Thread by @DrNicoleC

By request, here's a brief thread on avoidant restrictive food intake disorder (ARFID). 🧵 #EDAW2023

ARFID emerged as a diagnosis with the DSM-5 in 2013. In short, patients with ARFID have restrictive eating w/o evidence of body image disturbance. But let's dig a little more...

Here are the diagnostic criteria. You'll notice that other medical/mental health conditions don't prevent a dx of ARFID from being made (e.g. autism spectrum). However, if another condition is present the feeding disturbance has to be beyond what is typical for that condition...

I conceptualize ARFID in 3 major categories.
1⃣ Pts w/ fear of an adverse consequence (e.g. vomiting, choking abd pain)
2⃣ Pts w/ sensory concerns (e.g. sensitivity to food texture, smell, temperature)
3⃣ Pts w/ a lack of interest in eating, minimal appetite, a chore to eat

Of course, people can have characteristics in more than one category. Also, sometimes the difference between ARFID and restrictive anorexia nervosa can be subtle, a patient's course can cross diagnoses, or their dx is unclear initially...

However, the initial management (weight restoration/nutritional rehab) is unlikely to be different initially. Oftentimes, when patients are better nourished, they are able to better articulate the barriers to eating.

Sometimes, for people w/ ARFID for whom appetite and fullness are main barriers, a course of cyproheptadine can be helpful for appetite and gastric accommodation. This differs from what is usually beneficial in restrictive AN (where appetite isn't usually the main issue). /end