Avoidant-Restrictive Food Intake Disorder Clinical Presentation

Updated: Mar 21, 2016
  • Author: Lauren Brooke Belak; Chief Editor: David Bienenfeld, MD  more...
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Presentation

History

Because research on ARFID is limited, clinical understanding of this new diagnosis has depended largely on retrospective chart review and case studies. In an effort to better analyze the symptoms of patients with ARFID-type eating disturbances, Norris et al. closely assessed the clinical profiles of 699 adolescent eating disorder patients between 2000 and 2011. They found that significant weight loss or failure to make appropriate weight gains appeared to be the most common symptom among ARFID patients. They also found that the eating pathology of the patient profiles they studied seemed to be dominated by food avoidance based on food texture and smell or a general dislike of foods, followed by lack of appetite, and finally absolute food refusal. Associated symptoms in the profiles of the patients studied ranged from abdominal pain (35.3%), fear of vomiting (26.5%), generalized anxiety with eating (20.6%), complaints of feeling full (20.6%), nausea (17.6%), and unpleasant sensory experiences while eating (17.6%). [3]  

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Complications

Due to ARFID’s recent introduction to the literature, little is specifically known about its medical complications. Nevertheless, because ARFID may be associated with low weight, it is likely that marked disturbances in virtually all organ systems, similar to those observed in underweight patients with Anorexia Nervosa, may be seen in this patient population.   

In response to semi-starvation, bradycardia and hypotension may occur in patients with ARFID due to a reduction in basal metabolic rate.  Hypovolemia may further promote orthostatic hypotension and dizziness that does not resolve until the patient is rehydrated. Profound nutritional depletion in some ARFID patients may also promote gastrointestinal complications. Gastroparesis, which in Anorexia Nervosa is known to result once 15% to 20% of one’s ideal body weight is lost, [10] may also been seen in ARFID. Feelings of fullness, distention, and nausea can arise due to delayed emptying of the stomach. [11] Constipation also commonly ensues.

Semi-starvation may also disrupt a breadth of different endocrine pathways. For instance, male patients who are malnourished may be at risk of low serum testosterone levels. In female patients, pronounced caloric restriction suppresses the production of luteinizing (LH) and follicle-stimulating hormones (FSH), which can then inhibit estrogen production and ovulation. [12] Such disturbance may then lead to irregular menstrual cycles or amenorrhea. 

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