A tradeoff between safety and freedom: Adults' lived experiences of ARFID.

BACKGROUND: Avoidant restrictive food intake disorder (ARFID) is characterized as a pattern of restrictive eating leading to significant medical and/or psychosocial impairment (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Association, Washington, D.C., 2013). Most existing research on ARFID utilizes quantitative methodologies to study children and adolescents. As a result, the experiences of adults with ARFID have been underrepresented in research. To fill this gap, the current study examines the lived experiences of adults with a DSM-5 diagnosis of ARFID. METHOD: Participants (n = 9) included adult women aged 20-42 (M = 27, SD = 6.2) recruited from social media advertising. Open-ended, semi-structured interviews were conducted. Data were analyzed using interpretative phenomenological analysis (IPA). RESULTS: One of three overarching themes identified by IPA will be discussed in this study: "A tradeoff between safety and freedom," which consists of two subthemes: (a) Ensuring safety from food unknowns and (c) Longing for Freedom. This overarching theme explores the influence of ARFID on an individual's sense of safety and freedom. DISCUSSION: This study is one of few to qualitatively examine ARFID, and the only to do so using IPA. Findings offer novel insights relevant to researchers and clinicians who treat adults with ARFID and who wish to increase consideration and understanding of patient lived experience in their work.

Relation between ARFID symptomatology and picky eating onset and duration.

BACKGROUND: Picky eating (PE) is common in early childhood, peaking between ages 1 and 5 years. However, PE may persist beyond this normative period and pose threats to health and psychosocial functioning. Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by appetite, preference/selectivity, and/or fear of eating, leading to significant medical and/or psychosocial impairment. This retrospective study examined the relation between early childhood PE onset/duration and ARFID eating restrictions and symptoms. METHOD: Parents of children ages 6-17 (N = 437) completed a survey about their child's eating behavior, including the Nine-item ARFID Screen (NIAS) and questions about PE onset and impacts. Children were then categorized into groups based on PE onset (before or after age 5) and duration: never picky, normative picky, persistent picky, and late-onset picky. RESULTS: The groups differed (all p < .05) in mean NIAS subscales (picky eating, NIAS-PE; appetite, NIAS-A; fear, NIAS-F) and total scores (NIAS-T). Tukey post-hoc tests found that persistent PEs had significantly higher NIAS-PE, NIAS-A, and NIAS-T scores than never or normative PEs (all p < .05). Chi-Square tests found that persistent PEs were significantly more likely than all other groups to endorse ARFID criteria. CONCLUSION: Findings from this study suggest that PE that persists beyond or is identified after the normative period is associated with elevated ARFID symptoms compared to normative and never PEs. Persistent PE increases risk of impairment from PE and other ARFID eating restrictions. Given the health and psychosocial risks associated with ARFID, early identification and intervention for this group is warranted.