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Original article
Division of Adolescent Medicine, Cohen Childrens Medical Center, North ShoreeLong Island Jewish Health System, New Hyde Park, New York
Departments of Pediatrics, Internal Medicine, and Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
c
Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Childrens Hospital, Hershey, Pennsylvania
d
Department of Pediatrics, Oakland University William Beaumont School of Medicine, Division of Adolescent Medicine, Beaumont Childrens Hospital, Royal Oak, Michigan
e
Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
f
Center for Adolescent Medicine, Cleveland Clinic Childrens Hospital, Cleveland, Ohio
g
Division of Adolescent and Young Adult Health, Monroe Carell Jr. Childrens Hospital at Vanderbilt, Nashville, Tennessee
h
Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York
b
Article history: Received September 12, 2013; Accepted November 19, 2013
Keywords: Avoidant/Restrictive food intake disorder (ARFID); Children and adolescents; 5th Edition of the diagnostic and statistical
Manual (DSM-5); Anorexia nervosa (AN); Bulimia nervosa (BN)
A B S T R A C T
Purpose: To evaluate the DSM-5 diagnosis of Avoidant/Restrictive Food Intake Disorder (ARFID) in
children and adolescents with poor eating not associated with body image concerns.
Methods: A retrospective case-control study of 8e18-year-olds, using a diagnostic algorithm,
compared all cases with ARFID presenting to seven adolescent-medicine eating disorder programs
in 2010 to a randomly selected sample with anorexia nervosa (AN) and bulimia nervosa (BN).
Demographic and clinical information were recorded.
Results: Of 712 individuals studied, 98 (13.8%) met ARFID criteria. Patients with ARFID were
younger than those with AN (n 98) or BN (n 66), (12.9 vs. 15.6 vs. 16.5 years), had longer
durations of illness (33.3 vs. 14.5 vs. 23.5 months), were more likely to be male (29% vs. 15% vs. 6%),
and had a percent median body weight intermediate between those with AN or BN (86.5 vs. 81.0
and 107.5). Patients with ARFID included those with selective (picky) eating since early childhood
(28.7%); generalized anxiety (21.4%); gastrointestinal symptoms (19.4%); a history of vomiting/
choking (13.2%); and food allergies (4.1%). Patients with ARFID were more likely to have a comorbid medical condition (55% vs. 10% vs. 11%) or anxiety disorder (58% vs. 35% vs. 33%) and were
less likely to have a mood disorder (19% vs. 31% vs. 58%).
Conclusions: Patients with ARFID were demographically and clinically distinct from those with AN
or BN. They were signicantly underweight with a longer duration of illness and had a greater
likelihood of comorbid medical and/or psychiatric symptoms.
2014 Society for Adolescent Health and Medicine. All rights reserved.
Presented at the Society for Adolescent Health and Medicine Annual Meeting,
Atlanta, Georgia, March 13e16, 2013; 2013 International Conference on Eating
Disorders, Montreal, Canada. May 2e4, 2013; Resident Research Day, Hospital for
Sick Children and University of Toronto, May 22, 2013.
IMPLICATIONS AND
CONTRIBUTION
1054-139X/$ e see front matter 2014 Society for Adolescent Health and Medicine. All rights reserved.
http://dx.doi.org/10.1016/j.jadohealth.2013.11.013
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Table 1
DSM-5 diagnosis of Avoidant/Restrictive Food Intake Disorder [13]
Methods
Results
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Table 2
Clinical characteristics of patients with ARFID, anorexia nervosa, or bulimia nervosa
ARFID (n 98)
Age (years)
% Median body weight
Lowest weight (kg)
Highest weight (kg)
Duration (months)
Genderb,c
Female (%)
Male (%)
Intake setting
OPD (%)
Other (%)
Referral sourcec
Self (%)
PCP (%)
Mental health (%)
Emergency department (%)
Social service (%)
Other (%)
Medical condition or symptomb,c
Yes, related (%)
Yes, unrelated (%)
None (%)
Mood disorderc
MDD/dysthymia (%)
Other (%)
None (%)
Anxiety disorderb,c
GAD (%)
OCD (%)
Other (%)
None (%)
12.9
86.5
35.0
40.8
33.3
2.5
15.1
11.9
15.0
41.3
1.9a
9.2a
7.3a
12.9a
12.2a
71.3
28.6
85.7
14.3
94.0
6.0
87.7
12.3
85.7
14.3
97.0
3.0
6.2
51.6
11.3
10.3
1.0
0
10.2
50.0
16.3
11.2
4.1
3.0
15.5
53.0
22.7
4.6
1.5
3.0
34.6
16.3
49.1
8.2
2.0
89.8
4.6
6.1
89.3
7.2
11.3
81.5
19.4
11.2
69.4
23.1
35.4
41.5
28.6
6.1
23.5
41.8
14.3
8.2
13.3
64.2
7.6
1.5
24.2
66.7
ARFID Avoidant/Restrictive Food Intake Disorder; GAD generalized anxiety disorder; MDD major depressive disorder; OCD obsessive-compulsive disorder;
OPD out-patient department; PCP primary care physician.
a
Signicant difference from ARFID, p .05 by Tukeys Honestly Signicant Difference (HSD).
b
Signicant difference between anorexia nervosa and ARFID by Chi-square, p < .05 after Bonferroni correction.
c
Signicant difference between bulimia nervosa and ARFID by Chi-square, p < .05 after Bonferroni correction.
52