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Review
. 2024 Jun 7;12(1):74.
doi: 10.1186/s40337-024-01021-z.

Avoidant restrictive food intake disorder: recent advances in neurobiology and treatment

Natasha K O Fonseca  1 , Vitória D Curtarelli  2 , Juliana Bertoletti  3 , Karla Azevedo  2   4 , Tiago M Cardinal  5 , Júlia D Moreira  6   4 , Luciana C Antunes  5   6   4
Affiliations
Review

Avoidant restrictive food intake disorder: recent advances in neurobiology and treatment

Natasha K O Fonseca et al. J Eat Disord. .

Abstract

Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. ARFID, before referred to as "selective eating disorder", was introduced recently in the DSM-5 as a replacement for and expansion of the previous diagnosis. Individuals with ARFID may limit food variety and intake due to avoidance based on the sensory characteristics of the food or related to any adverse consequences of eating without the intention of losing weight and concerns of body image. The limited understanding of avoidant and restrictive eating poses challenges to effective treatment and management, impacting directly on the growth and development of children and adolescents. The ARFID neurobiological concept has not yet been clearly defined to clinical practice for nutritionists, thereby hindering screening and impeding the development of treatment recommendations. This narrative review provide useful practical information to consult the pathophysiology, the neurobiology, the clinical features, the assessment and the treatment for healthcare professionals seeking to enhance their clinical knowledge and management of this disorder.

Keywords: Avoidant restrictive food intake disorder; Eating disorders; Restrictive eating; Selective eating.

Plain language summary

Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. Individuals with ARFID exhibit limited food intake and variety, often due to a lack in eating, without the primary goal of weight loss. The limited understanding of avoidant and restrictive eating poses challenges in terms of effective treatment and management, which directly impacts the growth and development of children and adolescents, as well as their nutrition and psychosocial well-being. ARFID is a relatively recent diagnostic classification, representing a burgeoning field of study. The identification of diagnostic criteria and the pursuit of new knowledge in this area have only recently begun. Consequently, assessment tools and treatment strategies are still in the process of development and validation. This narrative review explored the neurobiological perspective of ARFID using the three-dimensional model, examined its etiology and risk factors, evaluated clinical screening and evaluation tools, discussed common clinical complications, and presented different types of nutritional, behavioural, and pharmacological interventions used in ARFID treatment.

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Conflict of interest statement

The authors have no conflicts of interest to declare. All authors consent to release for publication all details and figures in this manuscript.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Predisposing, precipitating, and perpetuating factors of the ARFID framework
Fig. 2
Fig. 2
The neurobiological basis of ARFID
Fig. 3
Fig. 3
The treatment of ARFID
See this image and copyright information in PMC

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