[Avoidant/Restrictive Food Intake Disorder (ARFID): What the pediatrician should know]. / Trastorno de Evitación y Restricción de la Ingesta de Alimentos (ARFID): Lo que el pediatra debe saber.

Feeding problems during childhood have been described over time by various authors. In 2013, Avoi dant/Restrictive Food Intake Disorder (ARFID) was included in the Diagnostic and Statistical Ma nual of Mental Disorders, 5th Edition (DSM-5), as a new diagnosis within the Feeding and Eating di sorders, to describe a group of patients with avoidant or restrictive eating behaviors unrelated to body image disorder or weight loss desire. ARFID may appear as significant weight loss and/or nutritional deficiency and/or a marked interference in psychosocial functioning. There are three forms of pre sentation, which can co-occur or occur independently. The first one includes children with sensory aversions (selective), who reject certain foods due to their taste, texture, smell, or shape; the second one includes those children with poor appetite or limited intake (limited intake); and the third one includes those children who reject certain foods or stop eating as a result of a traumatic event (aversi- ve). Due to the recent incorporation of ARFID into the DSM-5, there is a lack of information regar ding its treatment. The purpose of this review is to clarify diagnostic criteria and to describe targeted management and treatment interventions with a multidisciplinary approach, without deepening on the treatment of organic medical causes.

Eating disorders during the Edo period between 1603 and 1867 in Japan.

OBJECTIVE: The purpose of this study is to examine whether Fushoku-byo and Shinsen-ro are eating disorders or not. METHOD: We completed a retrospective review of Fushoku-byo and Shinsen-ro during the Edo period (1603-1867) using the original books of these disorders written by Kampo doctors and compared these disorders with eating disorders in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). RESULTS: There were more than 50 patients with Fushoku-byo and Shinsen-ro during the Edo period, when Japan was closed to the rest of the world. More than 90% of them were young women. All patients demonstrated food restriction or avoidance that significantly impaired their physical health or psychosocial functioning. Kampo doctors did not mention any fat phobia and disturbed body image. They considered these disorders to be caused by psychological distress and recommended psychological treatment. DISCUSSION: The finding in this study challenges some of the presumptions that the development of eating disorders in non-Western countries is attributed to modern Western influence. It is plausible that these patients could have been categorized as having unspecified feeding or eating disorder in the DSM-5, when the presence or absence of fat phobia and disturbed body image is unclear.

Eating disorders in adolescent boys and young men: an update.

PURPOSE OF REVIEW: To review the recent literature on eating disorders and disordered eating behaviors among adolescent boys and young men, including epidemiology, assessment, medical complications, treatment outcomes, and special populations. RECENT FINDINGS: Body image concerns in men may involve muscularity, and muscle-enhancing goals and behaviors are common among adolescent boys and young men. Recent measures, such as the Muscularity Oriented Eating Test (MOET) have been developed and validated to assess for muscularity-oriented disordered eating. Medical complications of eating disorders can affect all organ systems in male populations. Eating disorders treatment guidance may lack specificity to boys and men, leading to worse treatment outcomes in these population. Male populations that may have elevated risk of eating disorders and disordered eating behaviors include athletes and racial/ethnic, sexual, and gender minorities. SUMMARY: Eating disorders and disordered eating behaviors in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating. Treatment of eating disorders in boys and men may be adapted to address their unique concerns.

Current approach to eating disorders: a clinical update.

This article presents current diagnostic conceptualisations of eating disorders, including new disorders such as binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). This is followed by contemporary findings in the epidemiology of eating disorders, their broad sociodemographic distribution and the increases in community prevalence. Advances and the current status of evidence-based treatment and outcomes for the main eating disorders, anorexia nervosa, bulimia nervosa and BED are discussed with focus on first-line psychological therapies. Deficits in knowledge and directions for further research are highlighted, particularly with regard to treatments for BED and ARFID, how to improve treatment engagement and the management of osteopenia.

Adapting treatment in an eating disorder program to meet the needs of patients with ARFID: Three case reports.

Avoidant/restrictive food intake disorder (ARFID) was introduced in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Three different subtypes of ARFID are described: individuals who seem disinterested in eating, those who avoid certain foods because of a sensitivity to specific characteristics of the food, and those who are concerned about an aversive experience associated with eating. There is currently no first-line treatment for ARFID. Three case studies are presented of patients with ARFID who participated in a family-based partial hospitalization program/intensive outpatient program for eating disorders. A description of the course of treatment is included, as well as ways in which the eating disorder program adapted treatment to more closely meet the unique needs of these patients. An approach with emphasis on parental involvement seems promising, although research is needed to investigate this more fully.

Course of Disordered Eating Behavior in Young People With Early-Onset Type I Diabetes: Prevalence, Symptoms, and Transition Probabilities.

PURPOSE: The aims of this study were to analyze the prevalence and course of disordered eating behavior (DEB) in adolescents with intensively treated type I diabetes, describe differences in age-specific DEB symptoms, and identify predictors of current DEB. METHODS: Data were taken from 332/218 11- to 27-year-old participants (55.7% girls/women, mean age [SD] 17.8 [3.4] years, mean diabetes duration 14.9 [3.0] years) of two/three surveys of a Germany-wide longitudinal study on early-onset and long duration diabetes, respectively. A diabetes-adapted version of the SCOFF questionnaire was used to assess DEB. Both screening-based overall and age- and sex-specific prevalence of DEB and its symptoms were determined. To estimate transition probabilities between DEB states, first-order Markov transition models were implemented adjusting for previous sociodemographic, socioeconomic, and diabetes-specific covariates. RESULTS: The overall screening-based DEB prevalence among all 1,318 observations was 10.8% (95% confidence interval [CI]: 9.2%, 12.6%) with age-specific differences in symptom prevalence. Transition probabilities for developing/persistent DEB were twofold higher among female than male participants (risk ratio [RR] 2.3 [1.4, 3.9]/2.1 [1.3, 3.4]). In multiple adjusted regression, previous DEB (odds ratio [OR] 2.8 [95% CI 1.4, 5.6]), follow-up time (ORper 1-year increase 3.4 [1.4, 8.0]), and sex (ORgirls/women 2.1 [1.1, 3.9]) were the most important predictors of current DEB with further weaker associations for previous age and HbA1c. CONCLUSIONS: Our results contribute to better understanding the course of DEB in patients with early-onset diabetes and emphasize the relevance of regular DEB screenings including the age group of young adults.

Psychometric properties of the eating loss of control scale among postbariatric patients.

BACKGROUND: Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients. OBJECTIVE: This study presents a psychometric examination of the ELOCS in postoperative bariatric surgery patients. SETTING: Academic medical center in the United States. METHODS: One hundred seventy-one postbariatric treatment-seeking adults (82.5% female, 52.4% white) with LOC eating completed the ELOCS and measures assessing eating psychopathology and mood. Confirmatory factor analysis (CFA) was used to test fit for a 1-factor solution. Exploratory factor analysis (EFA) examined alternative factor structures. RESULTS: CFA revealed poor fit for a 1-factor structure (χ2 = 220.375, degrees of freedom = 135, P < .001, comparative fit index = .917, Tucker-Lewis index = .906, root mean square error of approximation = .067). EFA data suggested an alternative factor solution (χ2 = 157.76, degrees of freedom = 118, P = .009, comparative fit index = .965, Tucker-Lewis index = .955, root mean square error of approximation = .047). Factor 1 (α = .88) reflected behavioral aspects and factor 2 (α = .92) reflected cognitive/emotional aspects of LOC eating. Bivariate correlations with measures of eating and other psychopathology suggested good construct validity for factors. CONCLUSIONS: Findings suggest possible differences in the construct validity of the ELOCS among postbariatric patients. The 1-factor solution previously supported in clinical and nonclinical groups demonstrated poor fit. EFA revealed a possible alternative 2-factor solution that aligns with emerging literature, suggesting that LOC eating presents differently in postbariatric patients. Researchers interested in LOC eating among bariatric patients should consider use of the ELOCS and testing the proposed alternative factor structure.

The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines.

BACKGROUND: The World Health Organization (WHO) International Classification of Diseases and Related Health Problems (ICD) is used globally by 194 WHO member nations. It is used for assigning clinical diagnoses, providing the framework for reporting public health data, and to inform the organization and reimbursement of health services. Guided by overarching principles of increasing clinical utility and global applicability, the 11th revision of the ICD proposes major changes that incorporate empirical advances since the previous revision in 1992. To test recommended changes in the Mental, Behavioral, and Neurodevelopmental Disorders chapter, multiple vignette-based case-controlled field studies have been conducted which examine clinicians' ability to accurately and consistently use the new guidelines and assess their overall clinical utility. This manuscript reports on the results from the study of the proposed ICD-11 guidelines for feeding and eating disorders (FEDs). METHOD: Participants were 2288 mental health professionals registered with WHO's Global Clinical Practice Network. The study was conducted in Chinese, English, French, Japanese, and Spanish. Clinicians were randomly assigned to apply either the ICD-11 or ICD-10 diagnostic guidelines for FEDs to a pair of case vignettes designed to test specific clinical questions. Clinicians selected the diagnosis they thought was correct for each vignette, evaluated the presence of each essential feature of the selected diagnosis, and the clinical utility of the diagnostic guidelines. RESULTS: The proposed ICD-11 diagnostic guidelines significantly improved accuracy for all FEDs tested relative to ICD-10 and attained higher clinical utility ratings; similar results were obtained across all five languages. The inclusion of binge eating disorder and avoidant-restrictive food intake disorder reduced the use of residual diagnoses. Areas needing further refinement were identified. CONCLUSIONS: The proposed ICD-11 diagnostic guidelines consistently outperformed ICD-10 in distinguishing cases of eating disorders and showed global applicability and appropriate clinical utility. These results suggest that the proposed ICD-11 guidelines for FEDs will help increase accuracy of public health data, improve clinical diagnosis, and enhance health service organization and provision. This is the first time in the revision of the ICD that data from large-scale, empirical research examining proposed guidelines is completed in time to inform the final diagnostic guidelines.

Diagnostic Categories for Eating Disorders: Current Status and What Lies Ahead.

The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for 6 feeding and eating disorders were published in 2013 and were notable for officially recognizing binge-eating disorder and for articulating criteria for avoidant/restrictive food intake disorder. The criteria and the rationale for them are briefly described, and current and future challenges are discussed.

What does the ORTO-15 measure? Assessing the construct validity of a common orthorexia nervosa questionnaire in a meat avoiding sample.

Orthorexia nervosa (ON) is a proposed diagnostic category that captures a pathological need to eat healthfully. The ORTO-15 is a self-report measure ostensibly designed to assess ON, but its suitability for capturing symptoms of pathology has been questioned. Vegans differ from omnivores in their focus on health and present with similar or lowered endorsement of eating behaviors symptoms, making them an ideal group to assess the construct validity of the ORTO-15. We tested the hypothesis that the ORTO-15 captures normative, rather than pathological, health focus. In total, 106 omnivores, 34 meat reducers, 50 lacto-ovo-vegetarians, and 191 vegans completed the ORTO-15 to quantify the presence and severity of ON and the Eating Disorder Examination Questionnaire (EDE-Q) as an established measure of eating pathology. More than 75% of respondents met criteria for a diagnosis of ON per established ORTO-15 cutoffs. Respondents above the 2.50 EDEQ cutoff (suggesting the likely presence of an eating disorder) did not differ in ORTO-15 scores from those scoring below the cutoff. There was a univariate main effect of meat avoidance type on the EDE-Q global scale (p < .01), with vegans endorsing fewer symptoms on the EDE-Q than semi-vegetarians (post-hoc p < .05). Vegans were more likely to meet the clinical ON cutoff of 40 on the ORTO-15 compared to omnivores (omnibus p < .01; post-hoc p = .01). Based on the ORTO-15, vegans' scores should be indicative of pathological eating behavior, but EDE-Q scores instead indicate the lowest levels in this group. The ORTO-15 is able to differentiate between types of meat avoiders, but given the difference in health focus between groups, the scale may be tapping into a construct other than pathological eating beliefs and behaviors.

Crossed prevalence results between subtypes of eating disorder and bipolar disorder: A systematic review of the literature.

OBJECTIVE: To assess the association between sub-types of bipolar disorder (BD) (types I and II) and sub-types of eating disorders (EDs) (Anorexia Nervosa, Bulimia Nervosa, Binge-eating disorders) as well as their relative order of occurrence. METHODOLOGY: A systematic review of articles estimating prevalence rates for BD among patients with ED and vice versa. We also analysed all articles assessing their relative order of occurrence. RESULTS: Comorbid BD is common among patients with an ED. From 0.6 to 33.3% of bipolar subjects have an eating disorder. Conversely, from 0 to 35.8% of subjects with an ED can present a BD. This co-occurrence has mostly been observed among patients with anorexia of the bulimic/purging type, with bulimia or with binge-eating disorders. The association is less frequent in cases of anorexia of the restrictive type. In contrast, the BD sub-type does not seem to have an impact on the association with EDs. Whilst age at BD onset is earlier in case of a comorbid ED, age at ED onset does not seem to be impacted by the presence of an associated BD. There has been little data on the relative order of occurrence of the two disorders or on the impact of the thymic phase on the expression of EDs. CONCLUSIONS: EDs and BD are frequently comorbid, suggesting the need for crossed screening of these pathologies, in particular for EDs with purging behaviours and for patients with early BD onset.

Drunkorexia: A new term and diagnostic criteria.

Individuals who restrict their caloric intake and/or exercise excessively to mitigate the calories from alcohol consumption may suffer from an eating disorder, substance abuse disorder, or both. While the term "drunkorexia" has been used in both academic articles and popular culture, issues persist with respect to diagnosing and treating this condition. Classifying the behavior as a subcategory of Other Specified Feeding and Eating Disorders (OSFED) would provide patients with an increased likelihood of receiving insurance coverage for this condition. A consistent definition of this behavior and a more medically accurate/appropriate term-such as "alcoholimia"-are both needed to advance treatment and prevention efforts.

Pre- and Postbariatric Subtypes and Their Predictive Value for Health-Related Outcomes Measured 3 Years After Surgery.

BACKGROUND: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and 2 years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes 3 years after surgery. METHODS: Within a prospective multicenter patient registry, N = 229 bariatric patients were examined before bariatric surgery, 2 and 3 years postoperatively via clinical interviews and self-report questionnaires. Pre- and postbariatric subtypes were differentiated by temperament, emotion dysregulation, and disinhibited eating using latent profile analyses (LPA). The predictive value of pre- and postbariatric subtypes for surgery outcomes measured 3 years postoperatively was tested via linear regression analyses. RESULTS: LPA resulted in five prebariatric and three postbariatric subtypes which were significantly associated with different levels of general and eating disorder psychopathology. Post- versus prebariatric subtypes explained more variance regarding eating disorder psychopathology, depression, and quality of life assessed 3 years postoperatively, whereas neither pre- nor postbariatric subtypes predicted postbariatric weight loss. Patients with prebariatric deficits in self- and emotional control had an increased risk for showing these deficits postoperatively. CONCLUSIONS: A re-evaluation of patients' psychological status after bariatric surgery is recommended to detect patients with potential risk for adverse psychological surgery outcomes in the long term.

Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework.

Pediatric feeding disorders (PFDs) lack a universally accepted definition. Feeding disorders require comprehensive assessment and treatment of 4 closely related, complementary domains (medical, psychosocial, and feeding skill-based systems and associated nutritional complications). Previous diagnostic paradigms have, however, typically defined feeding disorders using the lens of a single professional discipline and fail to characterize associated functional limitations that are critical to plan appropriate interventions and improve quality of life. Using the framework of the World Health Organization International Classification of Functioning, Disability, and Health, a unifying diagnostic term is proposed: "Pediatric Feeding Disorder" (PFD), defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable practitioners and researchers to better characterize the needs of heterogeneous patient populations, facilitate inclusion of all relevant disciplines in treatment planning, and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy.

Maladaptive Eating in Posttraumatic Stress Disorder: A Population-Based Examination of Typologies and Medical Condition Correlates.

Posttraumatic stress disorder (PTSD) and eating pathology are frequently comorbid, and both are independent risk factors for various medical conditions. Using population-based data collected as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309), the primary objectives of this study were to (a) identify eating pathology classes among PTSD and (b) investigate associations between maladaptive eating and medical conditions among PTSD. Using the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5), we assessed PTSD and maladaptive eating symptoms in accordance with the DSM-5. We used a latent class analysis to identify maladaptive eating typologies among adults with lifetime PTSD (n = 2,339; 6.1%) and multivariable logistic regression models to examine associations between each of the six emergent maladaptive eating typologies and medical conditions. Results revealed that over 40% of individuals with PTSD endorsed indicators of maladaptive eating. In addition, each maladaptive eating typology among PTSD was significantly associated with unique sociodemographic characteristics and increased odds of medical conditions relative to no PTSD and no eating disorder, adjusted odds ratios (AORs) = 1.34-6.55, and PTSD with no eating psychopathology, AORs = 1.43-5.11. Results of this study provide a better understanding of maladaptive eating in adults with PTSD and potential medical sequelae. Results indicate maladaptive eating may be an important mechanism in the association between PTSD and medical conditions, which may inform targeted interventions among individuals with these comorbidities.

[ARFID: food restriction without fear of weight gain]. / ARFID: restriktivt ätande utan rädsla för viktuppgång - En patientgrupp som behandlats styvmoderligt i vården.

Avoidant/restrictive food avoidance disorder, or ARFID, is characterized by restrictive eating or avoidance of food in the absence of the cognitive restraint and weight phobia typically seen in anorexia nervosa. It is often based on a general disinterest in eating, selective eating due to sensory preferences, and/or fear of adverse consequences such as choking, although the diagnostic criteria allow for a number of other clinical presentations. Patients with ARFID tend to be younger, more often male, and have a longer duration of illness compared to patients with other eating disorders. Delimitation from other disorders affecting food intake can sometimes be problematic. Established specialized treatment models for restrictive eating disorders such as anorexia nervosa appears to be potentially effective in ARFID as well, but prospective treatment studies are much needed.

A new approach to eating-disorder classification: Using empirical methods to delineate diagnostic dimensions and inform care.

OBJECTIVE: Despite changes to the diagnostic criteria for eating disorders (EDs) in the DSM-5, the current diagnostic system for EDs has limited ability to inform treatment planning and predict outcomes. Our objective was to test the clinical utility of a novel dimensional approach to understanding the structure of ED psychopathology. METHOD: Participants (N = 243; 82.2% women) were community-recruited adults with a DSM-5 ED assessed at baseline, 6-month, and 1-year follow-up. Hierarchical factor analysis was used to identify a joint hierarchical-dimensional structure of eating, mood, and anxiety symptoms. Exploratory structural equation modeling was used to test the ability of the dimensional model to predict outcomes. RESULTS: At the top of the hierarchy, we identified a broad Internalizing factor that reflected diffuse symptoms of eating, mood, and anxiety disorders. Internalizing branched into three subfactors: distress, fear-avoidance (fears of certain stimuli and behaviors to neutralize fears, including ED behaviors designed to reduce fear of weight gain), and body dissatisfaction, which was nested within distress. The lowest level of the hierarchy was characterized by 15 factors. The hierarchical model predicted 60.1% of the variance in outcomes at 6-month follow-up, whereas all DSM eating, mood, and anxiety disorders combined predicted 35.8% of the variance in outcomes. DISCUSSION: A dimensional approach to understanding and diagnosing EDs improved the ability to prospectively predict clinical course above-and-beyond the traditional categorical (DSM-based) approach. Our findings have implications for endeavors to improve the prediction of ED prognosis and course, and to develop more effective trans-diagnostic treatments.

Pathological and non-pathological variants of restrictive eating behaviors in middle childhood: A latent class analysis.

Although restrictive eating behaviors are very common during early childhood, their precise nature and clinical correlates remain unclear. Especially, there is little evidence on restrictive eating behaviors in older children and their associations with children's shape concern. The present population-based study sought to delineate subgroups of restrictive eating patterns in N = 799 7-14 year old children. Using Latent Class Analysis, children were classified based on six restrictive eating behaviors (for example, picky eating, food neophobia, and eating-related anxiety) and shape concern, separately in three age groups. For cluster validation, sociodemographic and objective anthropometric data, parental feeding practices, and general and eating disorder psychopathology were used. The results showed a 3-cluster solution across all age groups: an asymptomatic class (Cluster 1), a class with restrictive eating behaviors without shape concern (Cluster 2), and a class showing restrictive eating behaviors with prominent shape concern (Cluster 3). The clusters differed in all variables used for validation. Particularly, the proportion of children with symptoms of avoidant/restrictive food intake disorder was greater in Cluster 2 than Clusters 1 and 3. The study underlined the importance of considering shape concern to distinguish between different phenotypes of children's restrictive eating patterns. Longitudinal data are needed to evaluate the clusters' predictive effects on children's growth and development of clinical eating disorders.