Eating disorder cognitions: a comparison between Avoidant/Restrictive Food Intake Disorder (ARFID) and Anorexia...

This study aims to investigate whether individuals with Avoidant/Restrictive Food Intake Disorder (ARFID) experience unhelpful cognitions that overlap with Anorexia Nervosa (AN). It also examines whether these cognitions play a role in driving problematic eating behaviours that are typically associated with AN because they are designed to prevent weight gain.

There were 184 participants (68 individuals with AN, 61 individuals with ARFID, and 55 people with no eating disorder) who were screened using Diagnostic Statistical Manual (DSM-5) criteria. Participants were an adult community sample who completed an anonymous online survey. Questionnaires measured core beliefs, assumptions and automatic thoughts that are associated with AN, and an assessment of concerns about weight and shape was completed. An observational design was used to compare how responses varied according to diagnosis.

Individuals with ARFID were found to have significantly higher levels of disordered core beliefs, assumptions, automatic thoughts, and weight/shape concerns than people with no eating disorder. They showed lower levels of these cognitions relative to individuals with AN. Disordered assumptions and automatic thoughts explained a large proportion of variance in behaviours intended to prevent weight gain in this group.

The findings have implications for the diagnosis and treatment of ARFID. They challenge diagnostic conceptualisations of ARFID as entirely separable from other eating disorders and any associated weight/shape concerns. They also highlight the need for clinicians to assess and treat unhelpful cognitions that may be maintaining disordered patterns of eating. Future research directions are discussed.