The Davoidant/restrictive auto of the intake of food (Arfid) is included in the DSM-5 in the category of nutrition and eating disorders. It replaces the diagnosis of childhood nutrition disorder or the first adolescence contained in the DSM-IV-TR.
Formalized as a diagnosis in the DSM-5 (2013), the Arfid was recently included in the ICD-11 (2018).
But what is meant when we talk about Arfid?
If we think about children, it is very frequent to find very selective small in food choices. They are labeled as “splashes”, they introduce the same (few) foods and seem not to nourish no interest in food. This attitude is often a source of great concern for parents who turn to the pediatrician to have suggestions and indications.
Obviously these children are not all affected by Arfid. To diagnose this restriction of the choice of foods, significant damage to health, development or general functioning must be associated.
What is Arfid
THE’Arfid is a Nutrition and eating disorder characterized by a persistent inability to satisfy adequate nutritional and/or energy needs which lead to clinically significant consequences. These consequences may include:
- Significant weight loss or inability to achieve the expected weight gain (normal development growth of development)
- Significant nutritional deficiency
- Dependence on enteroral nutrition or oral nutritional supplements to maintain weight or nutritional status
- Marked interference with psychosocial functioning
There food restriction It is not related to concern for the weight or shape of the body and this distinguishes Arfid from anorexia nervosa.
It is a diagnosis that collects a great variability of clinical manifestations inside. In the current state of research, we do not know what exactly the person moves to have such problematic behaviors. In fact, a specific psychopathology has not been identified.
However, three profiles have been identified that explain the reason for energy and/or nutritional deficiency:
- Apparent lack of interest for eating or food. Often there are emotional difficulties such as worries, anxiety or sadness that interfere with nutrition and produce disinterest in food.
- Avoidance based on the sensory characteristics of food. Some people, for example, eat only foods with certain textures, colors, temperatures or are very sensitive to the variations of tastes. They therefore avoid some foods because, in advance, they think they do not tolerate certain characteristics of that food.
- Worry relating to the negative consequences of eating. The reduction of food contribution is due to some fears such as:
– suffocate
– Vomit
– not to be able to swallow
– cause diarrhea
– cause allergic reactions
– cause abdominal or chest pain
The three profiles can vary in terms of gravity, but are not excluded each other.
The avoidant/restrictive disorder of the intake of food (Arfid) It may have debut in childhood or first adolescence, but in some cases, even in adulthood. At the moment there are no prevalence data on the non -clinical population.
Causes and care of ARFID
The etiology of this disorder is currently not known. However, the three -dimensional model of Thomas (2017) starts from the hypothesis that there is a genetic predisposition to anomalies in the perception of taste and in the homeostatic appetite. The emotional reactivity would also explain the three profiles previously described.
This predisposition could be activated by any traumatic experiences related to food, causing one restriction or avoidance of the intake of food. This, in turn, would lead to a nutritional impairment or limitation in exploration opportunities.
The limits of this model are linked to the fact that it is based on a biological hypothesis in the absence of specific biological markers. While remaining an interesting theoretical model, there is still no empirical validation.
Psychotherapy of the avoidance/restriction of food in children and adolescents
The cognitive behavioral treatment based on this model (CBT-AR) developed by Thomas Jj and Eddy Kt (2018), is mainly based on behavioral interventions such as systematic desensitization.
Recently, Calugi and Dalla Grave (2018) have proposed an alternative model to the three -dimensional model of Thomas, which sees the excessive assessment of the control of the power supply and/or concerns for the adverse consequences of the food as a psychopathological nucleus.
Treatment CBT-E adapted for the Arfidproposed by them, uses a series of specific strategies and techniques that aim to face the psychopathological nucleus.
To date, however, no behavioral cognitive therapeutic model has scientific evidence or has been tested by clinical research.
It is also necessary to develop and process specific screening and assessment measures for Arfid. This is in order to quantify the extent of the problem in the general population, identify the populations at risk and support the current research efforts.
BIBLIOGRAPHY
- Rachel Bryant-Waugh (2016) Avoidant Restricts Food Intake Disorder in: K Brownell and T Walsh (EDS) Eating Disorders and Obesity: A comprehensive handbooks, 3RD Edition. London: Guilford Press, 198-202
- Thomas Jj and Eddy Kt (2018) Cognitive-BEHAVIORAL TREATMENT OF AVOIDANT/RESTRICTIVE FOOD INCLake Disorder. Current Opinion in Psychiatry, 31, 425-430.
- Calugi, 2018, “Cognitive behavioral therapy adapted for the Arfid” presented to AIDAP National Congress 2018. Garda, 9-10 November 2018.
