Psychosocial Assessment - ARFID

This assessment should complement your standard psychosocial or mental health assessment.

Confidentiality

• Consent to speak with other treating team members

• Inform of the limitations of confidentiality

Presenting Eating / Feeding Concerns of Individual / Carer

• Growth / nutritional intake

• Lack of interest in feeding or poor appetite

• Problems with volume or range of food intake

• Sensory sensitivities when eating

• Traumatic / aversive feeding experience / fear of consequences

History

Past Medical and Psychiatric History

• General medical history (including constipation history, reflux, abdominal pain, illness, and ENT history)

• General psychiatric history (anxiety, depression, trauma, ADHD, autism, self-harm, suicidality)

• Previous treatment for feeding / eating disturbance

• History of traumatic feeding experiences (choke, gag, vomit, allergic reaction)

• History of sensory sensitivities to food and in general

• History of appetite and interest in eating / feeding

• Temperament / personality traits (cautious, shy, inhibited, obsessional, rigid)

• Developmental history including feeding, appetite, and oral motor development

Note: ensure that a comprehensive medical assessment has occurred by a medical practitioner before or straight after this assessment.

Social and Family History

• Living situation, social supports, friendships

• School / work history

• Education history, learning challenges, history of bullying

• Family history of mental health presentations relevant to ARFID (anxiety, neurodevelopmental differences, eating disorders, selective eaters)

• Family history of physical health related to ARFID (GI problems, Inflammatory Bowel Disease)

• Parental childhood experiences of eating / feeding

• Parental beliefs, values about food, eating, and mealtimes

• Strengths / protective factors (insight of individual / carer)

• Timeline of major family stress and / or significant change

Current Functioning

Assessment of Feeding / Eating Disturbance Behaviours and Nutrition Intake

• Current intake including portion sizes (breakfast, snack, lunch, snack, dinner, snack)

• List preferred foods and sometimes eaten foods

• Sensory properties of preferred foods (texture, taste, smell, appearance)

• List ‘Used to eat foods’ and (sensory properties of these foods)

• List avoided foods and (sensory properties of these foods)

• Are there any food groups absent from intake

• Rituals around eating (use of sauces / spices, eating on own, preparation requests)

• Oral supplementation drinks and daily amount

• Onset and timeframe of feeding concerns

• Beliefs about food / eating / body

• Cultural and religious considerations

• Allergies / food intolerances

• Reported nutritional deficiencies

• Food preferences (e.g. vegetarian, organic)

Other Behaviours (if present complete a comprehensive eating disorders assessment)

• Self-induced vomiting, use of laxatives or diet pills (reason for vomiting / laxatives)

• Binge eating episodes

• Excessive exercise

• Deliberate oral restriction to manage weight

• Weighing food, calorie-counting

• Alcohol / cigarette use to manage weight

• Night Eating

Other Behaviours (if present consider assessment for Pica or Rumination Disorders)

• Eating non-food substances

• Regurgitation of food

Appetite

• Current Interest in food / eating. Is this person motivated by food?

• Is there a lack of appetite. Onset.

• Requests / prompts to eat

• Satiety / hunger cures communicated

• Physical sensations reported when hungry / full

• Timeframe of appetite loss / poor appetite

Sensory Sensitivities to Food

Do they:

• Experience distress to the smell of food

• Experience distress to the appearance of food

• Experience distress to the sound of food in mouth or from others eating

• Experience distress to the texture or mixed texture of foods

• Avoid eating food due to the potential mess of the food on face and hands

• Report disgust of foods

• Have a heightened emotional response to food / eating

Negative Eating / Feeding Experiences

• List experiences, timeframe, and impact of event on current functioning

• Most recent traumatic event. Beliefs associated

• Foods avoided following traumatic event

• Management at time. Attempts to manage

• Historic interventions involving oral / oesophageal intervention / investigations e.g. NG feeding

Feeding / Eating Environment

• Mealtime routine for breakfast, lunch, and dinner. What happens before / during / after meals

• Where and on what do they sit at eat meals?

• Does the individual have good postural support during mealtimes?

• Who is present at mealtimes throughout the day / night. Roles at mealtimes

• Parent-child relationship around feeding, and at other times

• Are mealtimes enjoyable?

• Distress at mealtimes. Strategies to manage. History of strategies

• Who prepares meals. Involvement in preparation

• Time taken to eat meal. Strategies to manage

Growth including Weight

• Current weight / height / BMI

• Weight tracking history from childhood / adolescence / adult

• Premorbid weight

• Highest and lowest weight

• Desired weight and healthy weight

• History of faltering growth, including in utero

• Beliefs about weight and shape

• Strategies to increase weight / lose weight

• Timeframe of weight concerns

• Evidence of parent or carer concern

Impact of Feeding / Eating Disturbance on Physical Health

• Faltering growth, significant weight loss

• Nutritional deficiencies

• Reliance on oral supplements for calories

• Enteral feeding

• Lethargy

• Sleep, waking to eat / hunger

• Bowels, constipation

Impact of Feeding / Eating Disturbance on Psychosocial Functioning

• Attendance at school / employment / learning

• Unable to attend excursions / sleepovers etc. due to food challenges

• Evidence of starvation syndrome (cognitive impairment, changes in mood / personality)

• Individuals' perspective on maintaining factors of feeding / eating disturbance

• Insight

• Motivation to change

• Shame, anxiety about eating / feeding disturbance

• Effects on family or loved ones

Risk Assessment (as per usual care)

Discuss current psychosocial assessment with treating team, including the following assessments:

• Medical Assessment

• Nutritional Assessment

• Swallowing / Safety Assessment (if gagging / choking concerns reported)

Presence of Psychiatric Co-occurrence

• Neurodevelopmental differences (autism, ADHD, developmental, learning)

• Anxiety disorders

Presence of Medical Comorbidities

• Gastrointestinal problems i.e. reflux, constipation, abdominal pain, IBS

• Neurological conditions

• Food allergies / intolerances