Symptom Profiles Influence Accurate Identification of Avoidant/Restrictive Food Intake Disorder (ARFID)

Since its introduction in DSM-5, the diagnostic validity of avoidant/restrictive food intake disorder (ARFID) has been scrutinized due to heterogeneity in the diagnostic criteria. While most research has focused on the criteria themselves, recent attention has shifted to the three motivating factors for ARFID - lack of interest in food and eating, sensitivity to sensory characteristics of food, and fear of aversive consequences of eating (e.g., choking). However, minimal research has explored how these symptom profiles influence clinician diagnostic accuracy.

Licensed mental health providers completed a survey using standardized vignettes to assess accuracy in diagnosing ARFID, variation in diagnostic accuracy across the three motivating factors, and clinician characteristics associated with accuracy and confidence of diagnosis. A vignette depicting major depression served as a control.

A total of 122 participants completed the study. Diagnostic accuracy was lower for ARFID (68.9%) than major depression (95.1%). Accuracy also varied significantly across ARFID presentations: sensory sensitivity (94.0%), lack of interest in food and eating (72.7%), and fear of aversive consequences (46%). Eating disorder specialists were significantly more accurate and confident in their diagnoses than other clinicians. Prior experience treating ARFID was unrelated to accuracy or confidence.

Findings highlight challenges in accurately diagnosing ARFID and underscore the need for training on its diverse presentations. Improving clinician recognition of varied ARFID symptom profiles may enhance assessment and treatment.