Rethinking Screening, and Considering Cross-Cultural Similarities and Differences in the Clinical Presentation of Avoidant/Restrictive Food Intake Disorder (ARFID): A Commentary Building Upon Presseller et al. (2024)

Avoidant/restrictive food intake disorder (ARFID) is increasingly recognized globally, yet its clinical presentation may vary across cultures. This commentary highlights the importance of considering cultural context in the assessment of ARFID. We begin by reflecting on a study by Presseller et al. which examines the utility of the nine-item ARFID screen (NIAS) in a large Swedish sample, finding that the NIAS alone may not adequately differentiate ARFID from eating disorders driven by shape/weight concerns. Building upon this, we broaden the discussion to include the potential comorbidity of ARFID and other eating disorders driven by weight/shape concern, which also requires additional assessment. Furthermore, we explore potential cross-cultural similarities and differences in ARFID presentation, drawing on clinical experience in the Netherlands, Europe, and globally. Factors such as cultural norms surrounding eating, the acceptability of expressing feeding difficulties, and food availability itself may all influence how ARFID manifests. A deeper understanding of these cultural nuances is essential for accurate diagnosis, culturally sensitive treatment approaches, and ultimately, improved outcomes for individuals with ARFID worldwide. The nuanced interplay of cultural factors and diagnostic tools underscores the imperative for tailored approaches in addressing ARFID across diverse populations.