Course of avoidant/restrictive food intake disorder: Emergence of overvaluation of shape/weight

Background Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by avoidance/restriction of food intake by volume and/or variety. The emergence of shape/weight-related eating disorder symptoms in the longitudinal course of ARFID is an important clinical phenomenon that is neither robustly documented nor well understood. We aimed to characterize the emergence of eating disorder symptoms among adults with an initial diagnosis of ARFID who ultimately developed other eating disorders.Method Thirty-five participants (94% female; M age = 23.17 +/- 5.84 years) with a history of ARFID and a later, separate eating disorder completed clinical interviews (i.e., Structured Clinical Interview for DSM-5 - Research Version and Longitudinal Interval Follow-Up Evaluation) assessing the period between ARFID and the later eating disorder. Participants used calendars to aid in recall of symptoms over time. Descriptive statistics characterized the presence, order of, and time to each symptom. Paired samples t-tests compared weeks to emergence between symptoms.Results Most participants (71%) developed restricting eating disorders; the remainder (29%) developed binge-spectrum eating disorders. Cognitive symptoms (e.g., shape/weight concerns) tended to onset initially and were followed by behavioral symptoms. Shape/weight-related food avoidance presented first, objective binge eating, fasting, and excessive exercise occurred next, followed by subjective binge eating and purging.Conclusions Diagnostic crossover from ARFID to another (typically restricting) eating disorder following the development of shape/weight concerns may represent the natural progression of a singular clinical phenomenon. Findings identify potential pathways from ARFID to the development of another eating disorder, highlighting possible clinical targets for preventing this outcome. Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by avoidance/restriction of food intake by volume and/or variety. In contrast to other eating disorders (e.g., anorexia nervosa, bulimia nervosa), dietary restriction in ARFID is not motivated by shape and weight concerns. Instead, it is driven by sensory sensitivities, fear of aversive consequences, and lack of interest in food/eating. The emergence of other eating disorder symptoms - such as shape and weight concerns - in the longitudinal course of ARFID is an important clinical phenomenon that is neither robustly documented nor well understood. Following ARFID history, 71% of participants in our study developed a restricting eating disorder and 29% developed a binge-spectrum eating disorder. Cognitive symptoms of other eating disorders (e.g., shape/weight concerns) onset prior to behavioral symptoms (e.g., food avoidance). Diagnostic crossover from ARFID to another eating disorder following the development of shape/weight concerns represents an interesting and important clinical phenomenon. Our findings suggest potential pathways by which ARFID may lead to the development of a subsequent eating disorder, in turn highlighting critical targets that may be intervened on to prevent this trajectory.