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Avoidant/Restrictive Food Intake Disorder

The diagnosis of Avoidant/Restrictive Food Intake Disorder is new to the DSM-5. The inclusion of this condition may be attributed to the increased observation of children and adults who demonstrate disordered patterns of food and nutritional intake that lead to malnutrition that requires significant interventions with feeding but lack the psychological drives that are associated with anorexia nervosa.

Many pediatricians often encounter this failure-to-thrive in children and will usually conduct a medical work-up to rule-out any medical or physical causes. Once this is done without findings, a diagnosis of Avoidant/Restrictive Food Disorder may be made. Adults can also develop Avoidant/Restrictive Food Intake Disorder later in life and some individuals may go on to develop another eating disorder such as anorexia nervosa, bulimia nervosa, or binge-eating disorder. This diagnosis has been included in the new DSM-5 not just because food and eating is a problem, but the disorder usually causes significant problems and functioning at school or work. Patients will often avoid eating with others without supervision, feel too weak to perform work or focus in class or studies because of nutritional deficits, have disruptions in their lives due to ER visits, hospitalizations and frequent doctor visits, and suffer from mood disorders related to the condition.  The criteria for Avoidant/Restrictive Food Intake Disorder are as follows:

An eating or feeding disturbance (i.e. a lack of interest or desire to consume food; an avoidance of food based on sensory characteristics; a concern about avoidable consequences of eating) that is manifested by a persistent failure to meet appropriate nutritional and/or energy needs associated with one or more of the following:

  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children.
  • Significant nutritional deficiency
  • Dependence on enteral feeding or oral nutritional supplements
  • Marked interference with psychosocial functioning.

To meet criteria for this diagnosis, the disturbance is not better explained by a lack of availability of food or by a cultural sanctioned practice. The eating disturbance should also not be caused by a current medical condition or is better explained by a another mental condition including anorexia nervosa (there is no disturbance in the body perception and restriction is not due to a desire to lose weight.)

Many pediatricians often encounter this failure-to-thrive in children and will usually conduct a medical work-up to rule-out any medical or physical causes. Once this is done without findings, a diagnosis of Avoidant/Restrictive Food Disorder may be made. Adults can also develop Avoidant/Restrictive Food Intake Disorder later in life and some individuals may go on to develop another eating disorder such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. This diagnosis has been included in the new DSM-5 not just because food and eating is a problem, but the disorder usually causes significant problems and functioning at school or work. Patients will often avoid eating with others without supervision, feel too weak to perform work or focus in class or studies because of nutritional deficits, have disruptions in their lives due to ER visits, hospitalizations and frequent doctor visits, and suffer from mood disorders related to the condition. Treatment requires close medical monitoring with an emphasis on restoring nutritional requirements. Psychotherapy and behavioral therapy are also a mainstay to address related  psychological issues and at times psychiatric medications may be needed for severe cases.  The criteria for Avoidant/Restrictive Food Intake Disorder are as follows: