Avoidant/Restrictive Food Intake Disorder May Be Underdiagnosed

Gastroenterology patients with avoidant/restrictive food intake disorder (ARFID) are less likely to be taking psychotropic medications, have less-severe body image concerns, and are frustrated with being unable to eat what they want compared with patients without ARFID, according to study findings presented at the ACG 2019 

From 6% to 19% of gastroenterology patients have concurrent ARFID. However, these patients have not yet been characterized.

Kimberly Harer, MD, from the University of Michigan, and colleagues performed a retrospective analysis of 223 adult patients who were seen by a gastroenterologist and gastrointestinal (GI) psychologist at a tertiary care center from 2016 to 2018. ARFID was diagnosed based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Of all 223 patients, 28 (12.6%) met ARFID criteria.

No differences were observed in gender, age, educational level, GI diagnosis, GI symptom severity, mean body mass index, and frequency of nutrition referral between patients with ARFID and patients without ARFID.

Patients with ARFID were less likely to be taking a psychotropic medication than patients without ARFID (17.9% vs 50%). No significant difference existed in eating disorder history between patients with ARFID and patients without ARFID (3.6% vs 8.7%).

Results of Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaires indicated that patients with ARFID reported more severe food avoidance concerns, more frustration with being unable to eat what they wanted, and less severe body image concerns. IBS-QOL scores improved less among patients with ARFID after they had completed psychological therapies directed by a specialist.The researchers did not observe a difference in Brief Symptom Inventory scores or sleep quality scores between the groups.

“This is the first study comparing ARFID vs non-ARFID adult GI behavioral health patients,” Dr Harer concluded. “This data demonstrates the need to appropriately screen patients for ARFID and raises concern regarding the need [to] utilize a multidisciplinary treatment approach that takes into account GI, psychological, and nutritional needs.” —Melinda Stevens