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Session 2

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

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 – OCD??

Sensory issues
ARFID most of the times is present
AN can be present but usually not (unless those 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

• Strong visual processing – visual cues and why packages are so important

• Home cooking is difficult to manage as won't be similar all the time

• Every detail is important

• They usually don’t look to the food (because after taking a bite, you change It visually and therefore it looks different)

• Usually they will eat different foods in different environments (i.e. just eat nuggets at school and not at home – conditional cues
become part of the food)

• 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 what 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 about 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

Assessment

What is driving the avoidant / restrictive eating?

Lack of interest +/-
sensory issues +/-
concern or fear

What are the risks of the eating concern?

Impact on growth/ development, nutritional deficiency, impact on social/emotional development or family functioning

Any comorbidity?

E.g. ASD, ADHD, anxiety disorders

A new semi-structured multi-informant interview— (PARDI) has recently been developed to diagnose ARFID in children and adults (2019).
Long version

– structured interview

Short version

– questionnaires to be completed by both parents and YP if 14+

Outcome measures

  • Physical health measures

  • Standard ROMS (SDQ, RCADS, CGAS)

  • PARDI-AR-Q

    • Self-report 14+

    • Parent report 4+

  • What Matters to Me

    • Parent report goal measure

Well Done!

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References or Creators Credit

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My Notes

Supporting Videos

The Fight, Flight, Freeze Response

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