1
|
Fonseca NKO, Curtarelli VD, Bertoletti J, Azevedo K, Cardinal TM, Moreira JD, Antunes LC. Avoidant restrictive food intake disorder: recent advances in neurobiology and treatment. J Eat Disord 2024; 12:74. [PMID: 38849953 PMCID: PMC11157884 DOI: 10.1186/s40337-024-01021-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. ARFID, before referred to as "selective eating disorder", was introduced recently in the DSM-5 as a replacement for and expansion of the previous diagnosis. Individuals with ARFID may limit food variety and intake due to avoidance based on the sensory characteristics of the food or related to any adverse consequences of eating without the intention of losing weight and concerns of body image. The limited understanding of avoidant and restrictive eating poses challenges to effective treatment and management, impacting directly on the growth and development of children and adolescents. The ARFID neurobiological concept has not yet been clearly defined to clinical practice for nutritionists, thereby hindering screening and impeding the development of treatment recommendations. This narrative review provide useful practical information to consult the pathophysiology, the neurobiology, the clinical features, the assessment and the treatment for healthcare professionals seeking to enhance their clinical knowledge and management of this disorder.
Collapse
Affiliation(s)
- Natasha K O Fonseca
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
| | | | | | - Karla Azevedo
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Tiago M Cardinal
- Laboratory of Neuroscience and Eating Behavior, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Júlia D Moreira
- Department of Nutrition, Health Sciences Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Luciana C Antunes
- Laboratory of Neuroscience and Eating Behavior, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Department of Nutrition, Health Sciences Center, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Translational Nutritional Neuroscience Working Group, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| |
Collapse
|
2
|
Downs J. Care pathways for longstanding eating disorders must offer paths to recovery, not managed decline. BJPsych Bull 2024; 48:177-181. [PMID: 37287111 PMCID: PMC11134004 DOI: 10.1192/bjb.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 06/09/2023] Open
Abstract
Eating disorders are historically underserved in healthcare, but are increasingly prevalent and recognised for their high costs regarding mortality, quality of life and the economy. Those with longstanding eating disorders are commonly labelled 'severe and enduring' (SEED), which has been challenged for its conceptual vagueness and potential to discourage patients. Attempts to define individuals from this cohort as having 'terminal' illness have also gained traction in recent years. This paper is grounded in lived/living experience and relevant research. It challenges the logical coherence and utility of SEED, arguing that the word 'enduring' unhelpfully situates intractability of longstanding illness within patients themselves and the nature of their illness. This risks a sense of inevitability and overlooks the important role of contextual factors such as lacking resources and insufficient evidence for withholding active treatment. Recommendations suggest approaches to dismantling unhelpful binaries between early intervention and intensive support, recovery and decline.
Collapse
Affiliation(s)
- James Downs
- Patient Representative, Faculty of Eating Disorders, Royal College of Psychiatrists, UK
| |
Collapse
|
3
|
Miranda-Olivos R, Baenas I, Steward T, Granero R, Pastor A, Sánchez I, Juaneda-Seguí A, Del Pino-Gutiérrez A, Fernández-Formoso JA, Vilarrasa N, Guerrero-Pérez F, Virgili N, López-Urdiales R, Jiménez-Murcia S, de la Torre R, Soriano-Mas C, Fernández-Aranda F. Exploring the influence of circulating endocannabinoids and nucleus accumbens functional connectivity on anorexia nervosa severity. Mol Psychiatry 2023; 28:4793-4800. [PMID: 37759041 PMCID: PMC10914605 DOI: 10.1038/s41380-023-02253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder characterized by a harmful persistence of self-imposed starvation resulting in significant weight loss. Research suggests that alterations in the nucleus accumbens (NAcc) and circulating endocannabinoids (eCBs), such as anandamide (AEA) and 2-arachidonoylglycerol (2-AG), may contribute to increased severity and maladaptive behaviors in AN, warranting an examination of the interplay between central reward circuitry and eCBs. For this purpose, we assessed NAcc functional connectivity and circulating AEA and 2-AG concentrations in 18 individuals with AN and 18 healthy controls (HC) to test associations between circulating eCBs, NAcc functional connectivity, and AN severity, as defined by body mass index (BMI). Decreased connectivity was observed between the NAcc and the right insula (NAcc-insula; pFWE < 0.001) and the left supplementary motor area (NAcc-SMA; pFWE < 0.001) in the AN group compared to HC. Reduced NAcc-insula functional connectivity mediated the association between AEA concentrations and BMI in the AN group. However, in HC, NAcc-SMA functional connectivity had a mediating role between AEA concentrations and BMI. Although no significant differences in eCBs concentrations were observed between the groups, our findings provide insights into how the interaction between eCBs and NAcc functional connectivity influences AN severity. Altered NAcc-insula and NAcc-SMA connectivity in AN may impair the integration of interoceptive, somatosensory, and motor planning information related to reward stimuli. Furthermore, the distinct associations between eCBs concentrations and NAcc functional connectivity in AN and HC could have clinical implications for weight maintenance, with eCBs being a potential target for AN treatment.
Collapse
Affiliation(s)
- Romina Miranda-Olivos
- Clinical Psychology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Research Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
- Doctoral Program in Medicine and Translational Research, University of Barcelona, 08036, Barcelona, Spain
| | - Isabel Baenas
- Clinical Psychology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Research Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
- Doctoral Program in Medicine and Translational Research, University of Barcelona, 08036, Barcelona, Spain
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Roser Granero
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Research Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08193, Barcelona, Spain
| | - Antoni Pastor
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Integrative Pharmacology and Systems Neuroscience research group, Hospital del Mar Research Institute (IMIM), 08003, Barcelona, Spain
| | - Isabel Sánchez
- Clinical Psychology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Research Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Asier Juaneda-Seguí
- Doctoral Program in Medicine and Translational Research, University of Barcelona, 08036, Barcelona, Spain
- Ciber de Salud Mental (CIBERSAM), Instituto Salud Carlos III, 28029, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Research Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
- Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, 08907, Barcelona, Spain
| | - José A Fernández-Formoso
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Clinical Psychology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Research Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907, Barcelona, Spain
| | - Rafael de la Torre
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain
- Integrative Pharmacology and Systems Neuroscience research group, Hospital del Mar Research Institute (IMIM), 08003, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (CEXS-UPF), 08002, Barcelona, Spain
| | - Carles Soriano-Mas
- Ciber de Salud Mental (CIBERSAM), Instituto Salud Carlos III, 28029, Barcelona, Spain.
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907, Barcelona, Spain.
- Department of Social Psychology and Quantitative Psychology, School of Psychology, University of Barcelona, 08035, Barcelona, Spain.
| | - Fernando Fernández-Aranda
- Clinical Psychology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 08907, Barcelona, Spain.
- Psychoneurobiology of Eating and Addictive Behaviors Research Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907, Barcelona, Spain.
| |
Collapse
|
4
|
Dang AB, Kiropoulos L, Castle DJ, Jenkins Z, Phillipou A, Rossell SL, Krug I. Assessing severity in anorexia nervosa: Do the DSM-5 and an alternative severity rating based on overvaluation of weight and shape severity differ in psychological and biological correlates? EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 36694105 DOI: 10.1002/erv.2969] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/19/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study evaluated the severity ratings for anorexia nervosa (AN) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and an alternative severity rating based on overvaluation of weight/shape, on a range of psychological and biological variables. METHOD A sample of 312 treatment-seeking patients with AN (mean age = 25.3, SD = 7.6; mean BMI = 16.8 kg/m2 , SD = 2.4) were categorised using both DSM-5 severity levels (mild/moderate/severe/extreme) and weight/shape (low/high) overvaluation. The severity categories were compared on a range of psychological (e.g., eating psychopathology) and biological (e.g., sodium) variables. RESULTS Results showed that the overvaluation of weight/shape appeared better at indexing the level of severity in psychological variables among patients with AN compared to the DSM-5 severity rating with moderate to large effect sizes. Moreover, the DSM-5 mild and moderate severity groups experienced significantly higher eating and general psychopathology than the severe and extreme groups. Finally, neither the DSM-5 nor the weight/shape severity groups differed on any of the biological variables. CONCLUSIONS This study provided no support for the DSM-5 severity rating for AN, while initial support was found for the weight/shape overvaluation approach in indexing psychological but not biological correlates.
Collapse
Affiliation(s)
- An Binh Dang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David J Castle
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia.,Iverson Institute, Swinburne University of Technology, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Phillipou
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.,Department of Mental Health, Austin Health, Melbourne, Victoria, Australia
| | - Susan L Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Esin K, Ayyıldız F. Validity and reliability of the Turkish version of the Eating Disorder Examination Questionnaire (EDE-Q-13): short-form of EDE-Q. J Eat Disord 2022; 10:102. [PMID: 35836297 PMCID: PMC9281018 DOI: 10.1186/s40337-022-00628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The Eating Disorder Examination Questionnaire (EDE-Q) is a frequently used scale to evaluate eating behaviors and attitudes. In recent years, its use has increased due to the fact that the use of short forms is more practical. The aim of this study was to validate the short Turkish form of the Eating Disorder Examination Questionnaire (EDE-Q) including 13 items. METHODS The study included 924 adults at a mean age of 30.3 ± 10.93 years. EDEQ-13 was translated and adapted to Turkish according to the Beaton Guidelines. The Eating Attitudes Test-26 (EAT-26), the Satisfaction with Life Scale (SWLS), and the Body Appreciation Scale (BAS) were used to analyze their relationships to EDE-Q-13. RESULTS In this study, the rate of the total variance explained by the factors of EDE-Q-13 according to the Explanatory Factor Analysis (EFA) results of the scale was 83.54%. The Cronbach's alpha value of the scale was 0.89, and the Cronbach's alpha values of the 5 subscales were calculated in the range of 0.75-0.94. The criterion validity analysis showed an acceptable correlation between EDE-Q-13 and EAT-26, SWLS, and BAS. The confirmatory factor analysis (CFA) revealed that the model had fit values that were acceptable or good. CONCLUSION Both EFA and CFA results showed that it is appropriate to use the Turkish EDE-Q-13. EDE-Q-13 was significantly correlated with eating disturbances, body appreciation, and life satisfaction. In conclusion, the Turkish version of EDE-Q-13 possesses high levels of validity and reliability.
Collapse
Affiliation(s)
- Kübra Esin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gaziosmanpaşa University, Tokat, Turkey.
| | - Feride Ayyıldız
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| |
Collapse
|
6
|
Shimshoni Y, Silverman WK, Lebowitz ER. SPACE-ARFID: A pilot trial of a novel parent-based treatment for avoidant/restrictive food intake disorder. Int J Eat Disord 2020; 53:1623-1635. [PMID: 33464594 DOI: 10.1002/eat.23341] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This pilot trial aimed to assess the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of Supportive Parenting for Anxious Childhood Emotions adapted for avoidant/restrictive food intake disorder (SPACE-ARFID). SPACE-ARFID is a novel outpatient parent-based treatment that focuses on parental responses to child problematic eating habits and aims to promote food-related flexibility. METHOD Parents of 15 children (ages 6-14 years) with ARFID participated in 12 weekly sessions of SPACE-ARFID. Feasibility and acceptability were assessed by calculating enrollment, attendance, attrition, and adverse events. Treatment-satisfaction was assessed with the Client Satisfaction Questionnaire (CSQ-8), administered posttreatment. ARFID symptom severity and impairment and family accommodation were assessed at baseline and posttreatment. RESULTS Of 17 eligible families, 15 (88.24%) elected to participate in the trial. Of the 15 participating families, all except for 1 (6.67%) completed all 12 weekly treatment sessions. Both parents and children rated the treatment as highly satisfactory. ARFID symptom severity and impairment as well as family accommodation were significantly reduced from pre- to posttreatment. Increases in food-related flexibility are described. DISCUSSION Findings provide preliminary evidence that SPACE-ARFID, a parent-based treatment that focuses on parental responses to the ARFID symptoms is feasible, acceptable, and satisfactory and produces improvement in clinical outcomes.
Collapse
Affiliation(s)
- Yaara Shimshoni
- Yale University Child Study Center, New Haven, Connecticut, USA
| | | | - Eli R Lebowitz
- Yale University Child Study Center, New Haven, Connecticut, USA
| |
Collapse
|
7
|
Fan HH, Lin IC, Chen JE, Lee WH, Fang SB. Anorexia nervosa manifesting as massive ascites, hypercholesterolemia, and sequential binge eating in an 11-year-old girl: A case report. Medicine (Baltimore) 2020; 99:e21739. [PMID: 32871893 PMCID: PMC7458216 DOI: 10.1097/md.0000000000021739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Anorexia nervosa (AN) is a serious eating disorder associated with a distorted body image. Hypercholesterolemia has been found in patients with AN but the mechanism of hyperlipidemia in AN remains little known. Ascites in patients with AN has been attributed to hypoalbuminemia and liver diseases, but massive ascites without the aforementioned etiologies has never been reported in AN. PATIENT CONCERNS An 11-year-old girl was admitted for exclusion of organic underlying diseases due to severe body weight loss (18% within 3 weeks), poor appetite, and hypercholesterolemia (274 mg/dL). She complained of heartburn sensation, nausea, vomiting, constipation, and postprandial dull abdominal pain with fullness. DIAGNOSES The patient's condition met with all 3 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for diagnosing AN. On admission, her total cholesterol level was 337 mg/dL and hypocomplementemia (C3 55.5 mg/dL) was also found. Abdominal sonography and computed tomography scans showed massive ascites. However, neither proteinuria nor hypoalbuminemia was found. Upper gastroduodenal endoscopy showed chronic superficial gastritis and colonoscopy revealed negative findings. Ascites obtained by paracentesis demonstrated a transudate without bacterial infection, tuberculosis, or pancreatitis. Exploratory laparoscopy showed nonpurulent ascites. However, biopsies from the small intestine, mesentery, and liver showed chronic inflammation and fibrosis. INTERVENTIONS The intensive nutritional therapy by increasing total energy intake stepwise with a combination of high-energy formula and her favorite foods. OUTCOMES Her hypercholesterolemia, hypocomplementemia, and massive ascites resolved after her weight was restored. She developed binge eating with continuous weight gain after discharge. Her weight significantly increased to an obese level (body mass index [BMI] 25.9 kg/m) after loss to follow-up for 4 years until she returned to our emergency room due to suicide attempt. CONCLUSION Diagnostic crossover between subtypes in anorexia nervosa might be a potential risk factor for illness severity and poor prognosis. AN can manifest as massive ascites with normal albumin concentrations that could possibly be due to chronic inflammation of the intestinal serosa, mesentery, and peritoneal surface of the liver.
Collapse
Affiliation(s)
- Hung-Hao Fan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics
- Department of Pediatrics, School of Medicine, College of Medicine
| | | | - Jing-Er Chen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics
| | | | - Shiuh-Bin Fang
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics
- Department of Pediatrics, School of Medicine, College of Medicine
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
8
|
Zickgraf HF, Murray HB, Kratz HE, Franklin ME. Characteristics of outpatients diagnosed with the selective/neophobic presentation of avoidant/restrictive food intake disorder. Int J Eat Disord 2019; 52:367-377. [PMID: 30636013 PMCID: PMC8056744 DOI: 10.1002/eat.23013] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/10/2018] [Accepted: 12/16/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although Avoidant/Restrictive Food Intake Disorder (ARFID) has existed since the publication of DSM-5 in 2013, research on the descriptive psychopathology of treatment-seeking patients with formal ARFID diagnoses is sparse, and limited to tertiary eating disorder-focused treatment settings where most patients present with weight loss/malnutrition. In these settings, the selective/neophobic symptom presentation is rare compared to other primary eating restrictions. We aimed provide initial descriptive psychopathology of ARFID primary selective/neophobic symptom presentation in an outpatient setting, and to explore the prevalence of the core ARFID symptoms and clinical differences among patients meeting criteria based on weight/nutritional symptoms versus psychosocial impairment only. METHOD We reviewed the charts of 22 consecutive outpatients diagnosed with ARFID caused by selective/neophobic eating, and describe symptoms, impairment, illness trajectory, and demographic features. Patients who met ARFID criteria because of weight loss/nutritional problems were compared to those who met for psychosocial impairment only on demographic and clinical characteristics. RESULTS Patients were predominantly male (81.8%) and school-aged (4-11 years). 81.8% had no weight/nutritional symptoms documented by a medical provider. All met criteria for significant psychosocial impairment. There were few differences between patients who did versus did not meet weight loss/nutritional criteria for ARFID; they differed only in age and in the presence of appetite disturbances consistent with another proposed presentation of ARFID. DISCUSSION These results provide novel data on the clinical characteristics of individuals who present with a primary presentation of selective/neophobic ARFID, including support for psychosocial impairment as sufficient for fulfilling ARFID criterion A.
Collapse
Affiliation(s)
- Hana F. Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois,Child and Adolescent OCD, Tic, Trich, and Anxiety Group (COTTAGe), Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen B. Murray
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Hilary E. Kratz
- Department of Psychology, La Salle University, Philadelphia, Pennsylvania
| | - Martin E. Franklin
- Child and Adolescent OCD, Tic, Trich, and Anxiety Group (COTTAGe), Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|