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Milliren CE, Crowley M, Carmody JK, Bern EM, Eldredge O, Richmond TK. Pediatric hospital utilization for patients with avoidant restrictive food intake disorder. J Eat Disord 2024; 12:42. [PMID: 38528642 DOI: 10.1186/s40337-024-00996-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Avoidant restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder added to the DSM-5 in 2013 and ICD-10 in 2018. Few studies have examined hospital utilization for patients with ARFID specifically, and none to date have used large administrative cohorts. We examined inpatient admission volume over time and hospital utilization and 30-day readmissions for patients with ARFID at pediatric hospitals in the United States. METHODS Using data from the Pediatric Health Information System (PHIS), we identified inpatient admissions for patients with ARFID (by principal International Classification of Diseases, 10th Revision, ICD-10 diagnosis code) discharged October 2017-June 2022. We examined the change over time in ARFID volume and associations between patient-level factors (e.g., sociodemographic characteristics, co-morbid conditions including anxiety and depressive disorders and malnutrition), hospital ARFID volume, and hospital utilization including length of stay (LOS), costs, use of enteral tube feeding or GI imaging during admission, and 30-day readmissions. Adjusted regression models were used to examine associations between sociodemographic and clinical factors on LOS, costs, and 30-day readmissions. RESULTS Inpatient ARFID volume across n = 44 pediatric hospitals has increased over time (β = 0.36 per month; 95% CI 0.26-0.46; p < 0.001). Among N = 1288 inpatient admissions for patients with ARFID, median LOS was 7 days (IQR = 8) with median costs of $16,583 (IQR = $18,115). LOS and costs were highest in hospitals with higher volumes of ARFID patients. Younger age, co-morbid conditions, enteral feeding, and GI imaging were also associated with LOS. 8.5% of patients were readmitted within 30 days. In adjusted models, there were differences in the likelihood of readmission by age, insurance, malnutrition diagnosis at index visit, and GI imaging procedures during index visit. CONCLUSIONS Our results indicate that the volume of inpatient admissions for patients with ARFID has increased at pediatric hospitals in the U.S. since ARFID was added to ICD-10. Inpatient stays for ARFID are long and costly and associated with readmissions. It is important to identify effective and efficient treatment strategies for ARFID in the future.
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Affiliation(s)
- Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - McGreggor Crowley
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Julia K Carmody
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Elana M Bern
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Olivia Eldredge
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Tracy K Richmond
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Wronski ML, Kuja-Halkola R, Hedlund E, Martini MI, Lichtenstein P, Lundström S, Larsson H, Taylor MJ, Micali N, Bulik CM, Dinkler L. Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype. medRxiv 2024:2024.03.10.24304003. [PMID: 38558975 PMCID: PMC10980122 DOI: 10.1101/2024.03.10.24304003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder, characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with a range of psychiatric and somatic symptoms, and therefore consult various pediatric subspecialties; large-scale studies mapping comorbidities are however lacking. To characterize health care needs of people with ARFID, we systematically investigated ARFID-related mental and somatic conditions in 616 children with ARFID and >30,000 children without ARFID. Methods In a Swedish twin cohort, we identified the ARFID phenotype in 6-12-year-old children based on parent-reports and register data. From >1,000 diagnostic ICD-codes, we specified mental and somatic conditions within/across ICD-chapters, number of distinct per-person diagnoses, and inpatient treatment days between birth and 18th birthday (90 outcomes). Hazard ratios (HR) and incidence rate ratios (IRR) were calculated. Findings Relative risks of neurodevelopmental, gastrointestinal, endocrine/metabolic, respiratory, neurological, and allergic disorders were substantially increased in ARFID (e.g., autism HR[CI95%]=9.7[7.5-12.5], intellectual disability 10.3[7.6-13.9], gastroesophageal reflux disease 6.7[4.6-9.9], pituitary conditions 5.6[2.7-11.3], chronic lower respiratory diseases 4.9[2.4-10.1], epilepsy 5.8[4.1-8.2]). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had a significantly higher number of distinct mental diagnoses (IRR[CI95%]=4.7[4.0-5.4]) and longer duration of hospitalizations (IRR[CI95%]=5.5[1.7-17.6]) compared with children without ARFID. Children with ARFID were diagnosed earlier with a mental condition than children without ARFID. No sex-specific differences emerged. Interpretation This study yields the broadest and most detailed evidence of co-existing mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties. Funding Fredrik and Ingrid Thurings Foundation, Mental Health Foundation.
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Affiliation(s)
- Marie-Louis Wronski
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elin Hedlund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Miriam I. Martini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nadia Micali
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital – Mental Health Services CPH, Denmark
- Institute for Biological Psychiatry, Mental Health Centre Sct Hans, Copenhagen University Hospital – Mental Health Services, Copenhagen, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Maunder K, Markey O, Batchelor R, McNicholas F. A systematic review of COVID-19 and the presentation of avoidant/restrictive food intake disorder and avoidant/restrictive food intake disorder-like symptoms. BJPsych Open 2024; 10:e56. [PMID: 38433590 PMCID: PMC10951850 DOI: 10.1192/bjo.2023.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The adverse effects of COVID-19 and the associated restrictions on eating disorder populations have been discussed in recent literature. However, little is known about the presentation of cases with avoidant/restrictive food intake disorder (ARFID) during this period. AIMS To explore the extent of the literature on the presentation of ARFID, and ARFID-like cases, during the COVID-19 pandemic. METHOD Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE (Ovid) and Medline (Ovid) were searched for publications between March 2020 and May 2023. Google Scholar and reference lists were hand searched. At least two reviewers independently screened each paper. Narrative synthesis was used. RESULTS Seven papers were included: four case reports and three cohort studies (total ARFID sample of 46). Included papers were assessed as having high (n = 3) or moderate (n = 4) quality. Findings did not suggest an increase in ARFID cases during the COVID-19 pandemic, although it is unclear if this is because of a lack of impact or underrecognition of ARFID. A need for a multidisciplinary approach to differentiate between ARFID and organic causes of ARFID-like presentations (e.g. gastrointestinal effects of COVID-19) was highlighted. CONCLUSIONS Publications specifically pertaining to ARFID presentations during the COVID-19 pandemic have been few. Papers found have been of small sample sizes and lack subanalyses for ARFID within broader eating disorder samples. Continued surveillance is needed to evaluate any COVID-19-specific effects on the development, identification, treatment and outcomes of ARFID.
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Affiliation(s)
- Kristen Maunder
- Department of Child and Adolescent Psychiatry, University College Dublin, Ireland; Department of Liaison Child and Adolescent Psychiatry, Tallaght University Hospital, Ireland; and Department of Child and Adolescent Psychiatry, Linn Dara Child and Adolescent Mental Health Services, Dublin, Ireland
| | - Oscar Markey
- Department of Psychology, Universiteit Leiden, The Netherlands; Department of Psychology, Trinity College Dublin, Ireland; and Department of Child and Adolescent Psychiatry, Lucena St John of God's Child and Adolescent Mental Health Services, Dublin, Ireland
| | - Rachel Batchelor
- Department of Psychology, Oxford Institute of Clinical Psychology Training and Research, UK; and Department of Psychology, Oxford Health NHS Foundation Trust, UK
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin, Ireland; Department of Child and Adolescent Psychiatry, Lucena St John of God's Child and Adolescent Mental Health Services, Dublin, Ireland; and Department of Liaison Child and Adolescent Psychiatry, Children's Health Ireland at Crumlin, Ireland
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Pogos D, Whitelaw M, Burton C, Sawyer SM. Development of an inpatient protocol for adolescents with avoidant/restrictive food intake disorder: a case study. J Can Acad Child Adolesc Psychiatry 2024; 33:57-64. [PMID: 38449721 PMCID: PMC10914147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024]
Abstract
Introduction Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterised by a pattern of eating that leads to failure to meet appropriate nutritional and/or energy needs. Method In the absence of evidence-based inpatient guidelines for adolescents with ARFID, we set out to develop and pilot an inpatient protocol for adolescents with ARFID. Identification of the key differences between managing inpatients with ARFID and anorexia nervosa (AN) led to modification of an existing AN protocol with the goals of better meeting patient needs, enhancing alignment with outpatient care, and improving outcomes. A case report of an adolescent with ARFID who had three hospital admissions is presented to highlight these changes. Interviews with this patient and her family were undertaken, together with key staff, to explore the challenges of the AN protocol for this patient and the perceived benefits and any limitations of the ARFID protocol for this patient and others. Results The new ARFID protocol supports greater choice of meals, without the need for rest periods after meals and bathroom supervision. The similarities with the AN protocol reflect the need to promote timely weight gain through meal support, including a staged approach to nutritional supplementation. The protocol appears to have been well accepted by the patient and her family, as well as by staff, and continues to be used in cases of ARFID. Conclusion Further evaluation would help identify how well this protocol meets the needs of different adolescents with ARFID.
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Affiliation(s)
- Danielle Pogos
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia and Murdoch Children's Research Institute, Melbourne, Victoria
| | - Melissa Whitelaw
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia and Murdoch Children's Research Institute, Melbourne, Victoria
- Department of Nutrition and Food Services, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Claire Burton
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Mental Health, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia and Murdoch Children's Research Institute, Melbourne, Victoria
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
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Sanchez-Cerezo J, Neale J, Julius N, Croudace T, Lynn RM, Hudson LD, Nicholls D. Subtypes of avoidant/restrictive food intake disorder in children and adolescents: a latent class analysis. EClinicalMedicine 2024; 68:102440. [PMID: 38333539 PMCID: PMC10850399 DOI: 10.1016/j.eclinm.2024.102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Background The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) describes three primary avoidant/restrictive food intake disorder (ARFID) subtypes including sensory sensitivity, lack of interest in food or eating, and fear of aversive consequences. Studies exploring these subtypes have yielded varying results. We used latent class analysis (LCA) based on the psychopathology of ARFID in a sample of children and adolescents to empirically identify classes. Methods We carried out a surveillance study of ARFID in collaboration with the British Paediatric Surveillance Unit (BPSU) and the Child and Adolescent Psychiatry Surveillance System (CAPSS) in the United Kingdom and the Republic of Ireland from 1st of March 2021 to 31st of March 2022. Paediatricians and child and adolescent psychiatrists were contacted monthly to report newly diagnosed cases of ARFID electronically and complete a detailed clinical questionnaire. Cases aged 5-18 years were included. LCA was performed specifying 1-6 classes and likelihood-based tests for model selection. The Bayesian Information Criterion (BIC), the Akaike Information Criterion (AIC) and the Sample-Size Adjusted BIC were used to determine the most parsimonious model. Analysis of variance (ANOVA) and χ2 tests were used to compare the characteristics of the identified classes. A multinomial logistic regression (MLR) was performed to investigate predicting factors for the latent classes. Findings We identified 319 children and adolescents with ARFID. LCA revealed four distinct classes which were labelled as Fear subtype, Lack of Interest subtype, Sensory subtype, and Combined subtype. The probability of being classified as these were 7.2% (n = 23), 25.1% (n = 80), 29.5% (n = 94) and 38.2% (n = 122), respectively. Age at diagnosis, sex, weight loss, distress associated with eating, and autism spectrum disorder diagnosis were identified as predictors of class membership. Interpretation LCA identified four different classes in a sample of children and adolescents with ARFID. The Combined Subtype, a mixed presentation was the most common. The other three classes resembled the subtypes described in the literature. Clinicians should be aware of these different presentations of ARFID as they may benefit from different clinical interventions. Funding This study was funded by the Former EMS Ltd (charity number 1098725, registered October 9th 2017).
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Affiliation(s)
- Javier Sanchez-Cerezo
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Department of Psychiatry, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Josephine Neale
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Priory Hospital Ticehurst House, Ticehurst, East Sussex, UK
| | - Nikita Julius
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Tim Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Richard M. Lynn
- Institute of Child Health, University College London, London, UK
| | - Lee D. Hudson
- Institute of Child Health, University College London, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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Huffman LG, Lawrence-Sidebottom D, Beam AB, Parikh A, Guerra R, Roots M, Huberty J. Improvements in Adolescents' Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study. JMIR Form Res 2024; 8:e54253. [PMID: 38294855 PMCID: PMC10867747 DOI: 10.2196/54253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors. OBJECTIVE This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents' disordered eating behaviors. METHODS Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care. RESULTS Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001). CONCLUSIONS Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms.
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Affiliation(s)
| | | | | | | | | | | | - Jennifer Huberty
- Bend Health Inc, Madison, WI, United States
- FitMinded Inc LLC, Phoenix, AZ, United States
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Richson BN, Deville DC, Wierenga CE, Kaye WH, Ramirez AL. Expanding considerations for treating avoidant/restrictive food intake disorder at a higher level of care. J Eat Disord 2024; 12:13. [PMID: 38254246 PMCID: PMC10804643 DOI: 10.1186/s40337-024-00972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
Existing descriptions of the treatment of avoidant/restrictive food intake disorder (ARFID) at higher levels of care (HLOC) for eating disorders are limited, despite HLOC settings frequently serving patients with ARFID. The purpose of this commentary is to expand on the preliminary literature that describes pediatric ARFID treatment at HLOC by describing two specific components of our approach to treating pediatric ARFID that may not yet have traction in the current literature. Specifically, we highlight the utility of (1) treatment accommodations that appropriately account for patients' neurodevelopmental needs (e.g., executive functioning, sensory processing) and (2) the adjunctive use of Dialectical Behavior Therapy (DBT) elements within family-based pediatric ARFID treatment. We also describe necessary future directions for research in these domains to clarify if incorporating these considerations and approaches into pediatric ARFID treatment at HLOC does indeed improve treatment outcomes.
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Affiliation(s)
- Brianne N Richson
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, 4510 Executive Drive #315, San Diego, CA, 92121, USA.
- Sanford Center for Biobehavioral Research, 120 8th Street S, Fargo, ND, 58103, USA.
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, 1919 Elm St N, Fargo, ND, 58102, USA.
| | - Danielle C Deville
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, 4510 Executive Drive #315, San Diego, CA, 92121, USA
- Eating Disorders Center, Children's Mercy Kansas City, 5520 College Boulevard, Overland Park, KS, 66211, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, 4510 Executive Drive #315, San Diego, CA, 92121, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, 4510 Executive Drive #315, San Diego, CA, 92121, USA
| | - Ana L Ramirez
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, 4510 Executive Drive #315, San Diego, CA, 92121, USA
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Salameh G, El Khoury N, Hallit R, Malaeb D, Sakr F, Dabbous M, Fekih-Romdhane F, Obeid S, Hallit S. The mediating effect of dysmorphic concern in the association between avoidant restrictive food intake disorder and suicidal ideation in adults. BMC Psychiatry 2024; 24:42. [PMID: 38200526 PMCID: PMC10782566 DOI: 10.1186/s12888-023-05490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Reflecting on the existing literature on suicidal ideation and Avoidant/Restrictive Food Intake Disorder (ARFID), this article investigates the complex relationship between them, hypothesizing about the possibility of dysmorphic concerns, being a mediator linking ARFID to suicidal ideation. METHODS Using a snowball sampling approach, a survey was created on Google Forms and circulated across messaging applications and social media networks (WhatsApp, Instagram, Messenger). The sample involved 515 participants recruited between February and March 2023. The questionnaire included the following scales: Nine-items Avoidant/Restrictive Food Intake Disorder screen (NIAS), Dysmorphic Concern Questionnaire (DCQ), and Columbia-Suicide Severity Rating Scale (C-SSRS). When filling the questionnaire, respondents were warned that they can experience distress when answering certain questions and received information about mental health services. Five hundred fifteen adults participated in this study, with a mean age of 27.55 ± 10.92 years and 60.1% females. RESULTS After adjusting over potential confounders (i.e., age, education, marital status, and household crowding index), analyses showed that dysmorphic concerns fully mediated the association between avoidant restrictive eating and suicidal ideation. Higher avoidant restrictive eating was significantly associated with more dysmorphic concerns, and higher dysmorphic concerns were significantly associated with the presence of suicidal ideation. Finally, avoidant restrictive eating was not significantly associated with suicidal ideation. CONCLUSION This study highlights the potential indirect link between ARFID and suicidal ideation mediated by dysmorphic concerns. While no direct connection was observed between ARFID and suicidal ideation, the presence of dysmorphic concerns appeared to be a crucial factor in amplifying the risk of suicidal ideation in individuals with ARFID. This emphasizes the importance of addressing dysmorphic concerns alongside ARFID treatment to enhance mental health interventions and outcomes.
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Affiliation(s)
- Gaelle Salameh
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Nour El Khoury
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours University Hospital, Byblos, Postal Code 3, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Finn DM, Menzel JE, Gray E, Schwartz T. Pharmacotherapy for attention deficit/hyperactivity disorder in youth with avoidant restrictive food intake disorder: a case series of patients prescribed stimulant medication in a partial hospitalization program for eating disorders. J Eat Disord 2023; 11:226. [PMID: 38111067 PMCID: PMC10726637 DOI: 10.1186/s40337-023-00954-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Appetite suppression and weight loss are established potential side effects of most medications for attention deficit/hyperactivity disorder (ADHD). These side effects may be especially problematic when using stimulants to treat ADHD in the context of a restrictive eating disorder, such as avoidant restrictive food intake disorder (ARFID), although these diagnoses are often comorbid in children. This paper presents a combined approach to treating ADHD comorbid with ARFID using stimulant medication and behavior management within a partial hospitalization program (PHP) and intensive outpatient program (IOP)for eating disorders. The aim of this paper is to determine if the continued or new use of stimulant medication allows for adequate weight restoration by reviewing a series of cases receiving the combined treatment. CASE PRESENTATIONS Consecutive patients with a historical or new diagnosis of ADHD when presenting for treatment for ARFID were included in this case series. This series included 10 patients (8 male, 2 female) who received pharmacotherapy using stimulants and behavior management interventions involving structured mealtimes and contingency management. All treatment occurred within the context of a PHP/IOP for childhood eating disorders. All youth were able to effectively continue on stimulant medication, show clinical benefit in core ADHD symptoms, and able to gradually restore weight. In all cases, stimulant medications were not discontinued, but in some cases, doses were optimized (increased or decreased), switched to a different stimulant, or augmented with non-ADHD medication, such as mirtazapine, to support the management of ADHD while concurrently assisting in weight gain as necessary for the treatment of ARFID. Only one patient was newly started on a stimulant medication; as this was near the end of her treatment stay, limited conclusions can be drawn from this case. CONCLUSIONS These findings support the use of pharmacotherapy, including continuing stimulant medication, when combined with behavior management strategies as a potentially effective treatment approach for ADHD in youth with ARFID in the PHP/IOP setting. Future studies using more rigorous methodology, longer follow-up times, and within other treatment settings are needed.
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Affiliation(s)
- Daphna M Finn
- UCSD Eating Disorder Center for Treatment and Research, University of California, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA.
| | | | - Emily Gray
- Ohana at the Community Hospital of the Monterey Peninsula, Monterey, CA, USA
| | - Terry Schwartz
- UCSD Eating Disorder Center for Treatment and Research, University of California, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
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10
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D'Adamo L, Smolar L, Balantekin KN, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: a cross-sectional study. J Eat Disord 2023; 11:214. [PMID: 38049869 PMCID: PMC10694964 DOI: 10.1186/s40337-023-00939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen. METHODS Among 50,082 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined. RESULTS 2378 (4.7%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than most other diagnoses and higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%). CONCLUSIONS Findings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders, at risk for an eating disorder, or at low risk. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.
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Affiliation(s)
- Laura D'Adamo
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, NY, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA
- Center for m2Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA, 94022, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
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11
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Bulik CM, Micali N, MacDermod CM, Qi B, Munn-Chernoff MA, Thornton LM, White J, Dinkler L, Pisetsky EM, Johnson J, Devine KR, Ortiz SN, Silverman AE, Berthold N, Dumain A, Guintivano J, Halvorsen M, Crowley JJ. ARFID Genes and Environment (ARFID-GEN): study protocol. BMC Psychiatry 2023; 23:863. [PMID: 37990202 PMCID: PMC10664384 DOI: 10.1186/s12888-023-05266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The Avoidant Restrictive Food Intake Disorder - Genes and Environment (ARFID-GEN) study is a study of genetic and environmental factors that contribute to risk for developing ARFID in children and adults. METHODS A total of 3,000 children and adults with ARFID from the United States will be included. Parents/guardians and their children with ARFID (ages 7 to 17) and adults with ARFID (ages 18 +) will complete comprehensive online consent, parent verification of child assent (when applicable), and phenotyping. Enrolled participants with ARFID will submit a saliva sample for genotyping. A genome-wide association study of ARFID will be conducted. DISCUSSION ARFID-GEN, a large-scale genetic study of ARFID, is designed to rapidly advance the study of the genetics of eating disorders. We will explicate the genetic architecture of ARFID relative to other eating disorders and to other psychiatric, neurodevelopmental, and metabolic disorders and traits. Our goal is for ARFID to deliver "actionable" findings that can be transformed into clinically meaningful insights. TRIAL REGISTRATION ARFID-GEN is a registered clinical trial: clinicaltrials.gov NCT05605067.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden.
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, US.
| | - Nadia Micali
- Center for Eating and Feeding Disorders Research, Psychiatric Center Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
- Institute of Biological Psychiatry, Psykiatrisk Center Sct. Hans, Boserupvej 2, 4000, Roskilde, Denmark
- Great Ormond Street Hospital Institute of Child Health, University College London, London, UK
| | - Casey M MacDermod
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Baiyu Qi
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
| | - Melissa A Munn-Chernoff
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Texas Tech University, Lubbock, TX, 79409, USA
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jennifer White
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden
| | - Emily M Pisetsky
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jessica Johnson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Katelin R Devine
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Shelby N Ortiz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ava E Silverman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Smith College, Northampton, MA, 01063, USA
| | - Natasha Berthold
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- University of Western Australia, Crawley, WA, 6009, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, 6009, Australia
| | - Alexis Dumain
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, US
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Matthew Halvorsen
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - James J Crowley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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12
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Sim LA, Whiteside S, Harbeck-Weber C, Sawchuk N, Lebow J. Weight Suppression and Risk for Childhood Psychiatric Disorders. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01617-7. [PMID: 37853282 DOI: 10.1007/s10578-023-01617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
Weight suppression, defined as the discrepancy between an individual's highest historical weight and their current weight, has been implicated in the development and maintenance of eating disorders. Although weight suppression has also been found to impact mood, anxiety and suicidal behavior in patients with and without disordered eating, it has not been examined as a transdiagnostic risk factor for general psychopathology. The current study examined growth records of 281 children and adolescents (ages 7 to 17) newly diagnosed with psychiatric disorders to determine whether these children were more likely to be weight suppressed as compared to an age- and gender-matched control group. Findings suggest that weight suppression is related to an increased risk for anxiety disorders and externalizing disorders for males. These results underscore the need for psychiatric and behavioral health providers to review pediatric growth charts as a routine part of psychiatric evaluation. As weight restoration is a necessary precondition for eating disorder recovery, more research is necessary to determine if weight restoration can enhance treatments for psychiatric symptoms occurring in the context of weight suppression.
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Affiliation(s)
- Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Stephen Whiteside
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cynthia Harbeck-Weber
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nicholas Sawchuk
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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13
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Düplois D, Brosig L, Hiemisch A, Kiess W, Hilbert A, Schlensog-Schuster F, Schmidt R. Distribution and clinical comparison of restrictive feeding and eating disorders using ICD-10 and ICD-11 criteria. Int J Eat Disord 2023; 56:1717-1729. [PMID: 37243388 DOI: 10.1002/eat.23994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Within the eleventh edition of the International Classification of Diseases (ICD-11), diagnostic criteria for feeding and eating disorders were revised and new diagnoses including avoidant/restrictive food intake disorder (ARFID) are classifiable; however, nothing is known about how these changes affect the prevalence of feeding and eating disorders. This study compared the distribution and clinical characteristics of restrictive feeding and eating disorders between ICD-10 and ICD-11. METHOD The Eating Disorder Examination (EDE), its child version, and the EDE ARFID module were administered to N = 82 patients (0-17 years) seeking treatment for restrictive feeding and eating disorders and their parents. Clinical characteristics were derived from medical records, questionnaires, and objective anthropometrics. RESULTS The number of residual restrictive eating disorders (rrED) significantly decreased from ICD-10 to ICD-11 due to a crossover to full-threshold disorders, especially anorexia nervosa (AN) or ARFID. Patients reclassified to ICD-11 ARFID were younger, had an earlier age of illness onset, more restrictive eating behaviors, and tended to have more somatic comorbidities compared to those reclassified to ICD-11 AN. Patients with rrED according to both ICD-10 and ICD-11 were younger, had an earlier age of illness onset, less shape concern, and more somatic comorbidities than patients who were reclassified from ICD-10 rrED to ICD-11 AN or ARFID. DISCUSSION This study highlights the inclusive approach of ICD-11 criteria, paving the way for more targeted treatment, and ARFID's high clinical relevance. Future studies considering nonrestrictive feeding and eating disorders across the life span may allow further analyses on diagnostic crossover. PUBLIC SIGNIFICANCE Changes in diagnostic criteria for restrictive eating disorders within the newly published ICD-11 led to an increase in full-threshold disorders, while the number of rrED was significantly lowered compared to ICD-10 criteria. The results thus highlight the diagnostic utility of ICD-11 criteria and may help providing adequate treatment to children and adolescents with rrED.
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Affiliation(s)
- Dominik Düplois
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Luise Brosig
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Hospital for Children and Adolescents, Center for Pediatric Research, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Franziska Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Medical Center, Leipzig, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ricarda Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
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14
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Watts R, Archibald T, Hembry P, Howard M, Kelly C, Loomes R, Markham L, Moss H, Munuve A, Oros A, Siddall A, Rhind C, Uddin M, Ahmad Z, Bryant-Waugh R, Hübel C. The clinical presentation of avoidant restrictive food intake disorder in children and adolescents is largely independent of sex, autism spectrum disorder and anxiety traits. EClinicalMedicine 2023; 63:102190. [PMID: 37680940 PMCID: PMC10480549 DOI: 10.1016/j.eclinm.2023.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
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.
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Affiliation(s)
- Rosie Watts
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
| | - Tanith Archibald
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Pippa Hembry
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Maxine Howard
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Cate Kelly
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Rachel Loomes
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Laura Markham
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Harry Moss
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Alfonce Munuve
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anca Oros
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Amy Siddall
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Charlotte Rhind
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mohammed Uddin
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Zain Ahmad
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
| | - Rachel Bryant-Waugh
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, United Kingdom
| | - Christopher Hübel
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Centre for Register-based Research, Aarhus BSS Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Pediatric Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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15
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Bulik CM, Micali N, MacDermod CM, Qi B, Munn-Chernoff MA, Thornton LM, White J, Dinkler L, Pisetsky EM, Johnson J, Devine KR, Ortiz SN, Silverman AE, Berthold N, Dumain A, Guintivano J, Halvorsen M, James J. Arfid Genes and Environment (ARFID-GEN): Study Protocol. Res Sq 2023:rs.3.rs-3186174. [PMID: 37693386 PMCID: PMC10491341 DOI: 10.21203/rs.3.rs-3186174/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background The Avoidant Restrictive Food Intake Disorder Genes and Environment (ARFID-GEN) study is a study of genetic and environmental factors that contribute to risk for developing ARFID in children and adults. Methods A total of 3,000 children and adults with ARFID from the United States will be included. Parents/guardians and their children with ARFID (ages 7 to 17) and adults with ARFID (ages 18+) will complete comprehensive online consent, parent verification of child assent (when applicable), and phenotyping. Enrolled participants with ARFID will submit a saliva sample for genotyping. A genome-wide association study of ARFID will be conducted. Discussion ARFID-GEN, a large-scale genetic study of ARFID, is designed to rapidly advance the study of the genetics of eating disorders. We will explicate the genetic architecture of ARFID relative to other eating disorders and to other psychiatric, neurodevelopmental, and metabolic disorders and traits. Our goal is for ARFID to deliver "actionable" findings that can be transformed into clinically meaningful insights. Trial registration ARFID-GEN is a registered clinical trial: clinicaltrials.gov NCT05605067.
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Affiliation(s)
| | - Nadia Micali
- Mental Health Services of the Capital Region of Denmark
| | | | - Baiyu Qi
- University of North Carolina at Chapel Hill
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - J James
- University of North Carolina at Chapel Hill
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16
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Fekih-Romdhane F, Hallit R, Malaeb D, Sakr F, Dabbous M, Sawma T, Obeid S, Hallit S. Psychometric properties of an Arabic translation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a community sample of adults. J Eat Disord 2023; 11:143. [PMID: 37612764 PMCID: PMC10463449 DOI: 10.1186/s40337-023-00874-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND No epidemiological data is yet available on Avoidant/Restrictive Food Intake Disorder (ARFID) in Arab countries, which may in part be due to the lack of measures available in Arabic language. This constitutes a major obstacle to further progress of our understanding of the nature, aetiology, course, treatment, and prevention of ARFID, especially as some evidence suggested that ARFID may vary across cultures and food environments. We aimed to contribute to the literature in the eating disorders field by examining the psychometric properties of an Arabic translation of the Nine Item ARFID Screen (NIAS). METHOD This was a cross-sectional, web-based study. A total of 515 Lebanese community adults (mean age of 27.55 ± 10.92 years, 69.9% females) participated. The forward-backward method was adopted to translate the NIAS from English to Arabic. RESULTS Confirmatory Factor Analyses provided evidence for the adequate fit indices for the three-factor model (i.e., Picky eating, Fear, and Appetite) and the 9-item version of the NIAS. An adequate reliability of the Arabic NIAS was achieved, with McDonald's ω ranging from .75 to .90 for the total score and all three subscores. Multi-group analyses demonstrated measurement invariance by sex (males vs. females) and weight groups (underweight/healthy weight [BMI ≤ 25] vs. overweight/obese [BMI > 25]) at the configural, metric, and scalar levels. Adequate patterns of correlations between the NIAS and measures of disordered eating symptoms, psychological distress and well-being were seen. In particular, fear was significantly associated with non-ARFID disordered eating symptoms. Appetite and Picky eating, but not Fear, were inversely correlated with well-being. All three NIAS subscores and the total score were positively correlated with psychological distress. CONCLUSION Findings provided evidence that the Arabic NIAS is a short, valid and reliable self-report measure to screen for ARFID symptoms. In light of these findings, we recommend its use for clinical and research purposes among Arabic-speaking adults.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours University Hospital, Postal Code 3, Byblos, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Toni Sawma
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, 21478, Jeddah, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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17
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Weeks I, Abber SR, Thomas JJ, Calabrese S, Kuo B, Staller K, Murray HB. The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder. J Clin Gastroenterol 2023; 57:651-662. [PMID: 37079861 PMCID: PMC10623385 DOI: 10.1097/mcg.0000000000001853] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.
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Affiliation(s)
- Imani Weeks
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Sophie R. Abber
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Jennifer J. Thomas
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Samantha Calabrese
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Helen Burton Murray
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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18
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D'Adamo L, Smolar L, Balantekin K, Taylor CB, Wilfley D, Fitzsimmons-Craft E. Prevalence, Characteristics, and Correlates of Avoidant/Restrictive Food Intake Disorder among Adult Respondents to the National Eating Disorders Association Online Screen: A Cross-Sectional Study. Res Sq 2023:rs.3.rs-3007049. [PMID: 37333103 PMCID: PMC10274940 DOI: 10.21203/rs.3.rs-3007049/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Avoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association (NEDA) online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen compared to other probable eating disorder/risk categories. Methods Among 47,705 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined. Results 2,378 (5.0%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than all other diagnoses but higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%). Conclusions Findings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders or at risk for an eating disorder. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.
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Chovel Sella A, Hadaway N, Stern C, Becker KR, Holsen LM, Eddy KT, Micali N, Misra M, Thomas JJ, Lawson EA. Lower Ghrelin Levels Are Associated With Higher Anxiety Symptoms in Adolescents and Young Adults With Avoidant/Restrictive Food Intake Disorder. J Clin Psychiatry 2023; 84:22m14482. [PMID: 37134126 PMCID: PMC10336648 DOI: 10.4088/jcp.22m14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Objective: Avoidant/restrictive food intake disorder (ARFID) is associated with increased risk for anxiety, which may adversely affect prognosis. The appetite-stimulating hormone, ghrelin, increases in response to stress, and exogenous ghrelin decreases anxiety-like behaviors in animal models. The aim of this study was to evaluate the relationship between ghrelin levels and measures of anxiety in youth with ARFID. We hypothesized that lower ghrelin levels would be associated with increased anxiety symptoms. Methods: We studied a cross-sectional sample of 80 subjects with full and subthreshold ARFID diagnosed by DSM-5 criteria, aged 10-23 years (female, n = 39; male, n = 41). Subjects were enrolled in a study of the neurobiology of avoidant/restrictive eating conducted from August 2016 to January 2021. We assessed fasting ghrelin levels and anxiety symptoms (State-Trait Anxiety Inventory [STAI] and STAI for Children [STAI-C] measuring general trait anxiety; Beck Anxiety Inventory [BAI] and BAI for youth [BAI-Y] assessing cognitive, emotional, and somatic symptoms of anxiety; and Liebowitz Social Anxiety Scale [LSAS] assessing symptoms of social anxiety). Results: Consistent with our hypothesis, ghrelin levels were inversely associated with anxiety symptoms as assessed by STAI/STAI-C T scores (r = -0.28, P = .012), BAI/BAI-Y T scores (r = -0.28, P = .010), and LSAS scores (r = -0.3, P = .027), all with medium effect sizes. Findings held in the full threshold ARFID group when adjusting for body mass index z scores (STAI/STAI-C T scores, β = -0.27, P = .024; BAI/BAI-Y T scores, β = -0.26, P = .034; LSAS, β = -0.34, P = .024). Conclusions: These findings demonstrate that lower levels of ghrelin are associated with more severe anxiety symptoms in youth with ARFID and raise the question of whether ghrelin pathways could be targeted in the treatment of ARFID.
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Affiliation(s)
- Aluma Chovel Sella
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Division of Pediatric Endocrinology, Mass General for Children, Massachusetts General Hospital, Boston, Massachusetts
| | - Natalia Hadaway
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Casey Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Laura M Holsen
- Division of Women's Health, Department of Medicine and Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Nadia Micali
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Department of Pediatrics Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Division of Pediatric Endocrinology, Mass General for Children, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Indicates shared senior authorship
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Indicates shared senior authorship
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Corresponding author: Elizabeth A. Lawson, MD, MMSc, Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Indicates shared senior authorship
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20
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Straface E, Jacobis ITD, Capriati T, Pretelli I, Grandin A, Mascolo C, Vona R, Gambardella L, Cittadini C, Villani A, Marchili MR. The impact of the COVID-19 pandemic on eating disorders risk and symptoms: a retrospective study. Ital J Pediatr 2023; 49:50. [PMID: 37101237 PMCID: PMC10132438 DOI: 10.1186/s13052-023-01443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Social distancing and quarantine imposed by the authority during the COVID-19 pandemic caused restrictions, which had a negative impact on eating behavior, especially among adolescents. We proposed a retrospective study aimed to evaluate the effect of the COVID-19 pandemic on eating disorders risk and symptoms. METHODS In this study, a group of 127 pediatric patients (117 females and 10 males) with eating disorders admitted to the Bambino Gesù Children's Hospital of Rome (Italy), in the period between August 2019 and April 2021, was analyzed. All patient data were collected from patients' electronic medical records. RESULTS We found that 80.3% of patients were at the onset of eating disorders and that 26% of patients had familiarity for psychotic disorders. Often these patients had comorbidities and alterations in blood parameters such as leukocytopenia, neutropenia, hypovitaminosis and hormonal problems that could affect their future. CONCLUSIONS Our findings could provide a framework for developing clinical and educational interventions to mitigate the short- and long-term negative impact of the pandemic on adolescent future health.
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Affiliation(s)
- Elisabetta Straface
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy.
- Biomarkers Unit, Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena, Rome, 299 - 00161, Italy.
| | - Isabella Tarissi De Jacobis
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy.
| | - Teresa Capriati
- Gastroenterology and Nutritional Rehabilitation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Italo Pretelli
- Anorexia and Eating Disorder Unit, Child and Adolescent Psichiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Annalisa Grandin
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Cristina Mascolo
- Pediatric Academic Department, University of Rome Tor Vergata, Via Cracovia 50, Rome, 00133, Italy
| | - Rosa Vona
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy
| | - Lucrezia Gambardella
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy
| | - Camilla Cittadini
- Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161, Italy
| | - Alberto Villani
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Maria Rosaria Marchili
- Emergency Acceptance and General Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, Rome, 00165, Italy
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21
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Datta N, Matheson B, Walker AC, Van Wye E, Lock JD. Psychoeducational and motivational treatment for low-weight Avoidant/Restrictive Food Intake Disorder (ARFID): Three case reports in school-aged children. Clin Child Psychol Psychiatry 2023:13591045231169141. [PMID: 37032311 DOI: 10.1177/13591045231169141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Individuals with Avoidant/Restrictive Food Intake Disorder (ARFID) experience restrictive or highly selective eating problems that interfere with growth and development. Despite the increasing number of referrals for ARFID, no evidence-based treatments exist. This compilation of case composites describes a novel manualized treatment, Psychoeducational and Motivational Treatment (PMT) for children with ARFID, focusing on exploring motivation to change eating behaviors. This approach is based on motivational non-directive psychotherapy models, psychoeducational interventions, and the usefulness of play to support psychotherapeutic learning in school-age children. CASE PRESENTATIONS Three cases of children with ARFID treated using PMT are presented: a 7-year-old, a 10-year-old, and a 12-year-old. These cases illustrate how a clinician delivers PMT interventions in the context of developmental abilities and common comorbidities associated with ARFID. CONCLUSION PMT is a promising therapy for ARFID in school-age children. Challenges and strategies are discussed, including ways to address obstacles such as young age, comorbidities, and use of the virtual environment.
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Affiliation(s)
- Nandini Datta
- Department of Psychiatry and Behavioral Sciences, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Brittany Matheson
- Department of Psychiatry and Behavioral Sciences, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Avery Carter Walker
- Department of Psychiatry and Behavioral Sciences, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Eliza Van Wye
- Department of Psychiatry and Behavioral Sciences, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, 6429Stanford University School of Medicine, Stanford, CA, USA
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22
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Zickgraf HF, Garwood SK, Lewis CB, Giedinghagen AM, Reed JL, Linsenmeyer WR. Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults. Transgend Health 2023; 8:159-167. [PMID: 37013088 PMCID: PMC10066774 DOI: 10.1089/trgh.2021.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of the study was to provide initial evidence for the internal consistency and convergent validity of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in a sample of transgender and nonbinary (TGNB) youth and young adults. Methods Returning patients at a Midwestern gender clinic (n=164) ages 12-23 completed the NIAS, sick, control, one stone, fat, food (SCOFF), patient health questionnaire 9 (PHQ-9), and generalized anxiety disorder 7 (GAD-7) during their clinic visit. Age, sex assigned at birth, gender identity, weight, and height were also collected. Confirmatory factor analysis was used to establish the hypothesized three-factor structure of the NIAS in this sample. Relationships between the NIAS subscales and anthropometric data, SCOFF, PHQ-9, GAD-7, and sex assigned at birth were explored for convergent and divergent validity, and proposed screening cutoff scores were used to identify the prevalence of likely avoidant/restrictive food intake disorder (ARFID) in this population. Results The three-factor structure of the NIAS was an excellent fit to the current data. Approximately one in five (22%) of the participants screened positive for ARFID. Approximately one in four participants scored above the picky eating (27.4%) or appetite (23.9%) cutoffs. Assigned female at birth participants scored significantly higher on the NIAS-Total, Appetite, and Fear subscales than those assigned male at birth. NIAS-Total was significantly related to all convergent validity variables other than age, with a moderate-strong correlation with other symptom screeners (SCOFF, PHQ-9, GAD-7), and a small negative correlation with body mass index percentile. Conclusions Evidence supports the NIAS as a valid measure to screen for ARFID among TGNB youth and young adults.
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Affiliation(s)
| | - Sarah K. Garwood
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christopher B. Lewis
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Andrea M. Giedinghagen
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jamie L. Reed
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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23
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Sanchez-Cerezo J, Nagularaj L, Gledhill J, Nicholls D. What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature. Eur Eat Disord Rev 2023; 31:226-246. [PMID: 36527163 PMCID: PMC10108140 DOI: 10.1002/erv.2964] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/10/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) was a new diagnosis in DSM-5. This systematic review explores what is known to date about the epidemiology of ARFID in children and adolescents. METHOD Embase, Medline and PsycInfo were used to identify studies meeting inclusion criteria. PRISMA guidelines were followed. RESULTS Thirty studies met inclusion criteria, with most coming from specialised eating disorder services where prevalence rates were 5%-22.5%. Three studies from specialist feeding clinics showed the highest prevalence rates, ranging from 32% to 64%. Studies from non-clinical samples reported ARFID prevalence estimates ranging from 0.3% to 15.5%. One study, using national surveillance methodology, reported the incidence of ARFID in children and adolescents reaching clinical care to be 2.02 per 100,000 patients. Psychiatric comorbidity was common, especially anxiety disorders (9.1%-72%) and autism spectrum disorder (8.2%-54.75%). CONCLUSION The current literature on the epidemiology of ARFID in children and adolescents is limited. Studies are heterogeneous with regard to setting and sample characteristics, with a wide range of prevalence estimates. Further studies, especially using surveillance methodology, will help to better understand the nature of this disorder and estimate clinical service needs.
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Affiliation(s)
- Javier Sanchez-Cerezo
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Lidushi Nagularaj
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Julia Gledhill
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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24
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Dinkler L, Hedlund E, Bulik CM. Self-reported expertise and confidence in diagnosing and treating avoidant restrictive food intake disorder among Swedish clinicians. Eur Eat Disord Rev 2023; 31:433-442. [PMID: 36759941 DOI: 10.1002/erv.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/25/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To assess self-reported knowledge and confidence regarding avoidant restrictive food intake disorder (ARFID) diagnosis and treatment in Swedish clinicians from various disciplines. METHOD The study included 489 clinicians who attended educational lectures about ARFID. Participants responded to 20 ARFID-related questions and statements using the online audience engagement platform Mentimeter. Items assessed ARFID-related knowledge, education, and experience, as well as treatment methods offered to ARFID patients at clinicians' healthcare units. RESULTS We found predominantly correct responses to three basic knowledge-based items about ARFID. However, most participants (64.0%) reported never having received education about ARFID, and few participants reported feeling confident in their ability to diagnose (13.4%) and treat (10.7%) ARFID. Nearly half the sample reported either not knowing which ARFID treatments their unit offered (22.3%) or that no treatment was offered (21.3%). CONCLUSION Experience and confidence in diagnosing and treating ARFID are generally low in Swedish clinicians, and many individuals with ARFID do not receive treatment. We identify a pressing need for resources, clearer organisation, and structure, and for additional education and training opportunities for clinicians meeting individuals with ARFID.
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Affiliation(s)
- Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elin Hedlund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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25
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Nitsch A, Watters A, Manwaring J, Bauschka M, Hebert M, Mehler PS. Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study. Int J Eat Disord 2023; 56:978-990. [PMID: 36695305 DOI: 10.1002/eat.23897] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study is to describe the clinical features of adult patients with avoidant/restrictive food intake disorder (ARFID) to better understand the medical findings, psychological comorbidities, and laboratory abnormalities in this population. METHOD We completed a retrospective chart review of all adult patients with a diagnosis of ARFID, admitted for medical stabilization, between April 2016 and June 2021, to an inpatient hospital unit, which specializes in severe eating disorders. Information collected included anthropomorphic data, laboratory assessments, and medical history at time of admission. RESULTS One hundred and twenty-two adult patients with ARFID were identified as meeting inclusion criteria for the study. The most common ARFID presentation was "fear of adverse consequences." The majority were female (70%), with an average age of 32.7 ± 13.7 years and mean percent of ideal body weight (m%IBW) of 68.2 ± 10.9. The most common laboratory abnormalities were low serum prealbumin and vitamin D, hypokalemia, leukopenia, and elevated serum bicarbonate. The most common psychiatric diagnoses were anxiety and depressive disorders, and the most common medical diagnoses were disorders of gut-brain interaction (DGBI). DISCUSSION This is the largest study to the authors' knowledge of medical presentations in adult patients with ARFID. Our results reflect that the adult patient with ARFID may, in some aspects, present differently than pediatric and adolescent patients with ARFID, or from ARFID patients requiring less intensive care. This study highlights the need for further investigation of adult patients with ARFID. PUBLIC SIGNIFICANCE ARFID is a restrictive eating disorder first defined in 2013. This study explores the medical presentations of adult patients (>18 years old) with ARFID presenting for specialized eating disorder treatment and identifies unique features of the adult presentation for treatment, compared to pediatric and adolescent peers.
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Affiliation(s)
- Allison Nitsch
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jamie Manwaring
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Melanie Hebert
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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26
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Robison M, Rogers ML, Robertson L, Duffy ME, Manwaring J, Riddle M, Rienecke RD, Le Grange D, Duffy A, Plotkin M, Blalock DV, Mehler PS, Joiner TE. Avoidant restrictive food intake disorder and suicidal ideation. Psychiatry Res 2022; 317:114925. [PMID: 37732866 DOI: 10.1016/j.psychres.2022.114925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022]
Abstract
Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.
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Affiliation(s)
- Morgan Robison
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Jamie Manwaring
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Megan Riddle
- ACUTE at Denver Health, Denver, CO, USA; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL (Emeritus), USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Philip S Mehler
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Internal Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
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27
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Cooper‐Vince CE, Nwaka C, Eddy KT, Misra M, Hadaway NA, Becker KR, Lawson EA, Cooke L, Bryant‐Waugh R, Thomas JJ, Micali N. The factor structure and validity of a diagnostic interview for avoidant/restrictive food intake disorder in a sample of children, adolescents, and young adults. Int J Eat Disord 2022; 55:1575-1588. [PMID: 36324295 PMCID: PMC9641545 DOI: 10.1002/eat.23792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE There is a paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID) to aid identification and classification of cases for both clinical and research purposes. To evaluate the factor structure, construct validity, and criterion validity of the Pica ARFID and Rumination Disorder Interview (PARDI; ARFID module), we administered the PARDI to 129 children and adolescents ages 9-23 years (M = 16.1) with ARFID (n = 84), subclinical ARFID (n = 11), and healthy controls (n = 34). METHOD We used exploratory factor analysis to examine the factor structure of the PARDI in children, adolescents, and young adults with an ARFID diagnosis, the Kruskal-Wallis analysis of variance and Spearman correlations to test the construct validity of the measure, and non-parametric receiver operating characteristic curves to evaluate the criterion validity of the PARDI. RESULTS Exploratory factor analysis yielded a 3-factor structure: (1) concern about aversive consequences of eating, (2) low appetite/low interest in food, and (3) sensory sensitivity. Participants with ARFID demonstrated significantly higher levels of sensory sensitivity, low appetite/low-food interest, and concern about aversive consequences of eating symptoms relative to control participants. The construct validity for each PARDI subscale was supported and clinical cutoffs for the low appetite/low interest in food (1.1) and sensory sensitivity subscales (0.6) were established. DISCUSSION These data present evidence for the factor structure and validity of the PARDI diagnostic interview for diagnosing ARFID in children, adolescents, and young adults, supporting the use of this tool to facilitate ARFID clinical assessment and research. PUBLIC SIGNIFICANCE Due to the paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID), we evaluated the factor structure and validity of the Pica ARFID and Rumination Disorder Interview (ARFID module). Findings suggest that the interview assesses 3 components of ARFID: concern about aversive consequences of eating, low-appetite, and sensory sensitivity, and that clinical threshold scores on the latter two subscales can be used to advance ARFID assessment.
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Affiliation(s)
| | - Chika Nwaka
- Department of PsychiatryUniversity of GenevaGenevaSwitzerland
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Madhusmita Misra
- Division of Pediatric EndocrinologyMassachusetts General HospitalMassachusettsUSA,Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA,Neuroendocrine UnitMassachusetts General HospitalMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Natalia A. Hadaway
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Neuroendocrine UnitMassachusetts General HospitalMassachusettsUSA
| | - Kendra R. Becker
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Elizabeth A. Lawson
- Neuroendocrine UnitMassachusetts General HospitalMassachusettsUSA,Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Lucy Cooke
- Feeding and Eating Disorders ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Rachel Bryant‐Waugh
- South London and Maudsley NHS Foundation TrustLondonUK,Department of Child Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKings College LondonLondonUK
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA
| | - Nadia Micali
- Department of PsychiatryUniversity of GenevaGenevaSwitzerland,Department of Pediatrics, Gynecology and ObstetricsUniversity of GenevaGenevaSwitzerland,GOS Institute of Child HealthUniversity College LondonLondonUK
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28
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Brytek-matera A, Ziółkowska B, Ocalewski J. Symptoms of Avoidant/Restrictive Food Intake Disorder among 2–10-Year-Old Children: The Significance of Maternal Feeding Style and Maternal Eating Disorders. Nutrients 2022; 14:4527. [DOI: 10.3390/nu14214527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to investigate whether the feeding style and core behavioral features of eating disorders of mothers are related to the symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) among their children. This study involved 207 mothers of children aged 2 to 10 years (Mage = 5.82 ± 2.59 years), of which 19.32% were children with neurodevelopmental disorders and 22.71% were children with chronic diseases (e.g., allergy, asthma, diabetes). The mothers were asked to complete the ARFID Parents Questionnaire–Parents Report (ARFID-Q-PR), the Parental Feeding Style Questionnaire (PFSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Our findings revealed that both the maternal feeding style and core behavioral features of eating disorders were associated with ARFID symptoms among their 2–10-year-old children. While biological factors increase the risk of feeding/nutrition difficulties, the maternal attitude towards feeding and eating behavior may play a relevant role in children’s eating behavior.
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29
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Kambanis PE, Harshman SG, Kuhnle MC, Kahn DL, Dreier MJ, Hauser K, Slattery M, Becker KR, Breithaupt L, Misra M, Micali N, Lawson EA, Eddy KT, Thomas JJ. Differential comorbidity profiles in avoidant/restrictive food intake disorder and anorexia nervosa: Does age play a role? Int J Eat Disord 2022; 55:1397-1403. [PMID: 35848094 DOI: 10.1002/eat.23777] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Research comparing psychiatric comorbidities between individuals with avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) is limited. ARFID often develops in childhood, whereas AN typically develops in adolescence or young adulthood. Understanding how age may impact differential psychological comorbidity profiles is important to inform etiological conceptualization, differential diagnosis, and treatment planning. We aimed to compare the lifetime frequency of psychiatric comorbidities and suicidality between females with ARFID (n = 51) and AN (n = 40), investigating the role of age as a covariate. METHOD We used structured interviews to assess the comparative frequency of psychiatric comorbidities/suicidality. RESULTS When age was omitted from analyses, females with ARFID had a lower frequency of depressive disorders and suicidality compared to AN. Adjusting for age, only suicidality differed between groups. DISCUSSION This is the first study to compare comorbidities in a similar number of individuals with ARFID and AN, and a structured clinical interview to confer ARFID and comorbidities, covarying for age, and the first to compare suicidality. Although suicidality is at least three times less common in ARFID than AN, observed differences in other psychiatric comorbidities may reflect ARFID's relatively younger age of presentation compared to AN. PUBLIC SIGNIFICANCE Our results highlight that, with the exception of suicidality, which was three times less common in ARFID than AN irrespective of age, observed differences in psychiatric comorbidities in clinical practice may reflect ARFID's younger age at clinical presentation compared to AN.
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Affiliation(s)
- P Evelyna Kambanis
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie G Harshman
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Megan C Kuhnle
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Danielle L Kahn
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Melissa J Dreier
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kristine Hauser
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Madhusmita Misra
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Pediatrics, University of Geneva, Geneva, Switzerland.,Department of Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,GOSH Institute, University College London, London, UK
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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30
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Riva A, Pigni M, Albanese ND, Falbo M, Di Guardo S, Brasola E, Biso F, Nacinovich R. Eating Disorders in Children and Adolescent Males: A Peculiar Psychopathological Profile. Int J Environ Res Public Health 2022; 19:11449. [PMID: 36141722 PMCID: PMC9517020 DOI: 10.3390/ijerph191811449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Eating Disorders (EDs) are severe psychiatric disorders with high rates of mortality, multiple medical and psychiatric comorbidities associated, and often chronic illness. Historically, EDs are among the most gendered of psychiatric illnesses, and male presentations have been perceived as rare and unusual. This perception resulted in the systematic underrepresentation of males in research on Eds, and as consequence, in a scarcity of research investigating clinical and psychological features in this population. (2) Methods: The present study aims to evaluate clinical and psychopathological features in a sample of 287 children and adolescents, 27 males and 260 females with EDs, in order to identify similarities and differences. (3) Results: Males were younger than females, with similar medical and clinical conditions, but a different distribution of typology of EDs in middle childhood and middle adolescents. The Eating Disorders Inventory-3, TAS-20 for alexithymia and CDI for depressive symptoms' profiles are similar, while males showed higher scores at the global indexes of Symptom Checklist 90-Revised test in early adolescence. (4) Conclusions: Results suggest gender-specific similarities and differences in clinical and psychological features in children and adolescent males, which may require specific diagnosis and treatment.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, ASST Monza University of Milano-Bicocca, 20900 Monza, Italy
| | - Maria Pigni
- Child and Adolescent Mental Health Department, ASST Monza University of Milano-Bicocca, 20900 Monza, Italy
| | - Nunzia Delia Albanese
- Child and Adolescent Mental Health Department, ASST Monza University of Milano-Bicocca, 20900 Monza, Italy
| | - Mariella Falbo
- Child and Adolescent Mental Health Department, ASST Monza University of Milano-Bicocca, 20900 Monza, Italy
| | - Simona Di Guardo
- Child and Adolescent Mental Health Department, ASST Monza University of Milano-Bicocca, 20900 Monza, Italy
| | - Eleonora Brasola
- Child and Adolescent Mental Health Department, ASST Monza University of Milano-Bicocca, 20900 Monza, Italy
| | - Francesco Biso
- Department of Business Engineering, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, ASST Monza University of Milano-Bicocca, 20900 Monza, Italy
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31
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Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S. Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord 2022; 10:132. [PMID: 36064606 PMCID: PMC9442924 DOI: 10.1186/s40337-022-00654-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. METHODS This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. RESULTS A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. CONCLUSIONS This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.
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Affiliation(s)
- Ashlea Hambleton
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Genevieve Pepin
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
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32
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Breithaupt L, Kahn DL, Slattery M, Plessow F, Mancuso C, Izquierdo A, Dreier MJ, Becker K, Franko DL, Thomas JJ, Holsen L, Lawson EA, Misra M, Eddy KT. Eighteen-month Course and Outcome of Adolescent Restrictive Eating Disorders: Persistence, Crossover, and Recovery. J Clin Child Adolesc Psychol 2022; 51:715-725. [PMID: 35476589 PMCID: PMC9444807 DOI: 10.1080/15374416.2022.2034634] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake disorder (ARFID). To inform nosology of low-weight restrictive eating disorders in adolescents, we examined outcomes including persistence, crossover, and recovery in an 18-month observational study. METHOD We assessed 82 women (ages 10-23 years) with low-weight eating disorders including AN (n = 40; 29 restricting, 11 binge-eating/purging), atyp-AN (n = 26; 19 restricting, seven binge-eating/purging), and ARFID (n = 16) at baseline, nine months (9 M; 75% retention), and 18 months (18 M; 73% retention) via semi-structured interviews. First-order Markov modeling was used to determine diagnostic persistence, crossover, and recovery occurring at 9 M or 18 M. RESULTS Among all diagnoses, the likelihood of remaining stable within a given diagnosis was greater than that of transitioning, with the greatest probability among ARFID (0.84) and AN-R (0.62). Persistence of BP and atypical presentations at follow-up periods was less stable (AN-BP probability 0.40; atyp-AN-R probability 0.48; atyp-AN-BP probability, 0.50). Crossover from binge-eating/purging to restricting occurred 72% of the time; crossover from restricting to binge-eating/purging occurred 23% of the time. The likelihood of stable recovery (e.g., recovery at both 9 M and 18 M) was between 0.00 and 0.36. CONCLUSION Across groups, intake diagnosis persisted in about two-thirds, and recovery was infrequent, underscoring the urgent need for innovative treatment approaches to these illnesses. Frequent crossover between AN and atyp-AN supports continuity between typical and atypical presentations, whereas no crossover to ARFID supports its distinction.
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Affiliation(s)
- Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Danielle L. Kahn
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Franziska Plessow
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alyssa Izquierdo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa J. Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kendra Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Holsen
- Harvard Medical School, Boston, MA, USA
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elizabeth A. Lawson
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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33
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Kerem L, Van De Water AL, Kuhnle MC, Harshman S, Hauser K, Eddy KT, Becker KR, Misra M, Micali N, Thomas JJ, Holsen L, Lawson EA. Neurobiology of Avoidant/Restrictive Food Intake Disorder in Youth with Overweight/Obesity Versus Healthy Weight. J Clin Child Adolesc Psychol 2022; 51:701-714. [PMID: 33769133 PMCID: PMC8464625 DOI: 10.1080/15374416.2021.1894944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Avoidant/restrictive food intake disorder (ARFID) occurs across the weight spectrum, however research addressing the coexistesnce of ARFID with overweight/obesity (OV/OB) is lacking. We aimed to establish co-occurrence of OV/OB and ARFID and to characterize divergent neurobiological features of ARFID by weight. METHOD Youth with full/subthreshold ARFID (12 with healthy weight [HW], 11 with OV/OB) underwent fasting brain fMRI scan while viewing food/non-food images (M age = 16.92 years, 65% female, 87% white). We compared groups on BOLD response to high-calorie foods (HCF) (vs. objects) in food cue processing regions of interest. Following fMRI scanning, we evaluated subjective hunger pre- vs. post-meal. We used a mediation model to explore the association between BMI, brain activation, and hunger. RESULTS Participants with ARFID and OV/OB demonstrated significant hyperactivation in response to HCF (vs. objects) in the orbitofrontal cortex (OFC) and anterior insula compared with HW participants with ARFID. Mediation analysis yielded a significant indirect effect of group (HW vs. OV/OB) on hunger via OFC activation (effect = 18.39, SE = 11.27, 95% CI [-45.09, -3.00]), suggesting that OFC activation mediates differences in hunger between ARFID participants with HW and OV/OB. CONCLUSIONS Compared to youth with ARFID and HW, those with OV/OB demonstrate hyperactivation of brain areas critical for the reward value of food cues. Postprandial changes in subjective hunger depend on BMI and are mediated by OFC activation to food cues. Whether these neurobiological differences contribute to selective hyperphagia in ARFID presenting with OV/OB and represent potential treatment targets is an important area for future investigation.
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Affiliation(s)
- Liya Kerem
- Neuroendocrine Unit, Department of Medicine, Massachusetts
General Hospital and Harvard Medical School
- Division of Pediatric Endocrinology, Mass General Hospital
for Children
| | - Avery L. Van De Water
- Neuroendocrine Unit, Department of Medicine, Massachusetts
General Hospital and Harvard Medical School
- Division of Women’s Health, Department of Medicine
and Department of Psychiatry, Brigham and Women’s Hospital and Harvard
Medical School
| | - Megan C. Kuhnle
- Neuroendocrine Unit, Department of Medicine, Massachusetts
General Hospital and Harvard Medical School
| | - Stephanie Harshman
- Neuroendocrine Unit, Department of Medicine, Massachusetts
General Hospital and Harvard Medical School
| | - Kristine Hauser
- Neuroendocrine Unit, Department of Medicine, Massachusetts
General Hospital and Harvard Medical School
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program,
Massachusetts General Hospital, Department of Psychiatry and Harvard Medical
School
| | - Kendra R. Becker
- Eating Disorders Clinical and Research Program,
Massachusetts General Hospital, Department of Psychiatry and Harvard Medical
School
| | - Madhusmita Misra
- Neuroendocrine Unit, Department of Medicine, Massachusetts
General Hospital and Harvard Medical School
- Division of Pediatric Endocrinology, Mass General Hospital
for Children
| | - Nadia Micali
- Department of Psychiatry, Great Ormond Street Institute of
Child Health, University College London
- Department of Psychiatry, Faculty of Medicine and Child and
Adolescent Psychiatry Division, Department of Child and Adolescent Health,
University of Geneva
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program,
Massachusetts General Hospital, Department of Psychiatry and Harvard Medical
School
| | - Laura Holsen
- Division of Women’s Health, Department of Medicine
and Department of Psychiatry, Brigham and Women’s Hospital and Harvard
Medical School
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts
General Hospital and Harvard Medical School
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Dinkler L, Yasumitsu‐Lovell K, Eitoku M, Fujieda M, Suganuma N, Hatakenaka Y, Hadjikhani N, Bryant‐Waugh R, Råstam M, Gillberg C. Early neurodevelopmental problems and risk for avoidant/restrictive food intake disorder (ARFID) in 4‐7‐year‐old children: A Japanese birth cohort study. JCPP Advances 2022. [DOI: 10.1002/jcv2.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lisa Dinkler
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Department of Environmental Medicine Kochi Medical School Kochi University Nankoku, Kochi Japan
| | - Kahoko Yasumitsu‐Lovell
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Department of Environmental Medicine Kochi Medical School Kochi University Nankoku, Kochi Japan
| | - Masamitsu Eitoku
- Department of Environmental Medicine Kochi Medical School Kochi University Nankoku, Kochi Japan
| | - Mikiya Fujieda
- Department of Pediatrics Kochi Medical School Kochi University Nankoku, Kochi Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine Kochi Medical School Kochi University Nankoku, Kochi Japan
| | - Yuhei Hatakenaka
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Faculty of Humanities and Social Sciences University of the Ryukyus Nishihara, Okinawa Japan
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Athinoula A. Martinos Center for Biomedical Imaging Massachusetts General Hospital Harvard Medical School Charlestown Massachusetts USA
| | - Rachel Bryant‐Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders South London and Maudsley NHS Foundation Trust London UK
- Department of Child and Adolescent Psychiatry Institute of Psychiatry Psychology and Neuroscience King's College London London UK
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Department of Clinical Sciences Lund Lund University Lund Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Department of Psychiatry Kochi Medical School Kochi University Nankoku, Kochi Japan
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35
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Abstract
BACKGROUND Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study. METHODS The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression. RESULTS Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research. CONCLUSIONS This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.
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Affiliation(s)
- Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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Kennedy HL, Dinkler L, Kennedy MA, Bulik CM, Jordan J. How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (ARFID). J Eat Disord 2022; 10:53. [PMID: 35428338 PMCID: PMC9013144 DOI: 10.1186/s40337-022-00578-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/08/2022] [Indexed: 12/29/2022] Open
Abstract
Avoidant/restrictive food intake disorder (ARFID) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike anorexia nervosa, ARFID is characterised by avoidant or restricted food intake that is not driven by weight or body shape-related concerns. As with other eating disorders, it is expected that ARFID will have a significant genetic risk component; however, sufficiently large-scale genetic investigations are yet to be performed in this group of patients. This narrative review considers the current literature on the diagnosis, presentation, and course of ARFID, including evidence for different presentations, and identifies fundamental questions about how ARFID might fit into the fluid landscape of other eating and mental disorders. In the absence of large ARFID GWAS, we consider genetic research on related conditions to point to possible features or mechanisms relevant to future ARFID investigations, and discuss the theoretical and clinical implications an ARFID GWAS. An argument for a collaborative approach to recruit ARFID participants for genome-wide association study is presented, as understanding the underlying genomic architecture of ARFID will be a key step in clarifying the biological mechanisms involved, and the development of interventions and treatments for this serious, and often debilitating disorder.
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Affiliation(s)
- Hannah L Kennedy
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden.,Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, 411 19, Gothenburg, Sweden
| | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
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Carter Leno V, Micali N, Bryant-Waugh R, Herle M. Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating. Eur Eat Disord Rev 2022; 30:604-615. [PMID: 35388530 PMCID: PMC9542277 DOI: 10.1002/erv.2902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022]
Abstract
Objective Previous literature shows an increased risk for eating disorders in autistic individuals. This study tested whether fussy eating contributes to the association between childhood autistic traits and adolescent eating disorder behaviours. Method Using data from the Avon Longitudinal Study of Parents and Children, we estimated the intercept and slope of parent‐rated autistic traits and fussy eating between 7 and 14 years (N = 8982) and their association with self‐reported eating disorder behaviours at age 14 years, including the indirect path from autistic traits to eating disorder behaviours via fussy eating. Analyses were adjusted for child sex, maternal age at delivery, maternal body mass index and maternal education. Results Analyses found a small indirect pathway from autistic traits intercept to eating disorder behaviours via fussy eating slope (b = 0.017, 95% CI = 0.002–0.032, p = 0.026), with higher levels of autistic traits at age 7 years being associated with a shallower decline in fussy eating, which in turn was associated with greater eating disorder behaviours. Conclusion Findings point towards fussy eating as a potential link between childhood autistic traits and later disordered eating. Addressing fussy eating patterns before they become entrenched may decrease risk for eating disorders later in development. There is evidence that high levels of autistic traits are associated with an increased likelihood of experiencing an eating disorder. The current study sought to test whether the link between autism and eating disorders could in part be explained by variation in fussy eating. In a large prospective cohort study, we found a significant indirect effect of fussy eating, such that higher childhood autistic traits were associated with a shallower decline in fussy eating between childhood and adolescence, which in turn was associated with higher levels of eating disorder behaviours in adolescence.
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Affiliation(s)
- Virginia Carter Leno
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nadia Micali
- Department of Pediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Moritz Herle
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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38
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Farag F, Sims A, Strudwick K, Carrasco J, Waters A, Ford V, Hopkins J, Whitlingum G, Absoud M, Kelly VB. Avoidant/restrictive food intake disorder and autism spectrum disorder: clinical implications for assessment and management. Dev Med Child Neurol 2022; 64:176-182. [PMID: 34405406 DOI: 10.1111/dmcn.14977] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
AIM We examined clinical and neurodevelopmental presentations of children with avoidant/restrictive food intake disorder (ARFID) to inform clinical assessment and management. METHOD Five hundred and thirty-six patients (mean age 6y 10mo, SD 3y 5mo, range 10mo-20y; 401 males, 135 females) seen by the tertiary multidisciplinary feeding service at the Evelina London Children's Hospital between January 2013 and June 2019 were included in this case-control study. These children experienced significant feeding difficulties impacting nutrition, development, and psychosocial functioning requiring tertiary specialized input. Data on ARFID diagnosis, demographics, comorbidity, and nutrition was extracted from electronic patient records. RESULTS Forty-nine per cent of children met ARFID criteria. The remaining participants had other difficulties including feeding, medical, and/or neurodevelopmental conditions. ARFID is more prevalent among younger patients (4-9 years) and in children with comorbid autism spectrum disorder (ASD). Younger age, comorbid ASD, and male sex significantly predicted ARFID. Diet range and male sex significantly predicted nutritional inadequacy, while comorbid ASD did not. A trend was seen between younger age and nutritional inadequacy. INTERPRETATION Young children with ARFID should raise suspicion for ASD. Although significant nutritional deficiencies are common in children with comorbid ARFID and ASD, they are correctable with nutritional supplementation. Specialty perspective potentially limits generalizability of findings to community feeding services. We also emphasize the importance of early identification of nutritional deficits and management.
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Affiliation(s)
- Fadila Farag
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Annemarie Sims
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Katy Strudwick
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Janette Carrasco
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Amy Waters
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Vicki Ford
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Julia Hopkins
- Department of Nutrition and Dietetics, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Gabriel Whitlingum
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Michael Absoud
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
| | - Veronica B Kelly
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London
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Abstract
Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children's adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children's restrictive diets supplant more healthy food options. When this is combined with the children's noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices - aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.
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Affiliation(s)
- Skye Nandi Adams
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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40
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Ketchem C, Dellon E. Avoidant Restrictive Food Intake Disorder in Adults With Eosinophilic Esophagitis. Gastro Hep Advances 2022; 1:52-54. [PMID: 35874048 PMCID: PMC9306337 DOI: 10.1016/j.gastha.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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41
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Kim YK, Di Martino JM, Nicholas J, Rivera-Cancel A, Wildes JE, Marcus MD, Sapiro G, Zucker N. Parent strategies for expanding food variety: Reflections of 19,239 adults with symptoms of Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2022; 55:108-119. [PMID: 34761436 PMCID: PMC8841112 DOI: 10.1002/eat.23639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize helpful parent feeding strategies using reflections on childhood eating experiences of adults with symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID). METHOD We explored a unique text-based dataset gathered from a population of N = 19,239 self-identified adult "picky eaters." The sample included adults with symptoms of ARFID as evidenced by marked interference in psychosocial functioning, weight loss/sustained low weight, and/or nutritional deficiency (likely ARFID), and non-ARFID participants. We leveraged state-of-the-art natural language processing (NLP) methods to classify feeding strategies that were perceived as helpful or not helpful. The best classifiers that distinguished helpful approaches were further analyzed using qualitative coding according to a grounded theory approach. RESULTS NLP reliably and accurately classified the perceived helpfulness of caregivers' feeding strategies (82%) and provided information about features of helpful parent strategies using recollections of adults with varying degrees of food avoidance. Strategies perceived as forceful were regarded as not helpful. Positive and encouraging strategies were perceived as helpful in improving attitudes toward food and minimizing social discomfort around eating. Although food variety improved, adults still struggled with a degree of avoidance/restriction. DISCUSSION Adults perceived that positive parent feeding strategies were helpful even though they continued to experience some degree of food avoidance. Creating a positive emotional context surrounding food and eating with others may help to eliminate psychosocial impairment and increase food approach in those with severe food avoidance. Nevertheless, additional tools to optimize parent strategies and improve individuals' capacity to incorporate avoided foods and cope with challenging eating situations are needed.
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Affiliation(s)
| | | | - Julia Nicholas
- Psychiatry and Behavioral Sciences, Duke University, USA
| | | | | | | | - Guillermo Sapiro
- Electrical and Computer Engineering, Duke University, USA,Computer Sciences, Duke University, USA,Biomedical Engineering, Duke University, USA,Mathematics, Duke University, USA
| | - Nancy Zucker
- Psychiatry and Behavioral Sciences, Duke University, USA,Psychology and Neuroscience, Duke University, USA
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42
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Smith BL, Gutierrez R, Ludlow AK. A comparison of food avoidant behaviours and sensory sensitivity in adults with and without Tourette syndrome. Appetite 2022; 168:105713. [PMID: 34563498 DOI: 10.1016/j.appet.2021.105713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023]
Abstract
Food selectivity has been shown to be more persistent and severe in children with Tourette syndrome (TS) compared to their typically developing peers. The current study aimed to examine differences in food selectivity, food neophobia and Avoidant Restrictive Food Intake Disorder (ARFID)-associated behaviours, between adults with and without TS. Fifty-three adults diagnosed with TS were compared to 53 neurotypical adults and completed the following measures online: Adult Eating Behaviour Questionnaire (AEBQ), Nine-Item Avoidant/Restrictive Food Intake disorder screen (NIAS), Food Neophobia Scale (FNS) and the Sensory Perception Quotient (SPQ). Higher levels of food avoidant behaviours, in terms of food fussiness, food neophobia and ARFID-associated behaviours, were identified in adults with TS compared to adults without TS. While heightened sensory sensitivity failed to predict food fussiness, greater sensitivity to taste was found to be predictive of food neophobia in TS. These are the first findings to suggest that food avoidant behaviours are more prevalent for adults with TS and signal a need to address health implications.
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Affiliation(s)
- Bobbie L Smith
- Department of Psychology, Sport and Geography, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Roberto Gutierrez
- Department of Psychology, Sport and Geography, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Amanda K Ludlow
- Department of Psychology, Sport and Geography, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
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43
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Nygren G, Linnsand P, Hermansson J, Dinkler L, Johansson M, Gillberg C. Feeding Problems Including Avoidant Restrictive Food Intake Disorder in Young Children With Autism Spectrum Disorder in a Multiethnic Population. Front Pediatr 2021; 9:780680. [PMID: 34966704 PMCID: PMC8710696 DOI: 10.3389/fped.2021.780680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
We examined feeding problems, including Avoidant Restrictive Food Intake Disorder (ARFID), in preschool children with Autism Spectrum Disorder (ASD). Data were collected from a prospective longitudinal study of 46 children with ASD in a multiethnic, low resource area in Gothenburg, Sweden. Feeding problems were found in 76% of the children with ASD, and in 28%, the criteria for ARFID were met. The study highlights early onset age, the heterogeneity of feeding problems, and the need for multidisciplinary assessments in ASD as well as in feeding problems, and also the need for further elaboration of feeding disorder classifications in children.
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Affiliation(s)
- Gudrun Nygren
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child and Adolescent Specialist Centre, SV Hospital Group, Gothenburg, Sweden
| | - Petra Linnsand
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child and Adolescent Specialist Centre, SV Hospital Group, Gothenburg, Sweden
| | - Jonas Hermansson
- Child and Adolescent Specialist Centre, SV Hospital Group, Gothenburg, Sweden
| | - Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Johansson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child and Adolescent Specialist Centre, SV Hospital Group, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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44
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Bhattacharya A, Cooper M, McAdams C, Peebles R, Timko CA. Cultural shifts in the symptoms of Anorexia Nervosa: The case of Orthorexia Nervosa. Appetite 2021; 170:105869. [PMID: 34910984 DOI: 10.1016/j.appet.2021.105869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 12/26/2022]
Abstract
Orthorexia Nervosa (ON) is a term describing a fixation on food purity, involving ritualized eating patterns and a rigid avoidance of "unhealthy foods." Those self-identified as having ON tend to focus on food composition and feel immense guilt after eating food deemed "unhealthy." Although not formally recognized as a psychiatric disorder by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ON has received increasing attention since its identification in 1997. There is ongoing work to establish diagnostic and empirical tools for measuring ON; embedded in this is the question as to whether or not ON is a new eating disorder. In this paper, we argue ON is not a new psychiatric disorder but rather a new cultural manifestation of anorexia nervosa (AN). We begin by providing an overview of historical representations and classification of eating disorders, with a specific focus on AN. This is followed by discussion of the rise in diet culture and healthism since the 19th century. We conclude by examining the diagnostic validity and utility of ON through a discussion of empirical evidence. Classifying ON under the diagnostic umbrella of AN may improve our understanding of factors underlying restrictive eating behaviors.
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Affiliation(s)
- Anushua Bhattacharya
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.
| | - Marita Cooper
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical School, 6363 Forest Park Road, Dallas, TX, 75390, USA.
| | - Rebecka Peebles
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, 800 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA; Department of Psychology in Psychiatry, Perelman School of Medicine at University of Pennsylvania, 800 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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45
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Bertrand V, Tiburce L, Sabatier T, Dufour D, Déchelotte P, Tavolacci MP. Eater profile and associated factors in pediatric patients of the PEDIANUT cohort. Appetite 2021; 168:105763. [PMID: 34687824 DOI: 10.1016/j.appet.2021.105763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/21/2021] [Accepted: 10/16/2021] [Indexed: 11/17/2022]
Abstract
Appetite traits have multifactorial origins. In association with environmental and genetic factors, they could become problematic and lead to Feeding or Eating Disorders (FED). As the DSM-5 classification is not suitable for pediatric FED, another way to describe eating behavior is to distinguish the clinical profiles of "small eater" and "big eater". The aim of this study was to identify socio-demographic and medical factors associated with these profiles, and to compare problematic and non-problematic profiles. From the Pedianut study, we analyzed socio-demographic, medical and family history data among 401 children according to 4 age groups (<1 year n = 101, 1-6 years n = 99, 6-12 years n = 100, 12-18 years n = 101). The information collected on eating behavior made it possible to define small eater profile (SEP) and big eater profile (BEP) using predefined grids. BEP was more frequent in adolescents (35.6%), and SEP was more frequent in children aged 1-6 years (34.3%). BEP was associated with having separated parents, being male and the oldest sibling (p < 0.05). Problematic BEP was associated with eating while watching television, being a girl, and having sensory disorders (p < 0.05). SEP was associated, whatever age, with non-breastfeeding, chronic illness, psychological history, sensory disorders, language delays (in the 1-6 year age group), and family history of FED (in the adolescent group) (p < 0.05). This analysis of factors associated with eater profile opens new perspectives for research on risk factors associated with eating traits, which warrants further study in larger populations to delineate transition from healthy to problematic eating.
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Affiliation(s)
- Valérie Bertrand
- Pediatric unit, Le Havre Hospital, BP 24, 76083, Le Havre cedex, France; INSERM U1073, UNIROUEN, Normandie University, Rouen, France.
| | - Lyvia Tiburce
- Pediatric unit, Le Havre Hospital, BP 24, 76083, Le Havre cedex, France
| | | | - Damien Dufour
- Pediatric emergency care, Le Havre Hospital, BP 24, 76083, Le Havre cedex, France
| | - Pierre Déchelotte
- Department of Nutrition, Rouen University Hospital, Rouen, France; INSERM U1073, UNIROUEN, Normandie University, Rouen, France
| | - Marie-Pierre Tavolacci
- CIC 1404, Rouen University Hospital, Rouen, France; INSERM U1073, UNIROUEN, Normandie University, Rouen, France
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46
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Harshman SG, Jo J, Kuhnle M, Hauser K, Murray HB, Becker KR, Misra M, Eddy KT, Micali N, Lawson EA, Thomas JJ. A Moving Target: How We Define Avoidant/Restrictive Food Intake Disorder Can Double Its Prevalence. J Clin Psychiatry 2021; 82:20m13831. [PMID: 34496463 PMCID: PMC8493963 DOI: 10.4088/jcp.20m13831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The DSM-5 criteria for avoidant/restrictive food intake disorder (ARFID) include ambiguities. Diagnostic criteria that allow for clinical judgment are essential for clinical practice. However, ambiguities can have major implications for treatment access and comparability and generalizability of research studies. The purpose of this study was to determine the degree to which distinct operationalizations of the diagnostic criteria for ARFID contribute to differences in the frequency of individuals who are eligible for the ARFID diagnosis. Methods: Because criteria B, C, and D are rule-outs, we focused on criterion A, identified 19 potential operational definitions, and determined the extent to which these different methods impacted the proportion of individuals who met criteria for ARFID in a sample of children, adolescents, and young adults (n = 80; September 2016-February 2020) enrolled in an avoidant/restrictive eating study. Results: Within each criterion, the proportion of individuals meeting diagnostic criteria differed significantly across the methodologies (all P values < .008). Using the strictest definition of each criterion, 50.0% (n = 40) of participants met criteria for ARFID. In contrast, under the most lenient definition of each criterion, the number nearly doubled, resulting in 97.5% (n = 78) meeting ARFID criteria. Conclusions: Comparison of diagnostic definitions for ARFID among children, adolescents, and young adults confirmed a broad range of statistically distinct proportions within a single sample. Our findings support the need for additional contextual support and consensus among disciplines on operationalization in both research and clinical settings.
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Affiliation(s)
- Stephanie G Harshman
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Corresponding author: Stephanie G. Harshman, PhD, Massachusetts General Hospital, Neuroendocrine Unit, 55 Fruit St, Boston, MA 02114
| | - Jenny Jo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA
| | - Megan Kuhnle
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA
| | - Kristine Hauser
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA
| | - Helen Burton Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Medicine, Harvard Medical School, Boston, MA, 02114 USA
| | - Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114 USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Medicine, Harvard Medical School, Boston, MA, 02114 USA,Division of Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, MA, 02114 USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114 USA
| | - Nadia Micali
- Great Ormond Street Institute of Child Health, University College London, London, UK,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland,Department of Paediatrics Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Medicine, Harvard Medical School, Boston, MA, 02114 USA
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, 02114 USA,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114 USA
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47
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Becker KR, Mancuso C, Dreier MJ, Asanza E, Breithaupt L, Slattery M, Plessow F, Micali N, Thomas JJ, Eddy KT, Misra M, Lawson EA. Ghrelin and PYY in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls. Psychoneuroendocrinology 2021; 129:105243. [PMID: 34049199 PMCID: PMC8363304 DOI: 10.1016/j.psyneuen.2021.105243] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictive eating and failure to meet nutritional needs but is distinct from anorexia nervosa (AN) because restriction is not motivated by weight/shape concerns. We examined levels of orexigenic ghrelin and anorexigenic peptide YY (PYY) in young females with ARFID, AN and healthy controls (HC). METHODS 94 females (22 low-weight ARFID, 40 typical/atypical AN, and 32 HC ages 10-22 years) underwent fasting blood draws for total ghrelin and total PYY. A subset also provided blood 30, 60 and 120 min after a standardized meal. RESULTS Females with ARFID ate less than those with AN or HC (ps<0.012); were younger (14.4 ± 3.2 years) than those with AN (18.9 ± 3.1 years) and HC (17.4 ± 3.1 years) (ps<0.003) and at a lower Tanner stage (3.1 ± 1.5) than AN (4.5 ± 1.1;) and HC (4.4 ± 1.1; ps<0.005), but did not differ in BMI percentiles or BMI Z-scores from AN (ps>0.44). Fasting and postprandial ghrelin were lower in ARFID versus AN (ps≤.015), but not HC (ps≥0.62). Fasting and postprandial PYY did not differ between ARFID versus AN or HC (ps≥0.13); ARFID did not demonstrate the sustained high PYY levels post-meal observed in those with AN and HC. Secondary analyses controlling age or Tanner stage and calories consumed showed similar results. Exploratory analyses suggest that the timing of the PYY peak in ARFID is earlier than HC, showing a peak PYY level 30 min post-meal (p = .037). CONCLUSIONS ARFID and AN appear to have distinct patterns of secretion of gut-derived appetite-regulating hormones that may aid in differential diagnosis and provide new treatment targets.
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Affiliation(s)
- Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Christopher Mancuso
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elisa Asanza
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Switzerland; Department of Pediatrics Gynecology and Obstetrics, University of Geneva, Switzerland; GOSH Institute of Child Health, University College London, United Kingdom
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA, United States of America
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Harris HA, Micali N, Moll HA, van Berckelaer‐Onnes I, Hillegers M, Jansen PW. The role of food selectivity in the association between child autistic traits and constipation. Int J Eat Disord 2021; 54:981-985. [PMID: 33594728 PMCID: PMC8248436 DOI: 10.1002/eat.23485] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examines the association between child autistic traits and constipation symptoms, and explores whether this association is mediated by food selectivity. METHOD The sample included participants (N = 2,818) from the population-based birth cohort, Generation R (Rotterdam, the Netherlands). Parents reported their child's autistic traits at 6 years (using the Social Responsiveness Scale), food selectivity at 10 years (using the Stanford Feeding Questionnaire) and the frequency and severity of constipation symptoms they experienced at 10 years (using the ROME III functional constipation diagnostic criteria). Mediation analyses tested mediation through food selectivity in the association of autistic traits and the number of constipation symptoms, adjusting for covariates. RESULTS There was a positive association between parent-reported child autistic traits and constipation symptoms (r = 0.08, p < .001). We identified a significant indirect effect of autistic traits on constipation symptoms through food selectivity (β = 0.008, 95% Confidence Interval: 0.002, 0.014). DISCUSSION This study provides empirical support for the mediating role of food selectivity in the association between autistic traits and constipation. Behavioral interventions aimed to target food selectivity and support families of children with autistic traits may bolster conventional medical and nutritional treatments to alleviate gastrointestinal symptoms like constipation.
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Affiliation(s)
- Holly A. Harris
- Erasmus Medical CenterDepartment of Child & Adolescent Psychiatry/PsychologyRotterdamNetherlands,Erasmus Medical Center, Generation R StudyRotterdamNetherlands
| | - Nadia Micali
- Department of Pediatrics Gynaecology and Obstetrics, Faculty of MedicineUniversity of GenevaGenevaSwitzerland,Department of Psychiatry, Faculty of MedicineUniversity of GenevaGenevaSwitzerland,Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Henriette A. Moll
- Erasmus Medical Center, Sophia Children's HospitalDepartment of General PediatricsRotterdamNetherlands
| | - Ina van Berckelaer‐Onnes
- Leiden UniversityFaculty of Social and Behavioural Sciences, Clinical Child and Adolescent StudiesLeidenNetherlands
| | - Manon Hillegers
- Erasmus Medical CenterDepartment of Child & Adolescent Psychiatry/PsychologyRotterdamNetherlands,Erasmus Medical Center, Generation R StudyRotterdamNetherlands
| | - Pauline W. Jansen
- Erasmus Medical CenterDepartment of Child & Adolescent Psychiatry/PsychologyRotterdamNetherlands,Erasmus Medical Center, Generation R StudyRotterdamNetherlands,Erasmus University RotterdamDepartment of Psychology, Education and Child StudiesRotterdamNetherlands
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Affiliation(s)
- Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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50
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Tereshko L, Leaf JB, Weiss MJ, Rich A, Pistorino M. A systematic literature review of antecedent and reinforcement‐based behavioral feeding interventions without the implementation of escape extinction. Behavioral Interventions 2021. [DOI: 10.1002/bin.1769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa Tereshko
- Institute for Applied Behavioral Science Endicott College Beverly Massachusetts USA
- Beacon ABA Services, Inc Milford Massachusetts USA
| | - Justin B. Leaf
- Institute for Applied Behavioral Science Endicott College Beverly Massachusetts USA
- Autism Partnership Foundation Seal Beach California USA
| | - Mary Jane Weiss
- Institute for Applied Behavioral Science Endicott College Beverly Massachusetts USA
| | - Amy Rich
- Beacon ABA Services, Inc Milford Massachusetts USA
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