Sensory sensitivity and food disgust in ARFID presentations across ages

Sensory sensitivity plays a pivotal role in avoidant/restrictive food intake disorder (ARFID), and food disgust is widely accepted as a key factor in food avoidance across ages. However, their relationship remains unclear in ARFID in general and across its main presentations, picky eating, fear of aversive consequences, and lack of interest. Therefore, this cross-sectional study examined whether food disgust acted as a mediator of the relationship between sensory sensitivity and ARFID symptoms in children and adults. Parents and adults from the community participated in an online survey on children's and adults' sensory sensitivity, food disgust, and ARFID symptoms according to the three main presentations based on validated questionnaires. Data from 270 parents (children aged 2-17 years, 60.4% male) and 491 adults (18-73 years, 76.8% female) were analyzed. Consistently across ages, positive associations between food disgust and picky eating (medium to large effect) and fear of aversive consequences (small effect) were observed. Food disgust mediated (i.e., weakened) the association between sensory sensitivity and both picky eating (large effect) and fear of aversive consequences (small effect), but did not mediate this association for lack of interest. The results showed that different etiological mechanisms may play a role in the main presentations of ARFID. Food disgust was found to be particularly relevant for ARFID-picky eating in both children and adults, but was less relevant for ARFID-fear of aversive consequences and ARFID-lack of interest. Longitudinal studies are needed to explore the directionality between sensory sensitivity, food disgust, and ARFID symptoms. Addressing food disgust in therapeutic approaches for ARFID warrants further investigation.