Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment.

Jennifer J Thomas, Elizabeth A Lawson, Nadia Micali, Madhusmita Misra, Thilo Deckersbach, Kamryn T Eddy

Journal: Current psychiatry reports 2018;19(8):54

PMID: 28714048

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Abstract

PURPOSE OF REVIEW

DSM-5 defined avoidant/restrictive food intake disorder (ARFID) as a failure to meet nutritional needs leading to low weight, nutritional deficiency, dependence on supplemental feedings, and/or psychosocial impairment. We summarize what is known about ARFID and introduce a three-dimensional model to inform research.

RECENT FINDINGS

Because ARFID prevalence, risk factors, and maintaining mechanisms are not known, prevailing treatment approaches are based on clinical experience rather than data. Furthermore, most ARFID research has focused on children, rather than adolescents or adults. We hypothesize a three-dimensional model wherein neurobiological abnormalities in sensory perception, homeostatic appetite, and negative valence systems underlie the three primary ARFID presentations of sensory sensitivity, lack of interest in eating, and fear of aversive consequences, respectively. Now that ARFID has been defined, studies investigating risk factors, prevalence, and pathophysiology are needed. Our model suggests testable hypotheses about etiology and highlights cognitive-behavioral therapy as one possible treatment.

Address: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA. [email protected].; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. [email protected].; Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.; Department of Medicine, Harvard Medical School, Boston, MA, USA.; Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Institute of Child Health, University College London, London, UK.; Pediatric Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.; Divison of Neurotherapeutics, Massachusetts General Hospital, Boston, MA, USA.; Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

DOI: 10.1007/s11920-017-0795-5