ARFID Parent Training Protocol ("ARFID-PTP"): Results of a Randomized Pilot Trial Evaluating a Brief, Parent-Training Program for Avoidant/Restrictive Food Intake Disorder.

OBJECTIVE: Accessible treatment options for avoidant/restrictive food intake disorder (ARFID) in children are limited. The current study sought to assess acceptability, feasibility, and preliminary efficacy of a brief, virtual intervention for ARFID in children ("ARFID-PTP"). METHOD: Families of children ages 5-12 with ARFID (n = 30) were randomized to immediate or waitlist treatment groups, with both groups ultimately receiving ARFID-PTP. ARFID-PTP consists of two, 2-h individual treatment sessions with an optional booster session at 4-week follow-up. Families completed acceptability and feasibility measures at end-of-treatment, as well as preliminary efficacy measures at 4-week, 3-month, and 6-month follow-up. RESULTS: Of 30 families who completed an intake session, 27 (90%) completed treatment. Families rated acceptability as high (MCEQ-C = 7.75). Treatment was feasible by participant retention. Exposure adherence was lower than expected, and booster session requests were higher than expected, indicating that achieving feasibility across measures may require treatment modifications. Regarding preliminary efficacy, children in the immediate treatment group had a decrease in ARFID symptoms compared to those on the waitlist. Overall, at 6-month follow-up linear mixed models showed participants had significantly reduced ARFID symptoms by presentation (p < 0.05) and in follow-up completers, children incorporated eight new foods on average. DISCUSSION: ARFID-PTP is acceptable and preliminarily efficacious. The protocol may benefit from modifications to increase feasibility; however, booster session content and treatment outcomes suggest a priori feasibility markers may not accurately capture the utility of ARFID-PTP. Further work should continue to examine the efficacy ARFID-PTP, particularly in diverse samples where treatment accessibility is urgently needed. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04913194.

Exploring the relationship between food disgust and avoidant/restrictive food intake disorder (ARFID) presentations in a non-clinical collegiate sample.

OBJECTIVE: Disgust is an established mechanism driving restrictive eating behavior. Avoidant/restrictive food intake disorder (ARFID) is a restrictive eating disorder diagnosis characterized by extremely selective eating with three hypothesized presentations. It has been suggested that disgust is significantly associated with ARFID; however, there is limited empirical research to support this hypothesis. This study explores relationships between food-specific disgust, ARFID symptoms, and ARFID presentations. METHOD: Undergraduate students (n = 443, Mage = 19.14 years [SD = 1.25], 50.1% female, 52.7% White) completed a validated measure of food-specific disgust and an established self-report screening tool for the likely presence of ARFID and hypothesized ARFID presentations. RESULTS: Sixty-nine (14.5%) participants screened positively for the likely presence of ARFID. Food disgust did not differ between those who did and did not screen positively for ARFID (p > .05). Within the subsample of those screening positive for ARFID, disgust was not related to any of the three hypothesized presentations of ARFID (all p > .05). DISCUSSION: Our results did not show a significant association between disgust and positive ARFID screen or any of the hypothesized ARFID presentations. Importantly, these negative findings were obtained using validated screening tools for ARFID. Future research should seek to replicate these findings in clinical samples to further inform treatment. PUBLIC SIGNIFICANCE: Avoidant/restrictive food intake disorder (ARFID) is associated with significant medical and psychosocial complications, but the mechanism involved in its development and maintenance remain poorly understood. Findings from this study of college students screening positively for ARFID suggests that food disgust in not a key driver of ARFID symptoms. Exposure-based approaches, which are generally not thought to be effective in targeting disgust, may thus be appropriate in the treatment of ARFID.

Peer Ethnicity as a Mediator in the Relationship Between Ethnic Identity and Body Appreciation in Black College-Aged Women.

Strong ethnic identity is recognized as a protective factor against body image concern and eating pathology in Black women as they tend to hold cultural values in line with an acceptance of a variety of body shapes and sizes. Reinforcement of these cultural ideals may occur via same-race peer relationships. The current study examined the mediating role of same-race versus other-race peers in the relationship between ethnic identity and body appreciation in Black women. Participants were 139 Black undergraduate women (Mage = 18.94 years, MBMI = 25.33) who completed validated measures of ethnic identity and body appreciation and reported on the ethnic makeup of their friends. We conducted mediation analysis examining the role of same-race peers on the relationship between ethnic identity and body appreciation. Same-race peers mediated the relationship between ethnic identity and body appreciation, where having a greater percentage of friends increased both ethnic identity and body appreciation in Black women. The influence of same-race peers should be considered in the development of culturally informed prevention and intervention efforts for eating pathology in Black women.

ARFID Parent Training Protocol: A randomized pilot trial evaluating a brief, parent-training program for avoidant/restrictive food intake disorder.

Evidence-based treatment approaches for avoidant/restrictive food intake disorder (ARFID) remain limited and may be inaccessible to families due to geographic, financial, and/or time constraints. This study aims to establish the acceptability and feasibility of a brief ARFID Parent Training Program (ARFID-PTP), modified from other evidence-based approaches, using a randomized controlled trial design. Participants (n = 30) will be children aged 5-12 who meet diagnostic criteria for ARFID and their parents/guardians. Participants will be randomized to receive treatment immediately or following a 4-week wait (waitlist control). Treatment consists of two, 2-hr virtual treatment sessions with the family and a therapist plus an optional booster session. Primary aims include evaluating the (a) feasibility of ARFID-PTP as indicated by recruitment and retention rates, as well as treatment adherence at home and (b) acceptability as determined by ratings on the Credibility and Expectancy Questionnaire and satisfaction questions. A secondary aim is to assess the preliminary efficacy of ARFID-PTP via changes in scores on the Pica, ARFID, and Rumination Disorder Interview. If results indicate appropriate feasibility and acceptability, the proposed protocol will form the basis for larger scale trials of treatment efficacy in efforts to increase accessibility of evidence-based treatment for ARFID.

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.

Intensive Outpatient Programs for Pediatric Feeding Disorder: A Qualitative Study of Current Challenges and Future Directions.

BACKGROUND: Although intensive multidisciplinary interventions (IMIs) provide benefits for patients with pediatric feeding disorders (PFD), access to these programs is limited and challenges faced by the programs remain unclear. OBJECTIVE: To better understand the barriers faced by existing day programs that provide IMI, disparities in patient care, and areas for improvement to better inform policy and improve access to treatment for PFD. METHODS: Semi-structured interviews were conducted with a leader of outpatient programs providing IMI in the United States. Data regarding leader's perspectives on disparities in patient care, barriers faced by the intensive multidisciplinary feeding day programs, and future goals and directions for their programming were collected. Afterward, a qualitative content analysis was conducted to consolidate and categorize information related to patient care, access, and barriers faced by day programs and patients with PFD. RESULTS: Barriers and challenges were identified at the patient, program, and systems levels. Patient-level barriers included familial resources or socioeconomic status, geographic distance from the program site, and difficulty with the time commitment, whereas program-level barriers included limited site personnel and capacity and long wait times. System-level barriers primarily center on insurance, with inconsistent coverage of services and limited payer knowledge about PFD and IMI. CONCLUSION: IMIs are effective in managing PFD; however, a variety of patient-level, program-level, and systems-level factors serve as barriers for patient access to care and program success. Further research, improved reimbursement, and consensus statements on effective treatments can help improve access to and coverage for care, allowing for the development and sustainability of more programs.

Differential genetic associations between dimensions of eating disorders and alcohol involvement in late adolescent twins.

BACKGROUND: Twin studies have demonstrated shared genetic and environmental effects between eating disorders and alcohol involvement in adults and middle adolescents. However, fewer studies have focused on late adolescents or investigated a wide range of eating disorder dimensions and alcohol involvement subscales in both sexes. We examined genetic and environmental correlations among three eating disorder dimensions and two alcohol involvement subscale scores in late adolescent twins using bivariate twin models. METHODS: Participants were 3568 female and 2526 male same-sex twins aged 18 years old from the Child and Adolescent Twin Study in Sweden. The Eating Disorder Inventory-2 (EDI) assessed the drive for thinness, bulimia, and body dissatisfaction. Alcohol involvement was assessed with the Alcohol Use Disorder Identification Test consumption (AUDIT-C) and problem (AUDIT-P) subscales. RESULTS: Only phenotypic and twin correlations in female twins met our threshold for twin modeling. The proportion of total variance for each trait accounted for by additive genetic factors ranged from 0.50 to 0.64 in female twins, with the rest explained by nonshared environmental factors and measurement error. Shared environmental factors played a minimal role in the variance of each trait. The strongest genetic correlation (ra ) emerged between EDI bulimia and AUDIT-P (ra = 0.46, 95% confidence interval: 0.37, 0.55), indicating that the proportion of genetic variance of one trait that was shared with the other trait was 0.21. Nonshared environmental correlations between eating disorder dimensions and alcohol involvement ranged from 0.03 to 0.13. CONCLUSIONS: We observed distinct patterns of genetic and environmental effects for co-occurring eating disorder dimensions and alcohol involvement in female vs. male twins, supporting sex-specific treatment strategies for late adolescents with comorbid eating disorders and alcohol use disorder. Our findings emphasize the importance of assessing family history of multiple eating disorder dimensions while treating late adolescents with problematic alcohol use, and vice versa, to improve detection and treatment.

The moderating role of self-compassion on the relationship between emotion-focused impulsivity and dietary restraint in a diverse undergraduate sample.

OBJECTIVE: High levels of emotion-focused impulsivity (e.g., negative urgency) are significantly related to disordered eating behaviors, including dietary restraint. The objective of the current study was to understand the moderating role of self-compassion between emotion-focused impulsivity and dietary restraint in a diverse undergraduate sample. We hypothesized that high levels of self-compassion would protect individuals with high levels of emotion-focused impulsivity from engaging in high levels of dietary restraint. METHOD: Participants (n = 607, Mage = 18.8, 63 % female, 45.3 % White) completed the UPPS-P, Eating Disorder Examination Questionnaire, and the Self-Compassion Questionnaire as part of a larger study examining eating behaviors in college students. RESULTS: Negative urgency, but not positive urgency, was related to dietary restraint. Self-compassion moderated the relationship between both forms of impulsivity and dietary restraint, such that individuals with high emotion-focused impulsivity and high self-compassion had lower dietary restraint than individuals who had high emotion-focused impulsivity and low self-compassion. DISCUSSION: Emotion-focused urgency is a risk factor for dietary restraint; both factors are highly correlated with more severe eating pathology, such as binging and purging behaviors. Self-compassion may buffer against the risk of emotion-focused impulsivity on engaging in dietary restraint behaviors in a community sample, which may inform our understanding of preventative interventions against eating pathology. These results should be replicated in clinical populations and across eating disorder diagnoses.

Changes in eating and exercise behaviors during the COVID-19 pandemic in a community sample: A retrospective report.

OBJECTIVE: The COVID-19 pandemic has generated extreme physical, psychological, and social consequences across the world, many of which have the potential to exacerbate disordered eating and exercise behaviors. The purpose of this study was to retrospectively assess changes in eating pathology and exercise behaviors as a result of the COVID-19 pandemic in a community sample. METHOD: Participants (n = 159, Mage = 27.59 years, 90.6% female) were individuals in the United States surveyed during COVID-19. Participants completed measures quantifying eating pathology, exercise behaviors, and motives for exercise both prior to and during the pandemic. RESULTS: All results compare variables prior to and during COVID-19. Overall, individuals with a prior eating disorder (ED) diagnosis did not report significantly different changes in eating or exercise pathology compared to the non-ED group. Participants had significantly fewer episodes of overeating (p < .05, d = -0.23) and eating with loss of control (p < .05, d = -0.23), but not objective binge episodes. Respondents also indicated an overall decrease in time spent on strength/weight activity (p < .05, d = -0.34) and increase in cardiovascular activity (p < .05, d = 0.19), as well as significant changes in motives for exercise. DISCUSSION: Our results suggest that in a sample of primarily young adult females, with and without a prior ED, exercise behaviors and motives, but not eating pathology, shifted significantly in the first few months of the COVID-19 pandemic. Further longitudinal studies examining the maintenance and potential risk of these changes are warranted, particularly in individuals at high risk, as the pandemic continues.