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Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

  • Eating Disorders (S Wonderlich and JM Lavender, Section Editors)
  • Published:
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Abstract

Purpose of Review

DSM-5 defined avoidant/restrictive food intake disorder (ARFID) as a failure to meet nutritional needs leading to low weight, nutritional deficiency, dependence on supplemental feedings, and/or psychosocial impairment. We summarize what is known about ARFID and introduce a three-dimensional model to inform research.

Recent Findings

Because ARFID prevalence, risk factors, and maintaining mechanisms are not known, prevailing treatment approaches are based on clinical experience rather than data. Furthermore, most ARFID research has focused on children, rather than adolescents or adults. We hypothesize a three-dimensional model wherein neurobiological abnormalities in sensory perception, homeostatic appetite, and negative valence systems underlie the three primary ARFID presentations of sensory sensitivity, lack of interest in eating, and fear of aversive consequences, respectively.

Summary

Now that ARFID has been defined, studies investigating risk factors, prevalence, and pathophysiology are needed. Our model suggests testable hypotheses about etiology and highlights cognitive-behavioral therapy as one possible treatment.

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Acknowledgements

This paper was supported in part by R01MH108595 (mPIs: Thomas, Lawson, Micali).

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Correspondence to Jennifer J. Thomas.

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Conflict of Interest

Jennifer J. Thomas will receive future royalties from Cambridge University Press for the sale of her forthcoming book Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. Dr. Thomas reports grants from National Institute of Mental Health, Hilda and Preston Davis Foundation, and American Psychological Foundation.

Elizabeth A. Lawson is on the Scientific Advisory Board with a financial interest in OXT Therapeutics, Inc. Dr. Lawson reports grants from National Institute of Mental Health and National Institute of Diabetes and Digestive and Kidney Diseases.

Nadia Micali reports grants from National Institute of Mental Health.

Madhusmita Misra reports a grant from Novo-Nordisk and is an advisory board member. Dr. Misra also reports grants from the National Institute of Mental Health.

Thilo Deckersbach reports grants from National Institute of Health.

Kamryn T. Eddy will receive future royalties from Cambridge University Press for the sale of her forthcoming book Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. Dr. Eddy reports grants from National Institute of Mental Health, Hilda and Preston Davis Foundation, and American Psychological Foundation.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Thomas, J.J., Lawson, E.A., Micali, N. et al. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Curr Psychiatry Rep 19, 54 (2017). https://doi.org/10.1007/s11920-017-0795-5

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