Avoidant Restrictive Food Intake Disorder

An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: significant weight loss (or failure to achieve expected weight gain or faltering growth in children); significant nutritional deficiency; dependence on enteral feeding or oral nutritional supplements; or marked interference with psychosocial functioning. (from DSM-V)

Also Known As:

Networked: 115 relevant articles (4 outcomes, 21 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Malnutrition (Nutritional Deficiencies)
2.	Weight Loss (Weight Reduction)
3.	misophonia
4.	Avoidant Restrictive Food Intake Disorder
5.	Anorexia Nervosa

Experts

1.	Eddy, Kamryn T: 6 articles (11/2022 - 11/2018)
2.	Thomas, Jennifer J: 6 articles (11/2022 - 11/2018)
3.	Becker, Kendra R: 4 articles (11/2022 - 01/2019)
4.	Lawson, Elizabeth A: 4 articles (11/2022 - 01/2019)
5.	Micali, Nadia: 4 articles (11/2022 - 01/2019)
6.	Lane-Loney, Susan: 4 articles (06/2022 - 01/2017)
7.	Essayli, Jamal H: 4 articles (01/2022 - 01/2017)
8.	Misra, Madhusmita: 3 articles (11/2022 - 08/2019)
9.	Di Monaco, Rossella: 3 articles (12/2020 - 06/2019)
10.	Dinnella, Caterina: 3 articles (06/2020 - 06/2019)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Avoidant Restrictive Food Intake Disorder:

1.	Mirtazapine (Rexer)FDA LinkGeneric 01/01/2018 - "Although mirtazapine is an off-label approach in a pediatric population and carries a black box warning for an increased risk of suicide, it is an effective treatment for depression and anxiety symptoms in adults and is generally well tolerated.3,4 There are no studies to date reporting on the use of mirtazapine in patients with ARFID." 03/01/2023 - "Mirtazapine Improved Eating Patterns in Avoidant/Restrictive Food Intake Disorder." 09/01/2019 - "3 admissions on a pediatric Ward were necessary for this patient with ARFID, who was successfully managed with a partial hospitalization model, Family Based Treatment (FBT) and Mirtazapine. " 09/01/2019 - "Management of ARFID (Avoidant Restrictive Food Intake Disorder) in a 12-year-old on a Paediatric Ward in a General Hospital: Use of Mirtazapine, Partial Hospitalisation Model and Family Based Therapy."
2.	Selective Serotonin Reuptake Inhibitors (Serotonin Reuptake Inhibitors)IBA 01/01/2022 - "Randomized, placebo-controlled studies for children and adolescents with ARFID are warranted to better evaluate and understand the efficacy of SSRIs and hydroxyzine in this clinical population." 01/01/2022 - "Conclusion: These results provide preliminary evidence that SSRIs and hydroxyzine may be helpful in the treatment of children and adolescents with ARFID. " 01/01/2022 - "Selective Serotonin Reuptake Inhibitors and Hydroxyzine in the Treatment of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: Rationale and Evidence." 01/01/2022 - "We aimed to explore the effectiveness of selective serotonin reuptake inhibitors (SSRIs), either alone or in combination with hydroxyzine, in a well-defined cohort of children and adolescents with ARFID receiving treatment in a partial hospitalization program for eating disorders. "
3.	Hydroxyzine (Vistaril)FDA LinkGeneric 01/01/2022 - "Methods: We conducted a retrospective chart review of 53 patients with ARFID who were prescribed an SSRI (n = 39) or SSRI with hydroxyzine (n = 14). " 01/01/2022 - "Randomized, placebo-controlled studies for children and adolescents with ARFID are warranted to better evaluate and understand the efficacy of SSRIs and hydroxyzine in this clinical population." 01/01/2022 - "Conclusion: These results provide preliminary evidence that SSRIs and hydroxyzine may be helpful in the treatment of children and adolescents with ARFID. " 01/01/2022 - "Selective Serotonin Reuptake Inhibitors and Hydroxyzine in the Treatment of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: Rationale and Evidence." 01/01/2022 - "We aimed to explore the effectiveness of selective serotonin reuptake inhibitors (SSRIs), either alone or in combination with hydroxyzine, in a well-defined cohort of children and adolescents with ARFID receiving treatment in a partial hospitalization program for eating disorders. "
4.	Risperidone (Risperdal Consta)FDA LinkGeneric 01/01/2022 - "Here, authors report on a challenging case of low-functioning ASD child with comorbid ARFID and misophonia that responded favorably to a low-dose risperidone. " 01/01/2022 - "Low-Dose Risperidone for an Autistic Child with Comorbid ARFID and Misophonia."
5.	Vitamin DFDA LinkGeneric 11/02/2023 - "Results showed individuals with ARFID had significantly lower vitamin D levels than individuals with restrictive type AN, but not individuals with binge/purge type AN. Additionally, analyses showed that higher levels of vitamin D may play a role in the association between RH and weight on admission. " 11/02/2023 - "Individuals diagnosed with ARFID are as nutritionally fragile as those with AN regarding vitamin D and RH. " 11/02/2023 - "Thirty-five (35%) of individuals with ARFID were either deficient or insufficient in vitamin D, compared to 29% of individuals with AN. Individuals with AN had significantly higher mean vitamin D levels compared to those with ARFID (p = .03; η2 = 0.015). " 11/02/2023 - "The relationship between vitamin D and RH in AN and ARFID is unknown. " 07/17/2023 - "Individuals diagnosed with ARFID are as nutritionally fragile as those with AN regarding vitamin D and RH. "
6.	Phosphorus (Red Phosphorus)IBA 07/17/2023 - "There were no significant differences between groups in phosphorus nadir (p = .17, η2 = 0.12) or hypophosphatemia (p = .16, ϕc = 0.11); 44% of individuals with ARFID and 33% of individuals with AN had hypophosphatemia. " 11/02/2023 - "Therefore, the aims of this study were to (1) report rates of low serum 25-hydroxy vitamin D and RH in AN and ARFID; (2) describe associations between phosphorus and variables associated with RH identified in extant literature; (3) examine the relationship between 25-hydroxy vitamin D and RH and (4) investigate moderation by vitamin D between variables of interest and phosphorus level. " 07/17/2023 - "Therefore, the aims of this of this study were to 1) describe the prevalence of low serum 25-hydroxy vitamin D levels and RH in AN and ARFID 2) report associations between nadir phosphorus level and variables associated with RH in extant literature and 3) examine the relationship between 25-hydroxy vitamin D levels and serum phosphorus nadir in AN and ARFID. " 11/02/2023 - "The negative feedback loop involving vitamin D that maintains phosphorus homeostasis may play a role in the development of RH in AN and ARFID. " 07/17/2023 - "The negative feedback loop involving vitamin D that maintains phosphorus homeostasis may play a role in the development of RH in AN and ARFID."
7.	Proteins (Proteins, Gene)FDA Link 01/01/2023 - "Food neophobia (reluctance to try new foods) could be contributing to this delay and as such, this study aimed to explore the role of food neophobia on protein food source habits and willingness to eat insects as food. " 01/01/2022 - "The survey items included a Food Neophobia Scale, frequency of protein intake, oral-health-related quality of life (QOL) assessment, and oral diadochokinesis (ODK; /pa/, /ta/, /ka/) as an index of oral function. " 12/01/2021 - "Multinomial logistic regression indicated that the use of alternative proteins was associated with higher health and sustainability motives, and lower food neophobia. " 01/01/2021 - "For example, for insects and other novel alternative proteins the drivers of familiarity and affective processes of food neophobia and disgust seem more relevant. " 01/01/2021 - "In general, the following drivers of acceptance consistently show to be relevant for the acceptance of various alternative proteins: motives of taste and health, familiarity, attitudes, food neophobia, disgust, and social norms. "
8.	Hormones (Hormone)IBA 01/01/2021 - "ARFID and AN appear to have distinct patterns of secretion of gut-derived appetite-regulating hormones that may aid in differential diagnosis and provide new treatment targets." 07/01/2023 - "We aimed to study bone health in low-weight females with ARFID, as well as the association between peptide YY (PYY), an anorexigenic hormone with a role in regulation of bone metabolism, and bone mineral density (BMD) in these individuals. " 11/01/2022 - "In male and female children and adolescents, we hypothesized that fasting levels of cholecystokinin (CCK), a satiety hormone, would be elevated in participants with ARFID (full or subthreshold) versus healthy controls (HCs). "
9.	GhrelinIBA 01/01/2023 - "The aim of this study was to evaluate the relationship between ghrelin levels and measures of anxiety in youth with ARFID. " 01/01/2023 - "Conclusions: These findings demonstrate that lower levels of ghrelin are associated with more severe anxiety symptoms in youth with ARFID and raise the question of whether ghrelin pathways could be targeted in the treatment of ARFID." 01/01/2023 - "Lower Ghrelin Levels Are Associated With Higher Anxiety Symptoms in Adolescents and Young Adults With Avoidant/Restrictive Food Intake Disorder." 01/01/2021 - "Fasting and postprandial ghrelin were lower in ARFID versus AN (ps≤.015), but not HC (ps≥0.62). " 01/01/2021 - "94 females (22 low-weight ARFID, 40 typical/atypical AN, and 32 HC ages 10-22 years) underwent fasting blood draws for total ghrelin and total PYY. "
10.	ZincIBA 07/27/2023 - "This is the first study to systematically assess zinc levels in ARFID. " 07/27/2023 - "Examine serum zinc levels and their association with eating pathology, psychopathology, and executive functioning in youth with ARFID and AN. This study included 28 adolescents (Mage = 13, 75% female) receiving treatment for ARFID (n = 13) and AN (n = 15). " 07/27/2023 - "AN had relatively lower zinc levels, higher eating pathology, and anxiety, though ARFID had a longer duration of illness. " 07/27/2023 - "While zinc deficiency has been identified in AN, zinc level in ARFID has not been systematically assessed. " 07/27/2023 - "Serum zinc levels in youth with avoidant/restrictive food intake disorder and anorexia nervosa: Clinical correlation with weight and psychopathology."

Therapies and Procedures

1.	Enteral Nutrition (Feeding, Tube) 04/01/2023 - "A bolus feeding schedule may not promote oral intake in feeding tube-dependent children diagnosed with ARFID." 04/01/2023 - "Following adjustment for confounders, this retrospective chart review showed statistically higher odds of percentage of oral intake >0% in ARFID patients receiving overnight continuous enteral feeding schedules (odds ratio = 0.20, 95% CI: 0.05-0.83, P = 0.027). " 01/01/2023 - "This single-patient case study demonstrates that CBT-AR may be efficacious in reducing ARFID symptom severity among older adults with a feeding tube." 01/01/2022 - "She received 3 years of treatment for ARFID, but failed to make significant progress and ultimately required a feeding tube. " 12/01/2015 - "During hospitalization, although ARFID and AN patients had similar caloric intake, ARFID patients relied on more enteral nutrition and required longer hospitalizations than AN patients (8 vs. 5 days; p = .0006). "
2.	Therapeutics 01/01/2023 - "METHODS: This trial will randomize 100 children ages 6-12 years old who meet DSM-5 criteria for ARFID and their families to receive either 14 telehealth sessions of FBT-ARFID (n = 50) or a manualized Psychoeducational Motivation Therapy (PMT) treatment (n = 50), an individual therapy addressing the child's understanding of the problems ARFID is causing and promoting non-behavioral motivation and exploration of changing their eating patterns. " 03/24/2022 - "This study determined the feasibility of behavioral therapy for children with avoidant/restrictive food intake disorder and dependency on the tube or oral enteral nutrient formula in Japan. " 07/01/2023 - "PMT is a promising therapy for ARFID in school-age children. " 03/24/2022 - "Our data demonstrate that this behavioral therapy is feasible for children with avoidant/restrictive food intake disorder dependent on the tube or oral formula in Japan." 03/24/2022 - "Behavioral Therapy for Children with Avoidant/Restrictive Food Intake Disorder Dependent on Tube or Oral Enteral Nutrient Formula: A Feasibility Study."
3.	Medical Day Care (Partial Hospitalization) 01/01/2019 - "The current study explored the potential cooccurrence of behavioural phenotypes in patients with ARFID presenting to a partial hospitalization program. " 11/01/2022 - "Preliminary effectiveness of a cognitive-behavioral, family-centered partial hospitalization program for children and adolescents with avoidant/restrictive food intake disorder." 06/01/2022 - "Methods Data from 71 ARFID patients from our partial hospitalization program (PHP) for children and adolescents were examined. " 11/01/2020 - "A total of 39 adolescents with ARFID and 59 with AN presenting to a partial hospitalization program were included, with measures completed at intake and discharge. " 01/01/2019 - "Exploring the cooccurrence of behavioural phenotypes for avoidant/restrictive food intake disorder in a partial hospitalization sample."
4.	Behavior Control 01/29/2019 - "This study examines the attitude (A), subjective norm (SN), perceived behavioral control (PC), and food neophobia (FN) toward the consumption of foods of insect origin, as well as the conditions for eating insect-based foods among vegans, vegetarians, and omnivores. " 01/01/2019 - "Regarding this, our study is centered on the theory of planned behavior and considers environmental concern and food neophobia to discuss the effects of consumer attitudes, subjective norms, and perceived behavioral control on the purchase intention toward insect food. " 01/01/2019 - "The results revealed that consumer attitudes, perceived behavioral control, and food neophobia significantly influence purchase intention, whereas subjective norms and environmental concern did not demonstrate significant relationships with purchase intention. "
5.	Diet Therapy (Therapy, Diet) 03/22/2023 - "Reviewing what is known of clinical data from anorexia nervosa (AN) and similar cohorts, the chronicity and etiology of dietary restriction observed in ARFID are hypothesized to compromise bone health significantly. " 01/01/2020 - "Avoidant/Restrictive food intake disorder (ARFID) is characterized by dietary restrictions that are not based on weight or shape concerns but that result in marked interference in feeding, growth, or psychosocial functioning (American Psychiatric Association, 2013; Eddy et al., 2019). " 01/01/2019 - "Both groups reported similar levels of dietary restriction, although ARFID can be distinguished by relatively higher levels of food neophobia. " 11/01/2022 - "Objective: Avoidant/restrictive food intake disorder (ARFID) is characterized by food avoidance or dietary restriction not primarily motivated by body weight/shape concerns. " 11/28/2023 - "Excessive dietary restriction is common in patients with inflammatory bowel disease (IBD) and in severe cases can lead to Avoidant/Restrictive Food Intake Disorder (ARFID).ARFID is a new eating disorder that has been proposed in recent years. "