A Moving Target: How We Define Avoidant/Restrictive Food Intake Disorder Can Double Its Prevalence

Area of Science:

• Psychiatry
• Pediatrics
• Clinical Psychology

Background:

• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for avoidant/restrictive food intake disorder (ARFID) contain ambiguities.
• These ambiguities can impact treatment access, research comparability, and generalizability.
• Clear operationalization of diagnostic criteria is crucial for consistent clinical practice and research.

Purpose of the Study:

• To investigate the impact of different operational definitions of ARFID diagnostic criteria on diagnosis frequency.
• To assess the variability in ARFID diagnosis rates based on distinct methodological approaches.

Main Methods:

• Focused on Criterion A of the DSM-5 ARFID diagnosis, identifying 19 potential operational definitions.
• Examined the effect of these definitions on ARFID eligibility in a sample of 80 children, adolescents, and young adults.
• Analyzed diagnostic proportions across various operationalization methods.

Main Results:

• Significant differences in the proportion of participants meeting ARFID criteria were observed across different methodologies (all P values < .008).
• The strictest definition resulted in 50.0% of participants meeting ARFID criteria.
• The most lenient definition nearly doubled this figure, with 97.5% meeting ARFID criteria.

Conclusions:

• The study confirmed substantial statistical variation in ARFID diagnosis proportions within a single sample based on differing diagnostic definitions.
• Findings underscore the necessity for enhanced contextual support and interdisciplinary consensus on operationalizing ARFID criteria.
• Standardized operationalization is vital for both research and clinical settings to ensure consistent diagnosis and treatment.