Co-occurrence of Avoidant/Restrictive Food Intake Disorder and Traditional Eating Psychopathology

Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder introduced in the fifth edition of the DSM-5 that is characterized by inadequate volume and/or variety of food intake.¹ ARFID represents an expansion of the prior DSM-IV disorder "Feeding Disorder of Early Childhood" that can be diagnosed across the lifespan.^1,2DSM-5 clearly states that ARFID cannot be diagnosed in the context of significant shape/weight concerns and associated behaviors.¹ However, our clinical team has observed multiple instances in which adolescent girls have presented with frank ARFID and simultaneously reported, or ultimately developed, traditional eating-disorder psychopathology. The following two cases are representative of the most common presentations of this diagnostic overlap that we have seen. We discuss possible reasons for this overlap and suggest two revisions to DSM criteria that may help in treatment planning for this unexpected comorbidity. Each patient provided written consent for her case to be included.