Toward a Specific and Descriptive Definition of Avoidant/Restrictive Food Intake Disorder: A Proposal for Updated Diagnostic Criteria.

Abstract

The diagnostic criteria for avoidant/restrictive food intake disorder (ARFID) have been the source of confusion since its introduction to the DSM in 2013. In the current state, ARFID is diagnosed based on impairment, with no requirement that a specific pattern of behavioral or cognitive/affective symptoms be present. In this paper, we make the case for more positive etiologically based criteria for ARFID wherein Criterion A defines the psychopathology of ARFID. We propose a framework for DSM criteria involving food avoidance that is maintained by beliefs/hedonic reactions that are temporally close to and realistically/functionally associated with a specific food or eating occasion, characterized by one or more of the following expected aversive responses: disgust/distaste, anhedonia/uncomfortable fullness, and acute fear/panic. Our proposed Criterion B retains the four manifestations of impairment in the current definition as necessary, but not sufficient, for the ARFID diagnosis. When both Criteria A and B are met, our revised Criteria D (ARFID vs. other restrictive eating disorders) and E (ARFID vs. other medical/psychiatric conditions) state that ARFID should be diagnosed regardless of co-occurring/comorbid conditions. We discuss how this positive definition of ARFID would impact clinical diagnosis and subsequent treatment, with specific considerations for differential diagnosis between ARFID and other eating disorders, other forms of psychopathology, and relevant medical conditions. Additionally, we discuss how it might enhance research opportunities by providing increasingly homogeneous samples through which researchers could better understand the etiological mechanisms of ARFID.