Kambanis, P Evelyna; Tabri, Nassim; McPherson, Iman; Gydus, Julia E; Kuhnle, Megan; Stern, Casey M; Asanza, Elisa; ... Thomas, Jennifer J; + view all Kambanis, P Evelyna; Tabri, Nassim; McPherson, Iman; Gydus, Julia E; Kuhnle, Megan; Stern, Casey M; Asanza, Elisa; Becker, Kendra R; Breithaupt, Lauren; Freizinger, Melissa; Shrier, Lydia A; Bern, Elana M; Eddy, Kamryn T; Misra, Madhusmita; Micali, Nadia; Lawson, Elizabeth A; Thomas, Jennifer J; - view fewer (2024) Prospective Two-Year Course and Predictors of Outcome in Avoidant/Restrictive Food Intake Disorder. Journal of the American Academy of Child & Adolescent Psychiatry 10.1016/j.jaac.2024.04.010. (In press).

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Abstract

Objective: To evaluate the 2-year course and outcomes of full and subthreshold avoidant/restrictive food intake disorder (ARFID) in youth ages 9-23 at baseline using a prospective longitudinal design to characterize the remission and persistence of ARFID, evaluate diagnostic crossover, and identify predictors of outcome. We hypothesized that greater severity in each ARFID profile – sensory sensitivity, fear of aversive consequences, and lack of interest – would predict greater likelihood of illness persistence, controlling for age, sex, BMI percentile, ARFID treatment status, and baseline diagnosis. // Method: We followed participants (N = 100; ages 9-23 years; 49% female, 91% White) over two years. We used the Pica, ARFID, and Rumination Disorder Interview across three time points (Baseline, Year 1, Year 2) to measure the severity of each ARFID profile and evaluate illness persistence or remission, and the Eating Disorder Assessment for DSM-5 to evaluate diagnostic crossover. // Results: Across the 2-year follow-up period, half the sample persisted with their original diagnosis, and 3% of participants experienced diagnostic shift to anorexia nervosa. Greater severity in the sensory sensitivity and lack of interest profiles was associated with higher likelihood of ARFID persistence at Year 1 only; greater severity in the fear of aversive consequences profile was associated with higher likelihood of ARFID remission at Year 2 only. // Conclusion: Findings underscore the distinctiveness of ARFID from other eating disorders and emphasize its persistence over 2 years. Results also highlight the predictive validity and prognostic value of ARFID profiles (i.e., sensory sensitivity, fear of aversive consequences, lack of interest).

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