ARFID Co-occurring Anxiety and Mood Disorders

The research on anxiety and mood disorders and ARFID shows:

ARFID in children and adolescents has significant co occurring psychiatric disorders. Canas et al (2021) noted 81.8% prevalence of co-occurring psychiatric diagnoses among ARFID patients versus 33% among those with Anorexia Nervosa (AN).

Fisher et al., (2014), in their retrospective study of 98 paediatric patients, reported anxiety disorders including OCD, affecting 58% of ARFID patients in contrast to 35% of AN participants. Richmond et al (2023) also recorded high rates of anxiety disorders affecting 55% of their cohort. In two comparative studies, the rate of anxiety disorders was double among the paediatric ARFID group compared with the AN group _{(Zanna et al., 2021; Canas et al., 2021)}. ARFID was associated with higher scores for separation/panic than the group with AN _{(Zanna et al., 2020)} and greater levels of fear _{(Canas et al., 2021)}.

In a large prospective study of patients diagnosed with ARFID by a multidisciplinary team at a paediatric eating disorder centre (N=261), anxiety traits (fear-based: social, panic, and distress- based: generalised anxiety) correlated positively with all the symptoms of ARFID _{(Watts et al., 2023)}. For panic disorder traits, the highest positive correlations were with the three symptoms of:

• Physical feelings of panic & anxiety when eating

• Feeling afraid to eat

• Avoiding eating situations

Separation and generalised anxiety traits showed similar, yet slightly lower, correlations with these same symptoms.

For mood disorders, lower levels of depression symptoms were reported among paediatric ARFID patients compared to AN patients _{(Zanna et al., 2021; Canas et al., 2021)}. Richmond et al., (2023) noted 8% of ARFID patients reported depressive symptoms. This may be explained by the typically lower age of presentation among ARFID patients compared with AN patients.

Anxiety and depressive disorders were more common among adults than in paediatric ARFID populations. Nitsch et al., (2023) found higher rates of: anxiety disorders (68%); depression (48%); substance-related co-morbidity (30%); trauma and/or stress (20%); and OCD (7%); in contrast to the paediatric populations reported above.

Cañas, L., Palma, C., Molano, A. M., Domene, L., Carulla‐Roig, M., Cecilia‐Costa, R., Dolz, M., & Serrano‐Troncoso, E. (2021). Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population. European Eating Disorders Review, 29(2), 245-256. doi: 10.1002/erv.2815.

Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49-52. doi: 10.1016/j.jadohealth.2013.11.013

Nitsch, A., Watters, A., Manwaring, J., Bauschka, M., Hebert, M., & Mehler, P. S. (2023). Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study. International Journal of Eating Disorders. 56(5), 978-990. doi: 10.1002/eat.23897

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. (2023). 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, 63:102190. doi: 10.1016/j.eclinm.2023.102190.

Zanna, V., Criscuolo, M., Mereu, A., Cinelli, G., Marchetto, C., Pasqualetti, P., Tozzi, A. E., Castiglioni, M. C., Chianello, I., & Vicari, S. (2021). Restrictive eating disorders in children and adolescents: a comparison between clinical and psychopathological profiles. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 26, 1491-1501. doi: 10.1007/s40519-020-00962-z