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. 2024 Aug;54(11):2956-2966.
doi: 10.1017/S003329172400103X. Epub 2024 May 27.

Latent profile analysis reveals overlapping ARFID and shape/weight motivations for restriction in eating disorders

Sophie R Abber  1 , Kendra R Becker  2   3 , Casey M Stern  2 , Lilian P Palmer  2 , Thomas E Joiner  1 , Lauren Breithaupt  2   3 , Paraskevi Evelyna Kambanis  2   3 , Kamryn T Eddy  2   3 , Jennifer J Thomas  2   3 , Helen Burton-Murray  2   3   4
Affiliations

Latent profile analysis reveals overlapping ARFID and shape/weight motivations for restriction in eating disorders

Sophie R Abber et al. Psychol Med. 2024 Aug.

Abstract

Background: DSM-5 differentiates avoidant/restrictive food intake disorder (ARFID) from other eating disorders (EDs) by a lack of overvaluation of body weight/shape driving restrictive eating. However, clinical observations and research demonstrate ARFID and shape/weight motivations sometimes co-occur. To inform classification, we: (1) derived profiles underlying restriction motivation and examined their validity and (2) described diagnostic characterizations of individuals in each profile to explore whether findings support current diagnostic schemes. We expected, consistent with DSM-5, that profiles would comprise individuals endorsing solely ARFID or restraint (i.e. trying to eat less to control shape/weight) motivations.

Methods: We applied latent profile analysis to 202 treatment-seeking individuals (ages 10-79 years [M = 26, s.d. = 14], 76% female) with ARFID or a non-ARFID ED, using the Nine-Item ARFID Screen (Picky, Appetite, and Fear subscales) and the Eating Disorder Examination-Questionnaire Restraint subscale as indicators.

Results: A 5-profile solution emerged: Restraint/ARFID-Mixed (n = 24; 8% [n = 2] with ARFID diagnosis); ARFID-2 (with Picky/Appetite; n = 56; 82% ARFID); ARFID-3 (with Picky/Appetite/Fear; n = 40; 68% ARFID); Restraint (n = 45; 11% ARFID); and Non-Endorsers (n = 37; 2% ARFID). Two profiles comprised individuals endorsing solely ARFID motivations (ARFID-2, ARFID-3) and one comprising solely restraint motivations (Restraint), consistent with DSM-5. However, Restraint/ARFID-Mixed (92% non-ARFID ED diagnoses, comprising 18% of those with non-ARFID ED diagnoses in the full sample) endorsed ARFID and restraint motivations.

Conclusions: The heterogeneous profiles identified suggest ARFID and restraint motivations for dietary restriction may overlap somewhat and that individuals with non-ARFID EDs can also endorse high ARFID symptoms. Future research should clarify diagnostic boundaries between ARFID and non-ARFID EDs.

Keywords: anorexia nervosa; avoidant/restrictive food intake disorder; bulimia nervosa.

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Conflict of interest statement

Competing Interests: SRA, TEJ, PEK, LP, LB, and CMS have no personal or financial conflicts to declare. HBM and JJT receive royalties from Oxford University Press for their forthcoming book on rumination syndrome. JJT, KRB, and KTE receive royalties from Cambridge University Press for the sale of their books, Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults (JJT & KTE) and The Picky Eater’s Recovery Book (JJT, KRB, KTE).

Figures

Figure 1.
Figure 1.
Z-Score distributions of indicator variables by profile in a sample of 202 treatment-seeking individuals with feeding and eating disorders. Note: Error bars reflect standard error within each profile. Z-scores were used in the above figure given that scores on each NIAS subscale can range from 0–15, while scores on the EDE-Q Restraint subscale can range from 0–6. NIAS=Nine Item ARFID Screen, EDE-Q=Eating Disorders Examination Questionnaire
See this image and copyright information in PMC

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