Surveillance of Avoidant Restrictive Food Intake Disorder to commence in March

This study, run through the British Paediatric Surveillance Unit (BPSU), will identify the incidence rates of Avoidant/Restrictive Food Intake Disorder (ARFID) presenting to secondary health care, referral pathways, patterns of presentation, and clinical features. This study will begin surveillance for cases seen from March 2021.

Avoidant/Restrictive Food Intake Disorder (ARFID) is a diagnosis first introduced in Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) and recently included in the International Classification of Diseases (11th ed.; ICD-11; World Health Organisation, 2019). ARFID is conceptualised as an umbrella term to include a range of eating and feeding disturbances that lead to nutritional deficits and/or impairment of psychological functioning, as a result of food restriction. It replaced ‘Feeding Disorder of Infancy and Early Childhood’, acknowledging that ARFID symptoms are not restricted to children 6 years of age or younger but can occur across the lifespan.

ARFID encompasses several terms previously used to describe restrictive eating patterns presenting clinically but not meeting criteria for an eating disorder. This classification is thought to improve both clinical utility and provide a diagnosis for people previously excluded from other feeding or eating diagnoses. 

Despite some similarities in presentation of ARFID and those of anorexia nervosa, such as significant weight loss and limited food intake, they are distinct disorders as body image disturbance is not a core feature of ARFID. Instead, food restriction in ARFID may be due to high sensitivity to sensory aspects of food (such as texture, colour or temperature), lack of interest in food or anxiety around food, including fear of aversive consequences (i.e. – choking and vomiting) associated with eating. More than one of these features may be present.

Comorbid anxiety and Autism Spectrum Disorder are common among those with ARFID and some ARFID features are a risk factor for the development of Anorexia Nervosa i.e. early picky and restrictive eating patterns are a risk factor for anorexia nervosa, and some ARFID patients will transition to that diagnosis during treatment. Long-term outcomes are not known.

By using questionnaires sent to paediatricians through the British Paediatric Surveillance Unit (BPSU) and child and adolescent psychiatrists through the Child and Adolescent Psychiatric Surveillance system (CAPSS), this study aims to establish incidence rates (number of new cases) of ARFID presenting to secondary health care, referral pathways, patterns of presentation, and clinical features (eating behaviours, medical complications and the types of medical or psychiatric presentations it is associated with).

This will allow us to compare rates, presentation and management of ARFID with other countries, as well as generate new priority research questions that could in turn inform decision making to better match patient need with sufficient funding allocations. We hope the study findings will prompt further research into on causality, treatment, prognosis, and long-term outcomes of ARFID.

More about this study