Avoidant-Restrictive Food Intake Disorder Differential Diagnoses

Updated: Nov 22, 2021
  • Author: Lauren Brooke Belak; Chief Editor: David Bienenfeld, MD  more...
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Diagnostic Considerations

Pediatric patients with avoidant-restrictive food intake disorder (ARFID) appear more likely to have anxiety disorders, including generalized anxiety disorder, panic disorder, and/or social phobia (72%) relative to other eating disorder populations (31%). [2] Autism spectrum disorder (ASD), learning disorders, and cognitive impairment have also presented more frequently in pediatric patients with ARFID than in other eating disorder patients. Concomitant social or attention difficulties may also manifest more often in patients diagnosed with ARFID than in other eating disorder populations. However, a lower incidence of major depression is observed in ARFID adolescents relative to other eating disorders populations. [4, 2]

Because younger patients with ARFID report longer durations of illness at the time of clinical presentation relative to those with anorexia nervosa and bulimia nervosa, it can be deduced that patients with ARFID do not obtain help from clinicians early enough to prevent the progression of the disorder. “Picky” eating is considered a widespread problem in childhood, with anywhere between 13% and 22% of children ages 3 to 11 being reported as selective eaters. [13] The belief that children will grow out of “picky” eating is common; however, studies reveal that up to 40% of this rigidity can continue into adolescence. [14] Pediatricians therefore must be vigilant in identifying selective eaters and recognize that concomitant low weight or inability to grow along their developmental trajectory may signify the presence of an eating disorder in such patients. In fact, all patients who are not eating as much as they need to remain healthy and thrive should be assessed in the same way as patients who present for anorexia nervosa, as patients with ARFID are susceptible to the same related medical complications as patients with anorexia nervosa. [4]

Given ARFID is a relatively new diagnosis, many health professionals are still unfamiliar with its manifestations. In fact, a pilot study of Canadian pediatricians revealed that 63% of them were unfamiliar with ARFID. [15] A diagnostic tool called the Eating Disturbances in Youth-Questionnaire (EDY-Q) has been developed, listing 12 items that should be assessed when evaluating patients for ARFID, [16] and it has recently been confirmed as a valid and useful screening instrument. [8] Clinicians who are inexperienced with ARFID may benefit from utilizing the EDY-Q, because early detection is important for targeted prevention and proactive interventions.

Differential Diagnoses