Multimodal therapy for rigid, persistent avoidant/restrictive food intake disorder (ARFID) since infancy: A case...

Area of Science:

• Pediatric Gastroenterology
• Clinical Psychology
• Nutritional Psychiatry

Background:

• Avoidant/restrictive food intake disorder (ARFID) is a complex feeding disorder characterized by nutritional deficits and weight loss.
• Three clinical subtypes of ARFID have been identified, often presenting with overlapping features.
• Current clinical guidelines for ARFID management lack first-line recommendations.

Observation:

• An 11-year-old boy presented with lifelong ARFID, exhibiting features of all three subtypes, including sensory aversion, limited intake, and emetophobia.
• The patient's restricted diet to a single food item for over five years led to severe iron-deficiency anemia and multiple vitamin/mineral deficiencies.
• The case highlights the challenges in managing ARFID, particularly in complex presentations with multiple subtype features.

Findings:

• A multimodal therapeutic approach integrating cognitive-behavioral therapy (CBT), family-based therapy (FBT), and pharmacotherapy (sertraline, olanzapine) was implemented.
• Over a 7-week admission, the patient achieved successful weight restoration.
• The patient demonstrated the ability to incorporate at least three new food items into his diet.

Implications:

• This case supports the efficacy of a combined CBT, FBT, and pharmacological approach for managing complex ARFID cases.
• The findings suggest that integrated therapeutic strategies can be effective even in patients with ARFID features across multiple subtypes.
• Further research is warranted to develop robust clinical guidelines and evidence-based treatments for ARFID.