Professionals – Selective Eating vs ARFID

Session 2

Comorbidities and assessment

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Comorbidities

Table 2 clinical characteristics of patients by eating disorder diagnosis

	ARFID (N=39)	AN (N=93)	BN (N=20)	OSFEED/UFED (N=21)	p-value
Patient Characteristics (mean of %)
Age (years) (SD)	11.1 (1.7) ^*	14.0 (1.5)	14.9 (1.1)	14.2 (1.7)	<0.0001
% MBW (SD)	87.1 (13.0)	82.6 (9.2)	108.1 (19.5) ^*	93.2 (6.8)	<0.0001
% Body Weight Lost (SD)	10.5 (8.4)	18.5 (10.2) ^*	6.4 (6.5)	14.8 (12.2)	<0.0001
Length of illness (months) (SD)	9.2 (13.2)	8.6 (7.9)	15.9 (11.9)	9.8 (4.9)	N.S.
% Female	79.5	95.7	100	90.5	0.008
% Male	20.5 ^*	4.3	0	9.5
Symptoms & Features (%)
Enteral Supplement Use	46 ^*	20	0	0	<0.0001
Purge-vomit	0	6	95^*	38	<0.0001
Excessive exercise	15 ^*	68	65	52	<0.0001
Food allergy	20	5	10	5	N.S.
Fear of choking or vomiting	44 ^*	1	0	0	<0.0001
Sensory issues	26 ^*	1	0	0	<0.0001
Recent medical specialist consult	46	19	20	33	N.S.
Psychiatric comorbidities
Mood disorder	33 ^*	48	80	76	<0.0001
Anxiety	72 ^*	37	25	14	<0.0001
Autism Spectrum Disorder	13 ^*	0	0	0	<0.0001
Attention Deficit Disorder	4 ^*	0	1	1	N.S.
Learning Disorder	10 ^*	2	2	0	<0.0001
Cognitive imparment	26 ^*	2	10	0	<0.0001
*Significant finding on post-hoc analysis using Hochberg GT2 text. AN=Anoexia Nervosa ARFID=Avoidant/Restrictive Food Intake Disorder. BN=Bulimia Nervosa OSFED/UFED=other Specified Feeding or Eating Disorder/Unspecified Feeding or Eating Disorder % MBW =% Median Body Weight.

Nicely TA et all. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young
patients in day treatment for eating disorders. Journal of Eating Disorder,2014, 2:21.

ARFID and Anorexia Nervosa

Similarities

Differences

Restrictive eating

Body and shape concern
AN - 'feeling fat'.
ARFID - preoccupied with the number – i.e. not wanting the weight to change/to go up (fixation/rigidity but not because they 'feel fat').

Anxiety at meal times

Anxiety at meal times
ARFID – not knowing what to expect.
AN – fear of calories/volume of meals.

Weight loss

Difficulties at a very young age
ARFID usually before 10.
AN usually teenagers.

Rigidity or OCD

Sensory issues
Present most of the time with ARFID.
Can be present with AN but isn’t usually (with the exception of young people on the spectrum).

Meal times as most difficult moment of the day

Type of food eaten
AN will avoid carbs, fats and will have fear foods.
ARFID no pattern but usually they will eat biscuits, chocolate or a food that for AN is considered fear food.

Impact on family and social situations/isolation

Obsession around food
ARFID + ASD – numbers, specific things, rigidity.
AN – obsession about calories (fear of gaining weight) + rituals/rigidity mostly due to starvation.

ARFID and autism

There is an overlap between Autism and ARFID.

What we know is that when Autism is also present with ARFID, we have further things to consider (this is not an extensive list, just examples):

• Strong visual processing – which means that visual cues are important and why changing in food packaging can be difficult to manage (i.e. the food package was blue and now is yellow or even subtle change like the name has changed size).

• Home cooking can be difficult to manage – as there is no consistency and it changes all the time, even if you follow the same recipe. Think about food chain restaurants – you will always have the same flavour, size, consistency.

• Every detail is important – for example visual aspect and associations (i.e. at home I eat with my blue place but in school I don’t have the blue plate and therefore I can’t eat).

• Looking at the food can be difficult as it changes at every bite (i.e. when you bite a round biscuit, it won’t look round anymore).

• Talking about association again, they might only be able to eat different foods in different environments (i.e. just eating chicken nuggets in school but not at home).

• Use of distractions around meals – for MDT and family discussion.

• Meal times and activities ideally should be at the same time every day - CONSISTENCY ("If I know when it will happen, I get less anxious").

• Use a visual timetable to explain what happens at mealtimes and during the day (i.e. school timetable) – to avoid anxiety.

• Use a visual meal plan.

• Importance in looking for early communication.

• Food is visually inconsistent.

• Sensory preparation before meals.

>> Not every eating difficulty meets the criteria for ARFID.
>> Around 80% of ASC children have eating difficulties – usually around food sensitivity.