Prospective 2-Year Course and Predictors of Outcome in Avoidant/Restrictive Food Intake Disorder

Abstract

Objective

To evaluate the 2-year course and outcomes of full and subthreshold avoidant/restrictive food intake disorder (ARFID) in youth aged 9 to 23 years at baseline using a prospective longitudinal design to characterize the remission and persistence of ARFID, evaluate diagnostic crossover, and identify predictors of outcome. Greater severity in each ARFID profile—sensory sensitivity, fear of aversive consequences, and lack of interest—was hypothesized to predict greater likelihood of illness persistence, controlling for age, sex, body mass index percentile, ARFID treatment status, and baseline diagnosis.

Method

Participants (N = 100; age range, 9-23 years; 49% female; 91% White) were followed over 2 years. The Pica, ARFID, and Rumination Disorder Interview was used across 3 time points (baseline, year 1, year 2) to measure the severity of each ARFID profile and evaluate illness persistence or remission, and the Eating Disorder Assessment for DSM-5 was used to evaluate diagnostic crossover.

Results

Across the 2-year follow-up period, half the participants persisted with their original diagnosis, and 3% of participants experienced a diagnostic shift to anorexia nervosa. Greater severity in the sensory sensitivity and lack of interest profiles was associated with higher likelihood of ARFID persistence at year 1 only; greater severity in the fear of aversive consequences profile was associated with higher likelihood of ARFID remission at year 2 only.

Conclusion

Findings underscore the distinctiveness of ARFID from other eating disorders and emphasize its persistence over 2 years. Results also highlight the predictive validity and prognostic value of the ARFID profiles (ie, sensory sensitivity, fear of aversive consequences, lack of interest).

Plain language summary

In this longitudinal study, the authors examined the course and outcomes of avoidant/restrictive food intake disorder (ARFID) in a sample of 100 youth aged 9 to 23 years over the course of 2 years. Across the 2-year follow-up period, half the sample persisted with their original diagnosis, and 3% of participants developed anorexia nervosa. Results indicate that profiles of greater sensory sensitivity to food and lack of interest in food/eating were associated with higher likelihood of ARFID persistence at year 1 only, whereas greater severity in the fear of aversive consequences of eating was associated with higher likelihood of ARFID remission at year 2 only. These findings highlight the persistence of ARFID and suggest that outcomes may vary depending on an individual’s ARFID presentation.