The clinical presentation of avoidant restrictive food intake disorder in children and adolescents is largely independent of sex, autism spectrum disorder and anxiety traitsResearch in context

• Published in: EClinicalMedicine Vol. 63; p. 102190
• Main Authors: Rosie Watts, Tanith Archibald, Pippa Hembry, Maxine Howard, Cate Kelly, Rachel Loomes, Laura Markham, Harry Moss, Alfonce Munuve, Anca Oros, Amy Siddall, Charlotte Rhind, Mohammed Uddin, Zain Ahmad, Rachel Bryant-Waugh, Christopher Hübel
• Format: Journal Article
• Language: English
• Published: Elsevier 01-09-2023
• Subjects: Biological sex; Clinical presentation; Driver; Eating disorder; Heterogeneity; Panic disorder
• ISSN: 2589-5370; 2589-5370

Background: Avoidant restrictive food intake disorder (ARFID) is a new eating disorder with a heterogeneous clinical presentation. It is unclear which patient characteristics contribute to its heterogeneity. Methods: To identify these patient characteristics, we performed symptom-level correlation and driver-level regression analyses in our cross-sectional study in up to 261 ARFID patients (51% female; median age = 12.7 years) who were assessed at the Maudsley Centre for Child and Adolescent Eating Disorders, London between November 2019 and July 2022. Findings: Symptoms across the three drivers 1) avoidance based on sensory characteristics of food; 2) apparent lack of interest in eating; and 3) concern about aversive consequences positively correlated with each other. Patients' anxiety traits showed the greatest positive correlations with symptoms of concern about aversive consequences of eating. Patient sex was not significantly associated with any of the three ARFID drivers. Patients with comorbid autism spectrum disorder (ASD; 28%) showed more food-related sensory sensitivities (RR = 1.26) and greater lack of interest in eating (RR = 1.18) than those of patients without ASD (49%). Interpretation: In our clinical sample, the ARFID drivers occurred together and did not show clinically meaningful differences between the sexes. ASD may accentuate food-related sensory sensitivities and lack of interest, but may not drive a completely different symptom presentation. ARFID is multi-faceted and heterogenous, requiring a comprehensive multidisciplinary assessment to sufficiently understand the drivers of the restrictive eating behaviour. Results need replication in larger samples with more statistical power. Funding: None.