ARFID in Adults

There is limited research on prevalence, assessment, or treatment of adults with ARFID. Research is in its infancy. Preliminary research about adults are outlined below:

• Adults with ARFID display similar levels of distress and impairment to adults with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) _{(Zickgraf et al, 2016; Bourne et al, 2020; D'Adamo et al, 2023)}.

• Suicidal ideation has been shown to be higher in ARFID patients when compared to those with no ARFID symptoms _{(Robison et al, 2022; Kambanis et al., 2022)}.

• Adults with ARFID symptoms have very different eating behaviours than those with AN or BN, including higher levels of food neophobia, greater inflexibility with eating behaviour, avoiding a greater number of foods, and overall, a narrower range of foods eaten _{(Zickgraf et al, 2019)}.

• Zickgraf et al (2019) discovered that adults with the 'lack of interest' subtype were found to under-eat in response to emotional distress and had elevated satiety responsiveness compared with the other subtypes.

• Sella et al (2023) noted that lower levels of ghrelin (a hormone produced in your stomach when it's empty that signals to your brain that it's time to eat) were associated with more severe anxiety symptoms in their sample of 80 youth with ARFID aged 10-22 years. Further exploration will confirm whether ghrelin pathways could be targeted in the treatment of ARFID.

• Menzel et al (2019) found that among adults, disgust and executive functioning challenges (skills like planning, problem-solving, and flexible thinking) contribute to picky eating. More specifically, rigidity and set shifting (the ability to switch between tasks or mental frameworks), may contribute to picky eating.

• Harris et al (2019) found that disgust had a stronger relationship to both ARFID classification and selective eating behaviours than anxiety. It is likely that disgust of a specific food uniquely contributes to the aetiology and maintenance of selective eating _{(Brown et al., 2022)}. For further information about disgust in adults with ARFID see Harris et al's (2019) study on the Central Role of Disgust in Food Avoidance.

• Nitsche et al (2023) noted that in their study, fear of aversive consequences was the most common ARFID profile. "The most common psychiatric diagnoses were anxiety and depressive disorders, and the most common medical diagnoses were disorders of gut–brain interaction".

Bourne, L., Bryant-Waugh, R., Cook, J., & Mandy, W. (2020). Avoidant/restrictive food intake disorder: A systematic scoping review of the current literature. Psychiatry Research, 288, 112961. doi: 10.1016/j.psychres.2020.112961

Brown, T. A., Menzel, J. E., Reilly, E. E., Luo, T., & Zickgraf, H. (2022). Exploring the role of disgust sensitivity and propensity in selective eating. Appetite, 174, 106018.

D'Adamo, L., Smolar, L., Balantekin, K. N., Taylor, C. B., Wilfley, D. E., & Fitzsimmons-Craft, E. E. (2023). 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. Journal of Eating Disorders, 11(1), 214. doi: 10.1186/s40337-023-00939-0

Harris, A., Romer, A.L., Hanna, E.K., Keeling, L.A, LaBar, K.S., Sinnott-Armstrong, W., Strauman, T.J., Wagner, H.R., Marcus, M.D., & Zucker, N.L. (2019). The central role of disgust in food avoidance, International Journal of Eating Disorders. May, 52(5): 543-553. doi: 10.1002/eat.23047

Kambanis, P. E., Harshman, S. G., Kuhnle, M. C., Kahn, D. L., Dreier, M. J., Hauser, K., Slattery, M., Becker, K. R., Breithaupt, L., Misra, M., Micali, N., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2022). Differential comorbidity profiles in avoidant/restrictive food intake disorder and anorexia nervosa: Does age play a role?. International Journal of Eating Disorders, 55(10), 1397-1403. doi: 10.1002/eat.23777

Menzel, J. E., Reilly, E. E., Luo, T. J., & Kaye, W. H. (2019). Conceptualizing the role of disgust in avoidant/restrictive food intake disorder: Implications for the etiology and treatment of selective eating. International Journal of Eating Disorders, 52(4), 462-465. doi: 10.1002/eat.23006

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

Robison, M., Rogers, M. L., Robertson, L., Duffy, M. E., Manwaring, J., Riddle, M., Rienecke, R. D., Le Grange, D., Duffy, A., Plotkin, M., Blalock, D. V., Mehler, P. S., & Joiner, T. E. (2022). Avoidant restrictive food intake disorder and suicidal ideation. Psychiatry Research, 317, 114925. doi: 10.1016/j.psychres.2022.114925

Sella, A. C., Hadaway, N., Stern, C., Becker, K. R., Holsen, L. M., Eddy, K. T., Micali, N., Misra, M., Thomas, J. J., & Lawson, E. A. (2023). Lower Ghrelin Levels Are Associated With Higher Anxiety Symptoms in Adolescents and Young Adults With Avoidant/Restrictive Food Intake Disorder. The Journal of Clinical Psychiatry, 84(3), 46907. doi: 10.4088/JCP.22m14482

Zickgraf, H. F., Franklin, M. E., & Rozin, P. (2016). Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms. Journal of Eating Disorders, 4, 26. doi: 10.1186/s40337-016-0110-6

Zickgraf, H. F., Murray, H. B., Kratz, H. E., & Franklin, M. E. (2019). Characteristics of outpatients diagnosed with the selective/neophobic presentation of avoidant/restrictive food intake disorder. International Journal of Eating Disorders, 52(4), 367-377. doi: 10.1002/eat.23013