Course of avoidant/restrictive food intake disorder: Emergence of overvaluation of shape/weight

P Evelyna Kambanis; Christopher J Mancuso; Kendra R Becker; Kamryn T Eddy; Jennifer J Thomas; Kyle P De Young

doi:10.1186/s40337-024-01001-3

Course of avoidant/restrictive food intake disorder: Emergence of overvaluation of shape/weight

J Eat Disord. 2024 May 3;12(1):54. doi: 10.1186/s40337-024-01001-3.

Authors

P Evelyna Kambanis^{1

2}, Christopher J Mancuso³, Kendra R Becker^{4

5}, Kamryn T Eddy^{4

5}, Jennifer J Thomas^{4

5}, Kyle P De Young³

Affiliations

¹ Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Suite 200, Boston, MA, 02114, USA. pkambanis@mgh.harvard.edu.
² Department of Psychiatry, Harvard Medical School, Boston, MA, USA. pkambanis@mgh.harvard.edu.
³ Department of Psychology, University of Wyoming, Laramie, WY, USA.
⁴ Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Suite 200, Boston, MA, 02114, USA.
⁵ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

Abstract

Background: Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by avoidance/restriction of food intake by volume and/or variety. The emergence of shape/weight-related eating disorder symptoms in the longitudinal course of ARFID is an important clinical phenomenon that is neither robustly documented nor well understood. We aimed to characterize the emergence of eating disorder symptoms among adults with an initial diagnosis of ARFID who ultimately developed other eating disorders.

Method: Thirty-five participants (94% female; M_age = 23.17 ± 5.84 years) with a history of ARFID and a later, separate eating disorder completed clinical interviews (i.e., Structured Clinical Interview for DSM-5 - Research Version and Longitudinal Interval Follow-Up Evaluation) assessing the period between ARFID and the later eating disorder. Participants used calendars to aid in recall of symptoms over time. Descriptive statistics characterized the presence, order of, and time to each symptom. Paired samples t-tests compared weeks to emergence between symptoms.

Results: Most participants (71%) developed restricting eating disorders; the remainder (29%) developed binge-spectrum eating disorders. Cognitive symptoms (e.g., shape/weight concerns) tended to onset initially and were followed by behavioral symptoms. Shape/weight-related food avoidance presented first, objective binge eating, fasting, and excessive exercise occurred next, followed by subjective binge eating and purging.

Conclusions: Diagnostic crossover from ARFID to another (typically restricting) eating disorder following the development of shape/weight concerns may represent the natural progression of a singular clinical phenomenon. Findings identify potential pathways from ARFID to the development of another eating disorder, highlighting possible clinical targets for preventing this outcome.

Keywords: ARFID; Anorexia nervosa; Assessment; Avoidant/restrictive food intake disorder; Binge-eating disorder; Bulimia nervosa; Diagnosis; Diagnostic crossover; Longitudinal study; Overvaluation of shape/weight; Retrospective study.

Abstract

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