Avoidant/Restrictive Food Intake Disorder Flashcards

1
Q

how many criteria are there for ARFID

A

4

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2
Q

criterion A for ARFID

A

an eating or feeding disturbance as manifested by PERSISTENT FAILURE to meet appropriate nutritional and/or energy needs associated with one or more of the following (at least one of these must be present):

  • -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 in psychosocial functioning
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3
Q

what are the feeding or eating disturbances that may be seen in ARFID (listed/included in criterion A)

A

–apparent LACK OF INTEREST in eating or food

–avoidance based on SENSORY characteristics of food

–concern about AVERSIVE CONSEQUENCES of eating

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4
Q

criterion B of ARFID

A

disturbance not better explained by lack of available food or by an associated culturally sanctioned practice

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5
Q

criterion C of ARFID

A

eating disturbance does not exclusively occur during the course of AN or BN, and there is NO EVIDENCE of disturbance in the way in which one’s body weight or shape is experienced

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6
Q

what distinguishes ARFID from AN, BN

A

in ARFID, there is no disturbance in the way ones weight or shape is experienced

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7
Q

criterion D for ARFID

A

the eating disturbance is not attributable to a concurrent medical disorder or not better explained by another mental disorder

when ARFID occurs int he context of another condition or disorder, severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention

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8
Q

what does ARFID replace from the DSM-IV

A

replaces and extends the previous dx of “feeding disorder of infancy or early childhood”

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9
Q

what is the main diagnostic feature of ARFID

A

AVOIDANCE or RESTRICTION of food intake manifested by clinically significant failure to meet requirements for nutrition or energy requirements through oral intake of food

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10
Q

how do you determine if weight loss is significant (i.e as in criterion A)

A

it is a CLINICAL judgment (as is determination of significant nutritional deficiency)

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11
Q

can ARFID have a significant impact on physical health?

A

yes–> related impact on physical health can be of similar severity to that seen in AN (i.e hypothermia, bradycardia, anemia)

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12
Q

what does “dependence” on enteral feeding/supplements mean?

A

means that supplementary feeding is required to sustain adequate intake

i.e NG tube, nutritionally complete supplements, GJ tubes

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13
Q

what are terms used to describe those that engage in food avoidance or restriction due to severe sensory sensitivity to characteristics of the food?

A

(i.e may be sensitive to the food colour, smell, texture, temperature or taste)

"restrictive eating"
"selective eating"
"choosy eating"
"perseverant eating"
"chronic food refusal"
"food neophobia"
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14
Q

what is functional dysphagia/globus hystericus?

A

describes a conditioned negative response associated with food intake following, or in anticipation of, an aversive experience

i.e choking, traumatic investigation of the GI tract (i,e EGD), or repeated vomiting

can be a cause of ARFID (see criterion A)

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15
Q

how might infants or young children with ARFID present

A

may not engage with the primary caregiver during feeding

may not communicate hunger in favor of other activities

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16
Q

how might very young infants with ARFID present

A

as being too sleepy, distressed, agitated to feed

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17
Q

how might older children and teens with ARFID present

A

food avoidance or restriction may be associated with more generalized emotional difficulties that do not meet diagnostic criteria for an anxiety, depressive or bipolar disorder (may be called “food avoidance emotional disorder”)

18
Q

when does ARFID usually present

A

if related to lack of interest or sensory sensitivities–> in infancy or early childhood, and can persist in adulthood

(sensory sensitivities usually present in first decade of life)

if related to fear of aversive consequences–> can present at any age

19
Q

what is the natural course of ARFID related to sensory sensitivities

A

little data–> course appears to be relatively stable and long standing

*when persisting into adulthood, such avoidance/restriction can be associated with relatively normal functioning

20
Q

is there evidence directly linking ARFID and subsequent onset of an eating disorder?

21
Q

when should you consider coexisting parentel psychopathology or child abuse/neglect in the setting of suspected ARFID

A

if feeding and weight improve with change in caregivers

22
Q

temperamental risk factors for ARFID

A

anxiety disorders

ASD

OCD

ADHD

23
Q

environmental risks for ARFID

A

familial anxiety

24
Q

how does the presence of maternal eating disorder affect presence of ARFID

A

higher rates of feeding disturbances may occur in children of mothers with eating disorders

25
genetic and physiological risk factors for ARFID
hx Gi conditions GERD vomiting
26
how does gender affect dx ARFID
equally common in males and females in infancy ARFID comorbid with ASD affects more males than females
27
can ARFID be diagnosed with other medical conditions
yes, if all criteria are met and the eating disturbance requires specific clinical attention
28
ddx ARFID
1. other medical conditions - -GI diseases - -food allergies/intolerances - -occult malignancies 2. specific neurological/neuromuscular, structural, congenital disorders - -those related to oral/esophageal/pharyngeal sturucture and function i.e hypotonia of musculature, tongue protrusion, unsafe swallowing 3. reactive attachment disorder 4. ASD 5. specific phobia, social anxiety disorder, other anxiety disorders 6. Anorexia nervosa 7. OCD 8. MDD 9. Schizophrenia specturm d/os 10. factitious disorder
29
what is a specific phobia that may result in/be diagnosed instead as ARFID
specific phobia, other type, specified as "situations that may lead to choking or vomiting" can represent the primary fear, anxiety or avoidance required for diagnosis in situations when the eating problem becomes the primary focus of clinical attention (rather than the anxiety/fear/phobia itself), ARFID becomes the appropriate diagnosis
30
can you diagnose ARFID and AN concurrently?
no--> ARFID has no distortion of body image/fear of gaining weight *dx can be complicated in those with suspected AN that deny fear of gaining weight
31
how do you distinguish between factitious disorder and ARFID
"the presentation may be impressively dramatic and engaging, and the symptoms reported inconsistently"
32
what are the most commonly comorbid disorders with ARFID
anxiety disorders OCD neurodevelopmental disorders - -ASD - -ADHD - -intellectual disability
33
are there any consensus guidelines for ARFID treatment
no not yet because dx is so new
34
what should be the goals of treatment in ARFID
until more evidence available, likely focus should be similar to other restrictive disorders which is weight restoration and resumption of menses in amenorrheic females
35
do people with ARFID typically present with the same level of bradycardia and hypotension as those with AN?
no--> have often achieved a level of homeostasis as often have been underweight for long time
36
at what point might medical admission be considered for ARFID
if BMI less than 75% of the median BMI for sex and age
37
how to manage ARFID in patients who are not medically compromised
consider whether outpatient psychotherapy is sufficient may need referral to a day treatment or intensive outpatient treatment ED program consider nutrient replenishment ie with supplements
38
what medications might be used in treatment of ARFID
tldr; cyproheptadine, mirtazapine, lorazepam, olanzapine - - 1. cyproheptadine - -> antihistaminergic and antiserotonergic - -> can have weight gain and positive changes in meal times and feeding behaviours compared to those who dont take it - -> seems to promote increased appetite and gastric accomodation 2. there is no psychotropic medication treatment for ARFID approved by US FDA - -> case reports decribes use of mirtazapine, lorazepam and olanzapine
39
list psychological treatments for ARFID
CBT-AR | --> ages 10 and older
40
what is the role of mirtazapine and lorazepam in treatment of ARFID
to decrease anxiety related to eating
41
what is the role of olanzapine in treatment of ARFID
decrease cognitive rigidity in beliefs about food and promote weight gain
42
what is cyproheptadine
OFF LABEL for ARFID - -> antihistaminergic and antiserotonergic - -> can have weight gain and positive changes in meal times and feeding behaviours compared to those who dont take it - -> seems to promote increased appetite and gastric accomodation - -> there is a study that showed benefit in kids ages 6-7 with variety of feed/eat disorder