meta name="citation_author" content="Zerimar Ramirez">
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<meta name="citation_author" content="Sasidhar Gunturu">
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<meta name="citation_pmid" content="38753906">
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<meta name="DC.Contributor" content="Zerimar Ramirez">
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<meta name="DC.Contributor" content="Sasidhar Gunturu">
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<meta name="description" content="Avoidant restrictive food intake disorder (ARFID) represents a distinct entity established by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) within the spectrum of feeding and eating disorders. ARFID is characterized by significant limitations in food intake leading to malnutrition, weight loss, or nutritional deficiency, without the concurrent body image disturbances typically seen in anorexia nervosa or bulimia nervosa.[1] Individuals with ARFID display avoidance or restriction of food intake, often due to sensory issues, fear-related avoidance of eating, or low appetite, leading to nutritional deficiencies, weight loss, and psychosocial impairments. ARFID can occur at any age but typically arises in childhood and can persist into adulthood. Furthermore, this condition may also occur with other medical or psychiatric disorders, complicating both diagnosis and treatment.[2] Adding to the diagnostic complexity, ARFID manifests differently in individuals, with an array of symptoms across the 3 significant drivers of the disorder, making it a challenging disorder.[3] ">
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<meta name="og:description" content="Avoidant restrictive food intake disorder (ARFID) represents a distinct entity established by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) within the spectrum of feeding and eating disorders. ARFID is characterized by significant limitations in food intake leading to malnutrition, weight loss, or nutritional deficiency, without the concurrent body image disturbances typically seen in anorexia nervosa or bulimia nervosa.[1] Individuals with ARFID display avoidance or restriction of food intake, often due to sensory issues, fear-related avoidance of eating, or low appetite, leading to nutritional deficiencies, weight loss, and psychosocial impairments. ARFID can occur at any age but typically arises in childhood and can persist into adulthood. Furthermore, this condition may also occur with other medical or psychiatric disorders, complicating both diagnosis and treatment.[2] Adding to the diagnostic complexity, ARFID manifests differently in individuals, with an array of symptoms across the 3 significant drivers of the disorder, making it a challenging disorder.[3] ">
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autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK603710_"><span class="title" itemprop="name">Avoidant Restrictive Food Intake Disorder</span></h1><p class="contribs">Ramirez Z, Gunturu S.</p><p class="fm-aai"><a href="#_NBK603710_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-164812.s1"><h2 id="_article-164812_s1_">Continuing Education Activity</h2><p>Avoidant restrictive food intake disorder (ARFID) is a distinct diagnosis in the spectrum of eating disorders, characterized by significant limitations in food intake without the typical body image concerns seen in disorders like anorexia nervosa or bulimia nervosa. Individuals with ARFID display avoidance or restriction of food intake, often due to sensory issues, fear-related avoidance of eating, or low appetite, leading to nutritional deficiencies, weight loss, and psychosocial impairments. Diagnosis of ARFID involves confirming the absence of body image disturbance and excluding other eating disorders or medical conditions as the cause. Treatment for ARFID focuses on addressing immediate health concerns, restoring nutritional health, expanding food variety, and addressing fears or discomforts related to eating. Interventions may include cognitive behavioral therapy, family-based therapy, exposure therapy, and, in some cases, pharmacotherapy. </p><p>This activity for healthcare professionals is designed to enhance the learner's competence in performing thorough assessments encompassing medical, nutritional, and psychological aspects to accurately diagnose ARFID. Participants are guided through the latest diagnostic criteria, evidence-based interventions, and strategies for fostering a therapeutic alliance with patients and their families. Moreover, clinicians will learn the importance of collaborative care involving multidisciplinary teams, including physicians, dietitians, psychologists, and nurses, to optimize treatment outcomes and improve the quality of life for individuals with ARFID.</p><p>
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<b>Objectives:</b>
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<ul><li class="half_rhythm"><div>Identify the criteria utilized to diagnose avoidant restrictive food intake disorder.</div></li><li class="half_rhythm"><div>Compare management options available for avoidant restrictive food intake disorder.</div></li><li class="half_rhythm"><div>Evaluate the potential medical and psychosocial complications associated with avoidant restrictive food intake disorder.</div></li><li class="half_rhythm"><div>Apply interprofessional team strategies to improve care coordination and outcomes of patients with avoidant restrictive food intake disorder.</div></li></ul>
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<a href="https://www.statpearls.com/account/trialuserreg/?articleid=164812&utm_source=pubmed&utm_campaign=reviews&utm_content=164812" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Access free multiple choice questions on this topic.</a>
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</p></div><div id="article-164812.s2"><h2 id="_article-164812_s2_">Introduction</h2><p>Avoidant restrictive food intake disorder (ARFID) represents a distinct entity established by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) within the spectrum of feeding and eating disorders. ARFID is characterized by significant limitations in food intake leading to malnutrition, weight loss, or nutritional deficiency, without the concurrent body image disturbances typically seen in anorexia nervosa or bulimia nervosa.<a class="bibr" href="#article-164812.r1" rid="article-164812.r1">[1]</a> Individuals with ARFID display avoidance or restriction of food intake, often due to sensory issues, fear-related avoidance of eating, or low appetite, leading to nutritional deficiencies, weight loss, and psychosocial impairments. ARFID can occur at any age but typically arises in childhood and can persist into adulthood. Furthermore, this condition may also occur with other medical or psychiatric disorders, complicating both diagnosis and treatment.<a class="bibr" href="#article-164812.r2" rid="article-164812.r2">[2]</a> Adding to the diagnostic complexity, ARFID manifests differently in individuals, with an array of symptoms across the 3 significant drivers of the disorder, making it a challenging disorder.<a class="bibr" href="#article-164812.r3" rid="article-164812.r3">[3]</a> </p><p>The DSM-V outlines criteria for diagnosing ARFID, emphasizing the absence of body image disturbance and ruling out other eating disorders or medical conditions as the cause. Diagnosis involves a comprehensive medical, nutritional, and psychological evaluation to assess the patient's physical health, eating behaviors, and mental well-being. Treatment for ARFID focuses on addressing immediate health concerns, restoring nutritional health, expanding food variety, and addressing fears or discomforts related to eating. Interventions may include cognitive behavioral therapy, family-based therapy, exposure therapy, and, in certain cases, pharmacotherapy. Hospitalization may be necessary for patients with severe malnutrition or medical complications. Nutritional rehabilitation, psychological interventions, and collaborative care involving a multidisciplinary team of healthcare professionals are essential for optimizing treatment outcomes and improving the quality of life for individuals with ARFID.</p></div><div id="article-164812.s3"><h2 id="_article-164812_s3_">Etiology</h2><p>Despite increasing attention, ARFID's etiology and neurobiology remain poorly understood in the academic literature. The causes of ARFID are complex, encompassing genetic predispositions, environmental influences, neurobiological mechanisms, and psychosocial factors akin to other eating disorder etiologies.<a class="bibr" href="#article-164812.r4" rid="article-164812.r4">[4]</a> ARFID shares several eating disorder characteristics (eg, anorexia nervosa), including restrictive eating, low body weight, and nutritional deficiencies.<a class="bibr" href="#article-164812.r5" rid="article-164812.r5">[5]</a> Evidence also suggests a possible shared etiology between anorexia nervosa and ARFID, as patients with ARFID may be diagnosed with anorexia nervosa later.<a class="bibr" href="#article-164812.r6" rid="article-164812.r6">[6]</a></p><p>A recent sizeable Swedish twin study has indicated a significant heritable component to ARFID, suggesting that genetic factors play an essential role in the development of the disorder. In this study, twins aged 6 to 12 years showed that the predisposition to ARFID was primarily due to additive genetic factors, with inherited factors contributing approximately 79% and unshared environmental factors accounting for an estimated 21%, indicating a robust hereditary influence.<a class="bibr" href="#article-164812.r7" rid="article-164812.r7">[7]</a> These findings encourage further genetic research into the disorder. Early childhood experiences, sensory sensitivities, and anxiety disorders may also contribute to the development of ARFID.<a class="bibr" href="#article-164812.r8" rid="article-164812.r8">[8]</a> Neurobiological models propose that ARFID exhibits abnormalities in appetite regulation, sensory perception, and heightened fear system activation, which contribute to the emergence of comorbid anxiety disorders and the perpetuation of restrictive eating behaviors. Notably, ARFID encompasses a heterogeneous population influenced by biological and environmental factors in the development and persistence of their eating patterns.<a class="bibr" href="#article-164812.r9" rid="article-164812.r9">[9]</a><a class="bibr" href="#article-164812.r8" rid="article-164812.r8">[8]</a></p></div><div id="article-164812.s4"><h2 id="_article-164812_s4_">Epidemiology</h2><p>Previous studies employing comparable diagnostic criteria have reported an ARFID prevalence in the general child population ranging from 0.35% to 3.2% and globally in adult populations from 0.3% to 3.1%.<a class="bibr" href="#article-164812.r10" rid="article-164812.r10">[10]</a><a class="bibr" href="#article-164812.r11" rid="article-164812.r11">[11]</a><a class="bibr" href="#article-164812.r12" rid="article-164812.r12">[12]</a><a class="bibr" href="#article-164812.r13" rid="article-164812.r13">[13]</a><a class="bibr" href="#article-164812.r14" rid="article-164812.r14">[14]</a><a class="bibr" href="#article-164812.r15" rid="article-164812.r15">[15]</a> Some studies have shown males with ARFID have a higher prevalence than females, especially in pediatric populations.<a class="bibr" href="#article-164812.r16" rid="article-164812.r16">[16]</a><a class="bibr" href="#article-164812.r17" rid="article-164812.r17">[17]</a> However, DSM-V indicates a more balanced sex distribution of ARFID compared to other eating disorders (eg, anorexia nervosa and bulimia nervosa), which predominantly affect females. Furthermore, according to some studies, a larger proportion of ARFID cases are represented by males than in other eating disorders. These findings highlight the necessity for gender-sensitive approaches in both diagnosis and treatment.<a class="bibr" href="#article-164812.r16" rid="article-164812.r16">[16]</a></p><p>Moreover, ARFID commonly occurs with other comorbid conditions, particularly neurodevelopmental disorders, including autism spectrum disorder and attention-deficit/hyperactivity disorder (ADHD).<a class="bibr" href="#article-164812.r5" rid="article-164812.r5">[5]</a><a class="bibr" href="#article-164812.r16" rid="article-164812.r16">[16]</a><a class="bibr" href="#article-164812.r18" rid="article-164812.r18">[18]</a> Learning disabilities, obsessive-compulsive disorders (OCD), and anxiety disorders also occur with ARFID more frequently than other eating disorders.<a class="bibr" href="#article-164812.r5" rid="article-164812.r5">[5]</a><a class="bibr" href="#article-164812.r17" rid="article-164812.r17">[17]</a><a class="bibr" href="#article-164812.r19" rid="article-164812.r19">[19]</a> This association suggests that the underlying mechanism of ARFID may be related to broader neurodevelopmental and psychological processes. The worldwide prevalence of ARFID is unclear due to ambiguity in diagnostic definitions and operationalization; however, ARFID poses a significant clinical challenge due to the condition's diverse and often subtle presentations.<a class="bibr" href="#article-164812.r20" rid="article-164812.r20">[20]</a></p></div><div id="article-164812.s5"><h2 id="_article-164812_s5_">Pathophysiology</h2><p>ARFID is associated with alterations in brain regions involved in reward, motivation, and the sensory processing of food.<a class="bibr" href="#article-164812.r8" rid="article-164812.r8">[8]</a> For instance, the insula, an area that helps regulate internal body states and process sensory information, is critical in the pathophysiology of ARFID.<a class="bibr" href="#article-164812.r21" rid="article-164812.r21">[21]</a> When exposed to food stimuli, individuals with ARFID may have atypical activation patterns in the insula, leading to aversive responses to certain textures, tastes, or food smells. In addition, a recent study proposed that the pathophysiology of ARFID may be associated with the following 3 neurobiological hypotheses:</p><ol><li class="half_rhythm"><div>Individuals with sensory sensitivity may have an intensified perception of tastes, particularly bitter and sweet, which might classify them as "supertasters" due to a biological predisposition. </div></li><li class="half_rhythm"><div>A lack of interest in food observed in some with ARFID could be linked to reduced brain activity in appetite-regulating areas (eg, hypothalamus and insula), which affect hunger sensations and satiety. </div></li><li class="half_rhythm"><div>For patients with ARFID  stemming from fear of aversive consequences (eg, choking), an exaggerated fear response may be present, possibly triggered by overactive fear-related brain circuitry involving the amygdala and prefrontal cortex.<a class="bibr" href="#article-164812.r8" rid="article-164812.r8">[8]</a></div></li></ol><p>Research regarding ARFID is still emerging; the role of serotonin in sensory processing and anxiety suggests a potential mechanism through which neurotransmitter dysregulation could influence the disorder. Moreover, sensory processing issues, which are not exclusive to ARFID but are also present in other conditions (eg, autism), may be associated with abnormal serotonin function, further supporting the need to investigate serotonin's role in ARFID.<a class="bibr" href="#article-164812.r22" rid="article-164812.r22">[22]</a></p></div><div id="article-164812.s6"><h2 id="_article-164812_s6_">History and Physical</h2><p>
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<b>Clinical History</b>
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</p><p>ARFID is clinically diagnosed and comprises the patient's medical, nutritional, and psychological assessment. Evaluation for ARFID primarily entails gathering a thorough history, including the onset, duration, and extent of restrictive eating behaviors, any precipitating factors (eg, traumatic feeding experiences), and associated gastrointestinal complaints. The DSM-V outlines the following 4 criteria for diagnosing ARFID:</p><ul><li class="half_rhythm"><div><b>Criterion A</b>: An eating or feeding disturbance linked to significant weight loss, nutritional deficiency, reliance on enteral feeding or supplements, or a notable change in psychosocial functioning is present. The possible causes for this disruption outlined in the DSM-V-TR include low appetite, sensory issues with food, and fear-related avoidance of eating.<a class="bibr" href="#article-164812.r23" rid="article-164812.r23">[23]</a></div></li><li class="half_rhythm"><div><b>Criterion B</b>: The interference with eating is not due to religious or cultural factors or lack of food availability.</div></li><li class="half_rhythm"><div><b>Criterion C</b>: The disturbance is not attributable to other eating disorders like anorexia nervosa or bulimia nervosa, as evidenced by the absence of body image concerns.</div></li><li class="half_rhythm"><div><b>Criterion D</b>: Other psychiatric or medical conditions are excluded as an etiology for the disturbance.<a class="bibr" href="#article-164812.r1" rid="article-164812.r1">[1]</a><a class="bibr" href="#article-164812.r2" rid="article-164812.r2">[2]</a><a class="bibr" href="#article-164812.r23" rid="article-164812.r23">[23]</a><a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a></div></li></ul><p>Adding to the diagnostic complexity, ARFID can manifest differently in individuals, with an array of symptoms across the 3 major drivers of the disorder.<a class="bibr" href="#article-164812.r3" rid="article-164812.r3">[3]</a> Individuals with ARFID may display a persistent disinterest in eating or food, potentially leading to significant weight loss or an inability to meet nutritional needs adequately. While some patients with ARFID may have low body weight, the disorder can affect individuals of any weight.<a class="bibr" href="#article-164812.r6" rid="article-164812.r6">[6]</a> Individuals with ARFID frequently have a reduced appetite or adopt behaviors restricting food intake, including eating small bites, prolonged meal times, or excessive chewing.<a class="bibr" href="#article-164812.r5" rid="article-164812.r5">[5]</a> In female patients, clinicians should also obtain a menstrual history, which may identify primary amenorrhea in premenarchal females and secondary amenorrhea in postmenarchal females secondary to malnutrition and significant weight loss.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a> Furthermore, ascertaining the presence of mental health comorbidities or underlying medical conditions is imperative. Psychiatric comorbidities are frequently observed in those with ARFID, particularly anxiety disorders, including generalized anxiety disorder.<a class="bibr" href="#article-164812.r6" rid="article-164812.r6">[6]</a><a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a><a class="bibr" href="#article-164812.r25" rid="article-164812.r25">[25]</a> ARFID is also commonly associated with neurodevelopment disorders (eg, autism spectrum disorder and ADHD).<a class="bibr" href="#article-164812.r26" rid="article-164812.r26">[26]</a><a class="bibr" href="#article-164812.r27" rid="article-164812.r27">[27]</a> Additionally, various conditions may also present with appetite loss or weight reduction, including tumors or endocrine disorders (eg, type 1 diabetes, hyperthyroidism, or Addison disease), infections, gastrointestinal ailments (eg, Crohn disease, ulcerative colitis, or celiac disease), and swallowing difficulties (eg, achalasia or tonsillar hypertrophy). Therefore, differential diagnoses should be considered during the evaluation process.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a> </p><p>As part of a dietary history, a patient's eating habits should be documented, including past and current eating patterns, the types and amounts of food and drinks consumed, typical eating locations, preferred cooking methods, food brands, and meal sources (eg, specific restaurants or homemade meals). Additionally, clinicians should identify individual dietary preferences and aversions regarding textures, flavors, aromas, and food appearances.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a> Weight loss, failure to achieve expected growth, or reliance on nutritional supplements should also be noted. Dietary preferences characteristically revolve around aversions to specific food tastes, textures, colors, or smells rather than concerns about body shape or weight.<a class="bibr" href="#article-164812.r29" rid="article-164812.r29">[29]</a> Symptoms may include abdominal pain, nausea, or other gastrointestinal discomfort associated with eating, as well as intense fears of choking, nausea, vomiting, allergic reactions, or illness.<a class="bibr" href="#article-164812.r5" rid="article-164812.r5">[5]</a><a class="bibr" href="#article-164812.r3" rid="article-164812.r3">[3]</a><a class="bibr" href="#article-164812.r30" rid="article-164812.r30">[30]</a> Symptom onset may be sudden following a traumatic food-related incident, often accompanied by an anxiety disorder.<a class="bibr" href="#article-164812.r5" rid="article-164812.r5">[5]</a> Mealtimes often become stressful for families, and patients may avoid social gatherings involving food. Caregivers may notice a consistent pattern where the individual exhibits selectivity in their food preferences, often opting for a narrow variety of foods.<a class="bibr" href="#article-164812.r5" rid="article-164812.r5">[5]</a> Despite their nutritional impact, these behaviors are not driven by an expressed desire to lose weight but rather by the distressing experience associated with eating. </p><p>
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<b>Physical Examination</b>
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</p><p>In addition to assessing an individual's anxiety or phobic responses to eating, a full review of systems and a thorough physical examination are essential. Reviewing growth curves, including weight, height, and body mass index (BMI), is crucial in determining the patient's condition. Objective findings on physical examination may reveal signs consistent with malnutrition, including cachexia, muscle wasting, or micronutrient deficiencies (eg, pallor from anemia, petechiae, or vitamin C deficiency ecchymosis). In contrast to anorexia nervosa, ARFID does not involve body image disturbances. However, patients may suffer from significant nutritional deficiencies and experience physical effects, including fatigue, lack of concentration, and growth delay in children and adolescents due to inadequate food intake. Consequently, patients with ARFID may also develop anemia, bradycardia, or muscle-wasting conditions. Sexual maturity should also be assessed to determine the puberty stage and identify growth abnormalities.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a> Vital sign abnormalities may include bradycardia, hypotension, and orthostatic changes. In pediatric patients, body mass index (BMI) measurements and growth parameters should be carefully assessed against standard growth charts to identify deviations from expected growth trajectories. A gastrointestinal examination may reveal signs of delayed gastric emptying or constipation secondary to low dietary fiber intake.<a class="bibr" href="#article-164812.r1" rid="article-164812.r1">[1]</a></p></div><div id="article-164812.s7"><h2 id="_article-164812_s7_">Evaluation</h2><p>
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<b>Diagnostic Studies</b>
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</p><p>While laboratory tests are not diagnostic for ARFID, they are necessary to assess the nutritional status and identify deficiencies or metabolic disturbances. A complete blood count, a comprehensive metabolic panel with liver function tests, thyroid function, and vitamin and mineral levels are frequently performed, particularly in cases where malnutrition is suspected.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a> In addition, various laboratory tests to exclude differential diagnoses may be considered, including erythrocyte sedimentation rate, luteinizing hormone, follicle-stimulating hormone, estradiol, testosterone, urinalysis, and Celiac disease screening with tissue transglutaminase antibodies and total IgA.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a> These studies help to evaluate the hydration status, check for inflammatory conditions or malignancies, and assess hormone levels and nutritional deficiencies that may result from malnutrition. Radiographic imaging is not typically necessary unless specific gastrointestinal symptoms (eg, chronic constipation or suspicion of gastrointestinal obstruction) warrant further investigation through diagnostic imaging studies. Other tests, such as bone density scans, may be considered to assess the impact of chronic malnutrition on bone health, especially in longstanding cases. </p><p>
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<b>Psychological </b>
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<b>E</b>
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<b>valuation</b>
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</p><p>In the last decade, assessments have emerged for screening, evaluating, and tracking treatment outcomes for ARFID.<a class="bibr" href="#article-164812.r23" rid="article-164812.r23">[23]</a> Psychological evaluation for ARFID includes structured office-based interviews and self-reporting measures. Office-based screens that may be utilized for ARFID evaluation include the Eating disorder assessment for DSM-5 (EDA-5), structured clinical interview for DSM-5 (SCID-5), eating disorder examination (EDE) ARFID module, and pica, ARFID, and rumination disorder interview (PARDI assess ARFID). Each of these screening methods has positive and negative features.</p><p>Self-reporting screens, including the food phobia scale (FNS), nine-item ARFID screen (NIAS), pica, ARFID, and rumination disorder – ARFID questionnaire (PARDI-AR-Q), and the eating disorder examination questionnaire (EDE-Q) may also be utilized in the evaluation of ARFID. These self-reporting screens measure different aspects of ARFID psychopathology. While these measures offer valuable insights, they have limitations and require validation with office-based screening. Combining structured clinical interviews with self-reports provides a more thorough assessment, aiding diagnosis and treatment monitoring.</p><p>
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<b>Additional E</b>
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<b>valuation</b>
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</p><p>Further evaluation or consultation services may be indicated following clinical assessment with growth trajectories and laboratory evaluation.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a> Consultation with a dietitian for nutritional assessment is recommended in patients with ARFID. In cases where comorbid psychological conditions are suspected, a mental health evaluation is also essential. Patients who exhibit slow eating may need to evaluate their chewing and swallowing abilities; patients with growth concerns may be referred to an endocrinologist, while those with gastrointestinal symptoms may require a referral to a gastroenterologist.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a></p></div><div id="article-164812.s8"><h2 id="_article-164812_s8_">Treatment / Management</h2><p>Due to the recent emergence of the ARFID diagnosis, limited evidence supporting treatment strategies for this condition exists, and consensus guidelines have yet to be established. Cognitive behavioral therapy, family-based therapy, and pharmacotherapy are the most common treatment modalities suggested in the existing literature.<a class="bibr" href="#article-164812.r31" rid="article-164812.r31">[31]</a> To date, no studies have evaluated the effectiveness of ARFID-specific treatment through randomized, fully powered, controlled trials.<a class="bibr" href="#article-164812.r23" rid="article-164812.r23">[23]</a> The treatment goals for individuals diagnosed with ARFID should consist of the following key components:</p><ul><li class="half_rhythm"><div>Attain medical stability, addressing immediate health concerns and stabilizing comorbid medical conditions.</div></li><li class="half_rhythm"><div>Determine the most appropriate level of care, whether outpatient or inpatient, based on individual needs and severity of symptoms.</div></li><li class="half_rhythm"><div>Provide adequate nutrition and monitor progress regularly to restore weight to a healthy range and ensure proper growth.</div></li><li class="half_rhythm"><div>Enhance nutritional health by expanding the variety and quantity of foods consumed and addressing any nutrient deficiencies.</div></li><li class="half_rhythm"><div>Address and manage any fears or discomforts related to eating, which may involve exposure therapy or other behavioral interventions.</div></li><li class="half_rhythm"><div>Promote the enjoyment of eating by identifying enjoyable foods and developing a positive relationship with food.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a></div></li></ul><p>
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<b>Pharmacological Management</b>
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</p><p>Pharmacotherapy is not the primary approach for treating ARFID but may be applicable in certain cases.<a class="bibr" href="#article-164812.r32" rid="article-164812.r32">[32]</a> For instance, mirtazapine has been cited due to its appetite-stimulating and anxiolytic properties. Medications, including cyproheptadine, selective serotonin reuptake inhibitors (SSRIs), or atypical antipsychotics (eg, olanzapine), are often used to address associated symptoms rather than ARFID itself. Cyproheptadine, in particular, is an effective off-label option for ARFID as this medication enhances appetite; consideration as a potential treatment for malnourished adults and children, including those diagnosed with ARFID, is warranted.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a><a class="bibr" href="#article-164812.r31" rid="article-164812.r31">[31]</a> </p><p>Olanzapine has also been used off-label to help reduce anxiety, cognitive rigidity, and food-related beliefs that can contribute to ARFID symptoms; in some patients, weight gain may be promoted.<a class="bibr" href="#article-164812.r33" rid="article-164812.r33">[33]</a><a class="bibr" href="#article-164812.r34" rid="article-164812.r34">[34]</a> A case study reported that the addition of low-dose olanzapine to ARFID treatment helped reduce anxiety and depression in a patient.<a class="bibr" href="#article-164812.r35" rid="article-164812.r35">[35]</a> Another case series found that using olanzapine, along with the antidepressant fluoxetine, helped 2 adolescent twins with ARFID reach their target weights within 3 to 6 months of starting treatment.<a class="bibr" href="#article-164812.r34" rid="article-164812.r34">[34]</a> However, the supportive evidence for ARFID treatment with olanzapine is still limited, with no randomized controlled trials demonstrating efficacy. Therefore, olanzapine remains an off-label, experimental treatment.</p><p>
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<b>Inpatient Management</b>
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</p><p>In cases of ARFID, hospitalization may be necessary to address poor nutritional intake or dangerously low weight and to restore healthy eating behaviors.<a class="bibr" href="#article-164812.r36" rid="article-164812.r36">[36]</a> Studies primarily focused on adolescent or mixed-age groups have examined the hospital course of ARFID. Some findings suggest that adolescents and young adults with ARFID present with similar body mass index (BMI) or percent target weight upon admission compared to patients with anorexia nervosa.<a class="bibr" href="#article-164812.r37" rid="article-164812.r37">[37]</a> However, discrepancies among study findings have been noted.<a class="bibr" href="#article-164812.r38" rid="article-164812.r38">[38]</a><a class="bibr" href="#article-164812.r30" rid="article-164812.r30">[30]</a> Length of hospital stay varies across studies, with some reporting longer stays for ARFID patients and others finding no significant difference. Furthermore, weight gain rates during hospitalization also vary, with some studies indicating slower weight gain in ARFID compared to anorexia nervosa patients, though weight outcomes at discharge appear comparable. Longer-term follow-up studies suggest that adolescents with ARFID may have higher recovery rates compared to those with anorexia nervosa, although further research is needed to confirm these findings.</p><p>The American Psychiatric Association recommends hospitalization be considered in patients with ARFID if the following clinical factors are present:</p><ul><li class="half_rhythm"><div>BMI <75% of the median for age and gender</div></li><li class="half_rhythm"><div>Dehydration symptoms</div></li><li class="half_rhythm"><div>Abnormal electrolyte levels (eg, hypokalemia, hyponatremia, or hypophosphatemia)</div></li><li class="half_rhythm"><div>ECG irregularities, including prolonged QTc interval or significant bradycardia</div></li><li class="half_rhythm"><div>Physiological instability signs, such as:</div></li><li class="half_rhythm"><div>daytime bradycardia (<50 bpm) or nighttime bradycardia(<45 bpm)</div></li><li class="half_rhythm"><div>Hypotension (<90/45 mm Hg)</div></li><li class="half_rhythm"><div>Hypothermia (<96 °F (35.6 °C)</div></li><li class="half_rhythm"><div>Significant orthostatic pulse changes (increase in heart rate by >30 bpm for adults older than 19 or >40 bpm for adolescents younger than 19, or a sustained blood pressure decrease of >20 mm Hg systolic or >10 mm Hg diastolic) <a class="bibr" href="#article-164812.r39" rid="article-164812.r39">[39]</a><a class="bibr" href="#article-164812.r40" rid="article-164812.r40">[40]</a></div></li><li class="half_rhythm"><div>Stunted growth and developmental progress</div></li><li class="half_rhythm"><div>Unsuccessful outpatient treatment attempts</div></li><li class="half_rhythm"><div>Food refusal</div></li><li class="half_rhythm"><div>Immediate malnutrition-related medical complications like fainting, seizures, cardiac failure, or pancreatitis.</div></li><li class="half_rhythm"><div>Presence of a concurrent psychiatric or medical condition complicating or hindering effective outpatient care, such as severe depression, suicidal ideation, obsessive-compulsive disorder, psychosis, or type 1 diabetes.<a class="bibr" href="#article-164812.r41" rid="article-164812.r41">[41]</a><a class="bibr" href="#article-164812.r42" rid="article-164812.r42">[42]</a><a class="bibr" href="#article-164812.r43" rid="article-164812.r43">[43]</a><a class="bibr" href="#article-164812.r44" rid="article-164812.r44">[44]</a></div></li></ul><p>
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<b>Nutritional Management</b>
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</p><p>Nutritional rehabilitation, which focuses on establishing regular eating patterns and reintroducing a broader range of foods, is the cornerstone of ARFID management. Nutritional management often requires the expertise of dietitians specializing in eating disorders. Close monitoring of growth and development, particularly in pediatric populations, is crucial. The primary management of ARFID focuses on gradually improving nutritional adequacy, balanced eating habits, and weight gain with the help of a registered dietitian nutritionist (RDN) and the patient's family.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a> Together, they work to increase the patient's overall food intake, introduce new foods gradually, and help the patient make significant progress toward better nutritional health.</p><p>In severe cases, hospitalization may be necessary to address nutritional deficiencies and ensure safety. To avoid adverse effects on taste, hunger, mood, and energy, ensuring the timely replenishment of essential nutrients (eg, vitamin B12, vitamin C, iron, zinc, and folate) is vital. Nasogastric tube feedings may also be necessary to counteract malnutrition in severe cases where patients consume minimal food and drink. As the patient's overall intake improves, whether in a hospital or outpatient setting, the foods and beverages they previously enjoyed will gradually be reintroduced into their diet, with the ultimate goal of resuming their typical diet over time. Consequently, the nutritional treatment for ARFID aims to enhance the overall nutritional status, eating habits, and social functioning regarding food.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a></p><p>
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<b>Psychological Management</b>
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</p><p>Psychotherapeutic interventions form a significant part of the treatment landscape for ARFID. Cognitive-behavioral therapy tailored for ARFID, family-based therapy, and exposure therapies have shown efficacy. These therapies aim to reduce meal-related anxiety, modify disruptive eating patterns, and address distorted beliefs about food. These 3 psychological therapies primarily revolve around the following evidence-based approaches for ARFID:</p><ol><li class="half_rhythm"><div>Family-based treatment for ARFID: This approach targets specific aspects of ARFID based on the subtype, typically focusing on consistent and necessary eating habits and gradual weight gain. Therapists aim to enhance parents' confidence in modifying feeding strategies to decrease restrictive eating patterns.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a><a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a></div></li><li class="half_rhythm"><div>Cognitive behavior therapy for ARFID: This therapy addresses nutritional deficiency, increases exposure to new foods, and reduces negative feelings and expectations about food and eating.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a><a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a></div></li><li class="half_rhythm"><div>Supportive parenting for anxious childhood emotions for ARFID: A specific mental health treatment designed for children with anxiety disorders and OCD. With this approach, clinicians concentrate exclusively on working with caregivers to address caregiver accommodation to modify caregivers' behaviors and reactions to their child's symptoms.<a class="bibr" href="#article-164812.r28" rid="article-164812.r28">[28]</a> </div></li></ol><p>Psychological management often involves a combination of outpatient therapy sessions, intensive outpatient programs, and even partial hospitalization, depending on the severity of the condition. National and international guidelines advocate for a personalized approach to care, considering each patient's unique needs with ARFID. Collaborative care models are considered best practices, where an interprofessional team of healthcare professionals works together. Engaging a team of healthcare professionals with diverse specializations is recommended, including a primary care clinician, a mental health specialist, a dietician, a gastroenterologist, an occupational therapist, and a speech therapist, based on the patient's specific requirements.<a class="bibr" href="#article-164812.r31" rid="article-164812.r31">[31]</a></p></div><div id="article-164812.s9"><h2 id="_article-164812_s9_">Differential Diagnosis</h2><p>Several diagnoses may present with distinct clinical features that mimic ARFID and warrant specific clinical evaluations. Therefore, a careful and thorough assessment is necessary to distinguish ARFID from other medical, psychological, or psychiatric conditions. The differential diagnoses for ARFID that should also be considered include:</p><ul><li class="half_rhythm"><div>Anorexia nervosa</div></li><li class="half_rhythm"><div>Bulimia nervosa</div></li><li class="half_rhythm"><div>Gastroesophageal reflux disease </div></li><li class="half_rhythm"><div>Eosinophilic esophagitis</div></li><li class="half_rhythm"><div>Inflammatory bowel disease</div></li><li class="half_rhythm"><div>Food allergies</div></li><li class="half_rhythm"><div>Celiac disease</div></li><li class="half_rhythm"><div>Chronic idiopathic constipation</div></li><li class="half_rhythm"><div>Pica</div></li><li class="half_rhythm"><div>Rumination disorder</div></li><li class="half_rhythm"><div>Autism spectrum disorders (where food selectivity is common)</div></li><li class="half_rhythm"><div>Anxiety disorders</div></li><li class="half_rhythm"><div>Major depressive disorder (with changes in appetite or weight)</div></li><li class="half_rhythm"><div>Social phobia (may affect eating in public settings)</div></li><li class="half_rhythm"><div>OCD</div></li><li class="half_rhythm"><div>Post-traumatic stress disorder, following a traumatic event related to eating or food</div></li><li class="half_rhythm"><div>ADHD, when associated with impulsivity affecting eating behaviors</div></li><li class="half_rhythm"><div>Neurodevelopmental disorders with sensory sensitivities affecting feeding</div></li><li class="half_rhythm"><div>Structural anomalies of the oropharynx or gastrointestinal tract affecting intake</div></li><li class="half_rhythm"><div>Endocrine disorders like Addison disease or hypothyroidism affect appetite</div></li></ul></div><div id="article-164812.s10"><h2 id="_article-164812_s10_">Prognosis</h2><p>Evidence regarding the different dimensions of ARFID is lacking. Moreover, the existing data are insufficient to determine the course of the illness and prognosis for patients diagnosed with ARFID.<a class="bibr" href="#article-164812.r45" rid="article-164812.r45">[45]</a> The prognosis for ARFID can vary depending on several factors, including age of onset, duration of illness, and comorbidities. Early diagnosis and intervention are critical for successful treatment, but unfortunately, access to mental health services and treatment options is currently limited. In addition, chronic cases can lead to severe nutritional deficits and psychosocial impairments. A thorough biopsychosocial approach is necessary for effective treatment. Increasing awareness and targeted interventions will lead to better outcomes and improved access to care.<a class="bibr" href="#article-164812.r46" rid="article-164812.r46">[46]</a><a class="bibr" href="#article-164812.r47" rid="article-164812.r47">[47]</a><a class="bibr" href="#article-164812.r48" rid="article-164812.r48">[48]</a> Ongoing research is crucial to understand long-term outcomes better.</p></div><div id="article-164812.s11"><h2 id="_article-164812_s11_">Complications</h2><p>The medical complications arising from ARFID can closely mirror those of anorexia nervosa, mainly due to malnutrition and nutritional deficiencies. The condition can lead to various medical, psychological, and social complications. Complications of ARFID can be extensive, affecting various body systems due to persistent nutritional deficits.<a class="bibr" href="#article-164812.r24" rid="article-164812.r24">[24]</a><a class="bibr" href="#article-164812.r49" rid="article-164812.r49">[49]</a><a class="bibr" href="#article-164812.r50" rid="article-164812.r50">[50]</a><a class="bibr" href="#article-164812.r51" rid="article-164812.r51">[51]</a><a class="bibr" href="#article-164812.r50" rid="article-164812.r50">[50]</a></p><p>
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<b>Cardiopulmonary Complications</b>
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</p><p>Medical complications specific to the cardiopulmonary system include:</p><ul><li class="half_rhythm"><div>Bradycardia</div></li><li class="half_rhythm"><div>Hypotension</div></li><li class="half_rhythm"><div>Cardiac arrhythmias</div></li><li class="half_rhythm"><div>Refeeding syndrome</div></li><li class="half_rhythm"><div>Reduced cardiac mass</div></li><li class="half_rhythm"><div>Mitral valve prolapse</div></li><li class="half_rhythm"><div>Orthostatic hypotension</div></li><li class="half_rhythm"><div>Pericardial effusion</div></li><li class="half_rhythm"><div>Cardiomyopathy</div></li><li class="half_rhythm"><div>Heart failure</div></li><li class="half_rhythm"><div>Pulmonary edema associated with refeeding syndrome</div></li></ul><p>
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<b>Renal Complications</b>
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</p><p>Complications affecting the renal system include:</p><ul><li class="half_rhythm"><div>Acute kidney injury</div></li><li class="half_rhythm"><div>Electrolyte imbalances (eg, hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, and hypophosphatemia)</div></li><li class="half_rhythm"><div>Chronic kidney disease</div></li><li class="half_rhythm"><div>Proteinuria</div></li><li class="half_rhythm"><div>Renal calculi</div></li></ul><p>
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<b>Gastrointestinal Complications</b>
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</p><p>Medical complications specific to the gastrointestinal system include:</p><ul><li class="half_rhythm"><div>Constipation</div></li><li class="half_rhythm"><div>Gastroparesis</div></li><li class="half_rhythm"><div>Gastroesophageal reflux disease</div></li><li class="half_rhythm"><div>Dysphagia</div></li><li class="half_rhythm"><div>Bloating and gas</div></li><li class="half_rhythm"><div>Irritable bowel syndrome</div></li><li class="half_rhythm"><div>Functional dyspepsia</div></li><li class="half_rhythm"><div>Peptic ulcers</div></li><li class="half_rhythm"><div>Abnormal liver function</div></li></ul><p>
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<b>Endocrinological and Reproductive Complications</b>
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</p><p>The following reproductive and hormonal complications may also develop:</p><ul><li class="half_rhythm"><div>Growth hormone dysregulation</div></li><li class="half_rhythm"><div>Hypothalamic amenorrhea</div></li><li class="half_rhythm"><div>Thyroid function abnormalities (eg, euthyroid sick syndrome, hypothyroidism, low metabolic rate)</div></li><li class="half_rhythm"><div>Adrenal insufficiency</div></li><li class="half_rhythm"><div>Delayed puberty</div></li><li class="half_rhythm"><div>Bone metabolism disturbances (eg, decreased bone mineral density and increased fracture risk)</div></li><li class="half_rhythm"><div>Hypoglycemia</div></li><li class="half_rhythm"><div>Leptin and ghrelin imbalance</div></li><li class="half_rhythm"><div>Pancreatic function impairment</div></li><li class="half_rhythm"><div>Low libido</div></li><li class="half_rhythm"><div>Infertility</div></li><li class="half_rhythm"><div>Pregnancy complications</div></li><li class="half_rhythm"><div>Erectile dysfunction</div></li></ul><p>
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<b>Musculoskeletal Complications</b>
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</p><p>Complications affecting muscle and skeletal systems include:</p><ul><li class="half_rhythm"><div>Decreased muscle mass</div></li><li class="half_rhythm"><div>Osteopenia and osteoporosis</div></li><li class="half_rhythm"><div>Growth retardation</div></li><li class="half_rhythm"><div>Rickets</div></li><li class="half_rhythm"><div>Muscle weakness</div></li><li class="half_rhythm"><div>Delayed recovery from injury</div></li></ul><p>
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<b>Dermatological Complications</b>
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</p><p>The following skin disorders may also develop:</p><ul><li class="half_rhythm"><div>Dry, flaky skin</div></li><li class="half_rhythm"><div>Bruising</div></li><li class="half_rhythm"><div>Hair thinning or loss</div></li><li class="half_rhythm"><div>Eczema or dermatitis</div></li><li class="half_rhythm"><div>Pallor</div></li><li class="half_rhythm"><div>Acrodermatitis</div></li><li class="half_rhythm"><div>Edema</div></li></ul><p>
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<b>Hematological Complications</b>
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</p><p>Complications affecting the hematologic system include:</p><ul><li class="half_rhythm"><div>Anemia (eg, iron, vitamin B12, or folate deficiencies)</div></li><li class="half_rhythm"><div>Leukopenia</div></li><li class="half_rhythm"><div>Thrombocytopenia</div></li><li class="half_rhythm"><div>Coagulation disorders</div></li></ul><p>
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<b>Immunological Complications</b>
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</p><p>Complications affecting the immunologic system include:</p><ul><li class="half_rhythm"><div>Increased infection susceptibility</div></li><li class="half_rhythm"><div>Impaired wound healing</div></li><li class="half_rhythm"><div>Reduce efficacy of vaccinations (due to weakened immune system)</div></li><li class="half_rhythm"><div>Chronic inflammation</div></li><li class="half_rhythm"><div>Atrophy of lymphoidtTissues</div></li></ul><p>
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<b>Neuropsychological Complications</b>
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</p><p>Several neurologic and psychologic conditions may develop due to ARFID, including:</p><ul><li class="half_rhythm"><div>Cognitive Impairments (including memory, attention, and executive function)</div></li><li class="half_rhythm"><div>Neuropathy</div></li><li class="half_rhythm"><div>Seizures</div></li><li class="half_rhythm"><div>Developmental delays</div></li><li class="half_rhythm"><div>Mood disorders</div></li><li class="half_rhythm"><div>Concentration and learning difficulties</div></li><li class="half_rhythm"><div>Headaches</div></li><li class="half_rhythm"><div>Reduced brain volume</div></li><li class="half_rhythm"><div>Sleep disturbances</div></li><li class="half_rhythm"><div>Syncope</div></li><li class="half_rhythm"><div>Eating disorders</div></li><li class="half_rhythm"><div>Personality changes (eg, irritability and emotional lability)</div></li><li class="half_rhythm"><div>Social isolation</div></li><li class="half_rhythm"><div>Impaired social development and decreased overall quality of life</div></li><li class="half_rhythm"><div>Strained family relationships and increased stress</div></li></ul></div><div id="article-164812.s12"><h2 id="_article-164812_s12_">Deterrence and Patient Education</h2><p>Management of ARFID involves implementing strategies to prevent the development or worsening of the disorder and educating individuals about its nature, symptoms, and management. These efforts aim to raise awareness about ARFID risk factors, including extreme pickiness or food avoidance behaviors in children, and provide support to address these issues early on to prevent the disorder's progression. Patient education initiatives may include information sessions, pamphlets, or online resources that outline ARFID's symptoms, potential consequences, and available treatment options. Additionally, healthcare clinicians play a crucial role in educating patients and their families about ARFID, its impact on physical and mental health, and the importance of seeking timely intervention and support. </p></div><div id="article-164812.s13"><h2 id="_article-164812_s13_">Pearls and Other Issues</h2><p>ARFID poses substantial risks to both physical and mental health, potentially resulting in malnutrition, growth impairments, and the necessity for nutritional intervention. Patients may rely on tube feeding or dietary supplements, significantly impacting their overall quality of life. Moreover, the disorder can precipitate anxiety and other comorbid mental health conditions. Overlooking the psychological aspects of ARFID treatment should be avoided. Addressing anxiety and sensory aversions related to eating is equally paramount to enhancing food consumption. Healthcare professionals should be equipped to evaluate the influence of ARFID on the patient's quality of life and psychosocial well-being.<a class="bibr" href="#article-164812.r52" rid="article-164812.r52">[52]</a> Despite its growing importance, ARFID is frequently underdiagnosed or inadequately treated within clinical settings. Although the standard care protocol typically entails a multidisciplinary team of specialized healthcare clinicians, the therapeutic approach for this disorder encounters specific gaps due to the lack of interventional trials and variations in methodologies across existing studies.</p><p>Preventive measures should focus on early identification of at-risk individuals, particularly children displaying pronounced pickiness or food avoidance behaviors that impede growth and development, and offer support to prevent the disorder's progression. A systematic review of current practices is advantageous for understanding and managing ARFID; however, standardized guidelines and further research are crucial. Moreover, the epidemiology of ARFID demonstrates significant disparities in sex and gender-related matters, distinguishing it as a distinct entity within eating disorders. Gender nuances in ARFID extend beyond mere prevalence, affecting presentation, risk factors, and treatment engagement. For example, societal expectations and gender norms may influence the acknowledgment and reporting of eating difficulties, particularly among males, who might be less inclined to seek assistance due to stigma or misconceptions about eating disorders primarily afflicting females. This gender gap underscores the importance of fostering awareness and comprehension among healthcare practitioners and the general public to ensure equal access to care for all individuals affected by ARFID, regardless of their sex or gender identity.</p></div><div id="article-164812.s14"><h2 id="_article-164812_s14_">Enhancing Healthcare Team Outcomes </h2><p>To enhance patient-centered care, outcomes, patient safety, and team performance related to ARFID, an interprofessional team comprising physicians, advanced practitioners, nurses, pharmacists, and other health professionals collaborates closely. They collectively address the distinct challenges presented by ARFID, characterized by a persistent lack of interest in eating, selective food avoidance, and resultant weight loss or nutritional deficiencies. This team approach ensures comprehensive treatment, with dietitians assessing nutritional status and devising tailored meal plans, speech-language pathologists targeting oral-motor and sensory processing difficulties, and occupational therapists expanding food repertoires and improving mealtime behaviors. Mental health professionals provide cognitive-behavioral therapy and exposure therapy to address psychological factors maintaining ARFID.</p><p>The individualized treatment approach considers patient age, condition, and accompanying symptoms, with regular dietary screening in pediatric follow-up essential for addressing nutritional and psychological effects. Through coordinated care and specialized expertise, the interprofessional team ensures thorough assessment and multidisciplinary treatment, optimizing patient outcomes and improving the quality of life for individuals with ARFID.</p></div><div id="article-164812.s15"><h2 id="_article-164812_s15_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-164812.s16"><h2 id="_article-164812_s16_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-164812.r1">Archibald T, Bryant-Waugh R. Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions. <span><span class="ref-journal">JCPP Adv. </span>2023 Jun;<span class="ref-vol">3</span>(2):e12160.</span> [<a href="/pmc/articles/PMC10519741/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10519741</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37753149" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37753149</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-164812.r2">Sanchez-Cerezo J, Nagularaj L, Gledhill J, Nicholls D. 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Inpatient hospital course and self-reported symptomatology in underweight adults with ARFID compared to age- and sex-matched controls with anorexia nervosa. <span><span class="ref-journal">J Eat Disord. </span>2023 Nov 20;<span class="ref-vol">11</span>(1):206.</span> [<a href="/pmc/articles/PMC10658840/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10658840</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37986115" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37986115</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="article-164812.r37">Fjeldstad M, Kvist T, Sjögren M. Weight Gain in Adults with Avoidant/Restrictive Food Intake Disorder Compared to Restrictive Anorexia Nervosa-Pilot Findings from a Longitudinal Study. <span><span class="ref-journal">Nutrients. </span>2021 Mar 07;<span class="ref-vol">13</span>(3)</span> [<a href="/pmc/articles/PMC8001165/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8001165</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33799928" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33799928</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="article-164812.r38">Strandjord SE, Sieke EH, Richmond M, Rome ES. Avoidant/Restrictive Food Intake Disorder: Illness and Hospital Course in Patients Hospitalized for Nutritional Insufficiency. <span><span class="ref-journal">J Adolesc Health. </span>2015 Dec;<span class="ref-vol">57</span>(6):673-8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/26422290" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26422290</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="article-164812.r39">Singer W, Sletten DM, Opfer-Gehrking TL, Brands CK, Fischer PR, Low PA. Postural tachycardia in children and adolescents: what is abnormal? <span><span class="ref-journal">J Pediatr. </span>2012 Feb;<span class="ref-vol">160</span>(2):222-6.</span> [<a href="/pmc/articles/PMC3258321/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3258321</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21996154" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21996154</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="article-164812.r40">Raj SR, Guzman JC, Harvey P, Richer L, Schondorf R, Seifer C, Thibodeau-Jarry N, Sheldon RS. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. <span><span class="ref-journal">Can J Cardiol. </span>2020 Mar;<span class="ref-vol">36</span>(3):357-372.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32145864" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32145864</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="article-164812.r41">Hornberger LL, Lane MA., COMMITTEE ON ADOLESCENCE. Identification and Management of Eating Disorders in Children and Adolescents. <span><span class="ref-journal">Pediatrics. </span>2021 Jan;<span class="ref-vol">147</span>(1)</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/33386343" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33386343</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="article-164812.r42">Crone C, Fochtmann LJ, Attia E, Boland R, Escobar J, Fornari V, Golden N, Guarda A, Jackson-Triche M, Manzo L, Mascolo M, Pierce K, Riddle M, Seritan A, Uniacke B, Zucker N, Yager J, Craig TJ, Hong SH, Medicus J. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. <span><span class="ref-journal">Am J Psychiatry. </span>2023 Feb 01;<span class="ref-vol">180</span>(2):167-171.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/36722117" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36722117</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="article-164812.r43">Society for Adolescent Health and Medicine. Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults. <span><span class="ref-journal">J Adolesc Health. </span>2022 Nov;<span class="ref-vol">71</span>(5):648-654.</span> [<a href="/pmc/articles/PMC10864000/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10864000</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36058805" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36058805</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="article-164812.r44">Society for Adolescent Health and Medicine. Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kohn M, Kreipe RE. Position Paper of the Society for Adolescent Health and Medicine: medical management of restrictive eating disorders in adolescents and young adults. <span><span class="ref-journal">J Adolesc Health. </span>2015 Jan;<span class="ref-vol">56</span>(1):121-5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25530605" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25530605</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="article-164812.r45">Zimmerman J, Fisher M. Avoidant/Restrictive Food Intake Disorder (ARFID). <span><span class="ref-journal">Curr Probl Pediatr Adolesc Health Care. </span>2017 Apr;<span class="ref-vol">47</span>(4):95-103.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28532967" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28532967</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="article-164812.r46">Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. <span><span class="ref-journal">Neuropsychiatr Dis Treat. </span>2016;<span class="ref-vol">12</span>:213-8.</span> [<a href="/pmc/articles/PMC4725687/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4725687</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26855577" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26855577</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="article-164812.r47">Kurz S, van Dyck Z, Dremmel D, Munsch S, Hilbert A. Early-onset restrictive eating disturbances in primary school boys and girls. <span><span class="ref-journal">Eur Child Adolesc Psychiatry. </span>2015 Jul;<span class="ref-vol">24</span>(7):779-85.</span> [<a href="/pmc/articles/PMC4490181/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4490181</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25296563" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25296563</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="article-164812.r48">Forman SF, McKenzie N, Hehn R, Monge MC, Kapphahn CJ, Mammel KA, Callahan ST, Sigel EJ, Bravender T, Romano M, Rome ES, Robinson KA, Fisher M, Malizio JB, Rosen DS, Hergenroeder AC, Buckelew SM, Jay MS, Lindenbaum J, Rickert VI, Garber A, Golden NH, Woods ER. Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the national eating disorders quality improvement collaborative. <span><span class="ref-journal">J Adolesc Health. </span>2014 Dec;<span class="ref-vol">55</span>(6):750-6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25200345" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25200345</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="article-164812.r49">Friars D, Walsh O, McNicholas F. Assessment and management of cardiovascular complications in eating disorders. <span><span class="ref-journal">J Eat Disord. </span>2023 Jan 30;<span class="ref-vol">11</span>(1):13.</span> [<a href="/pmc/articles/PMC9886215/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9886215</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36717950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36717950</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="article-164812.r50">Eddy KT, Harshman SG, Becker KR, Bern E, Bryant-Waugh R, Hilbert A, Katzman DK, Lawson EA, Manzo LD, Menzel J, Micali N, Ornstein R, Sally S, Serinsky SP, Sharp W, Stubbs K, Walsh BT, Zickgraf H, Zucker N, Thomas JJ. Radcliffe ARFID Workgroup: Toward operationalization of research diagnostic criteria and directions for the field. <span><span class="ref-journal">Int J Eat Disord. </span>2019 Apr;<span class="ref-vol">52</span>(4):361-366.</span> [<a href="/pmc/articles/PMC6485247/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6485247</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30758864" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30758864</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="article-164812.r51">Aulinas A, Marengi DA, Galbiati F, Asanza E, Slattery M, Mancuso CJ, Wons O, Micali N, Bern E, Eddy KT, Thomas JJ, Misra M, Lawson EA. Medical comorbidities and endocrine dysfunction in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls. <span><span class="ref-journal">Int J Eat Disord. </span>2020 Apr;<span class="ref-vol">53</span>(4):631-636.</span> [<a href="/pmc/articles/PMC7184800/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7184800</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32198943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32198943</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="article-164812.r52">Cucinotta U, Romano C, Dipasquale V. A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice. <span><span class="ref-journal">Healthcare (Basel). </span>2023 Aug 10;<span class="ref-vol">11</span>(16)</span> [<a href="/pmc/articles/PMC10454601/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10454601</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37628443" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37628443</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Zerimar Ramirez declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Sasidhar Gunturu declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK603710_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Zerimar Ramirez</span><sup>1</sup>; <span itemprop="author">Sasidhar Gunturu</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> BronxCare Health System</div><div class="affiliation"><sup>2</sup> ICAHN School of Medicine at Mt. Sinai</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">May 1, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Ramirez Z, Gunturu S. Avoidant Restrictive Food Intake Disorder. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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