Avoidant restrictive food intake disorder, traumatic events and PTSD in adolescents and adults admitted to residential treatment

Abstract

Objective: Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder linked to autism spectrum disorder (ASD) that has been associated with prior traumatic experiences, but its relationship to posttraumatic stress disorder (PTSD) has been relatively unexplored. Whether trauma and PTSD are more closely associated with specific clinical profiles of ARFID (fear of adverse consequences of eating, sensory sensitivity, and/or lack of interest in food/eating) is unclear.

Method: 89 patients (25 adolescents, 64 adults) admitted to residential treatment (RT) with a DSM-5 diagnosis of ARFID completed initial assessments, including the PTSD Checklist for DSM-5. Trauma histories were identified via the Life Events Checklist for DSM-5 (adults), the Child Trauma Questionnaire (adolescents), and by detailed chart reviews.

Results: 50 % of adults and 40 % of adolescents (47 % total) met criteria for PTSD, which was more prevalent in patients with sensory sensitivity (60 %) and pre-admission comorbid ASD (80 %). The most common types of traumatic experiences associated with PTSD were sexual assault, unwanted/uncomfortable sexual experiences, and physical assault. In most cases (61 %), traumas reportedly occurred before or at the same time as the eating disturbances, which began on average at 12.4 years of age. Patients with PTSD also had significantly more prior suicide attempts.

Discussion: Traumatic experiences and resultant PTSD were common in both adolescents and adults with ARFID, especially in those with sensory sensitivity and comorbid ASD. These findings need to be confirmed in larger, more representative samples. Development of treatment approaches that integrate trauma-focused treatments are indicated.

Keywords: ARFID; Comorbidity; Feeding and eating disorders; PTSD; Sensory sensitivity; Suicide; Trauma.