Kamryn T Eddy1,2, Stephanie G Harshman1,3,4, Kendra R Becker1,2, Elana Bern5, Rachel Bryant-Waugh6, Anja Hilbert7, Debra K Katzman8, Elizabeth A Lawson3,4, Laurie D Manzo9, Jessie Menzel10,11, Nadia Micali6,12,13, Rollyn Ornstein14, Sarah Sally15, Sharon P Serinsky16, William Sharp17,18, Kathryn Stubbs18, B Timothy Walsh19,20, Hana Zickgraf21, Nancy Zucker22, Jennifer J Thomas1,2. 1. Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts. 2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. 3. Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts. 4. Department of Medicine, Harvard Medical School, Boston, Massachusetts. 5. Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts. 6. Great Ormond Street Institute of Child Health, University College London, London, United Kingdom. 7. Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany. 8. Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada. 9. Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Boston, Massachusetts. 10. Department of Psychiatry, University of California, San Diego, California. 11. Eating Disorder Center for Treatment and Research, University of California San Diego, San Diego, California. 12. Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 13. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York. 14. Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania. 15. Department of Speech, Language, and Swallowing Disorders, MassGeneral Hospital for Children, Boston, Massachusetts. 16. Occupational Therapy Services, MassGeneral Hospital for Children, Boston, Massachusetts. 17. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 18. Children's Multidisciplinary Feeding Program, Children's Healthcare of Atlanta, Atlanta, Georgia. 19. Columbia Center for Eating Disorders, Department of Psychiatry, Columbia University, New York, New York. 20. Eating Disorders Research Unit, New York State Psychiatric Institute, New York, New York. 21. Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania. 22. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.
Abstract
OBJECTIVE: Since its introduction to the psychiatric nomenclature in 2013, research on avoidant/restrictive food intake disorder (ARFID) has proliferated highlighting lack of clarity in how ARFID is defined. METHOD: In September 2018, a small multi-disciplinary pool of international experts in feeding disorder and eating disorder clinical practice and research convened as the Radcliffe ARFID workgroup to consider operationalization of DSM-5 ARFID diagnostic criteria to guide research in this disorder. RESULTS: By consensus of the Radcliffe ARFID workgroup, ARFID eating is characterized by food avoidance and/or restriction, involving limited volume and/or variety associated with one or more of the following: weight loss or faltering growth (e.g., defined as in anorexia nervosa, or by crossing weight/growth percentiles); nutritional deficiencies (defined by laboratory assay or dietary recall); dependence on tube feeding or nutritional supplements (≥50% of daily caloric intake or any tube feeding not required by a concurrent medical condition); and/or psychosocial impairment. CONCLUSIONS: This article offers definitions on how best to operationalize ARFID criteria and assessment thereof to be tested in existing clinical populations and to guide future study to advance understanding and treatment of this heterogeneous disorder.
OBJECTIVE: Since its introduction to the psychiatric nomenclature in 2013, research on avoidant/restrictive food intake disorder (ARFID) has proliferated highlighting lack of clarity in how ARFID is defined. METHOD: In September 2018, a small multi-disciplinary pool of international experts in feeding disorder and eating disorder clinical practice and research convened as the Radcliffe ARFID workgroup to consider operationalization of DSM-5 ARFID diagnostic criteria to guide research in this disorder. RESULTS: By consensus of the Radcliffe ARFID workgroup, ARFID eating is characterized by food avoidance and/or restriction, involving limited volume and/or variety associated with one or more of the following: weight loss or faltering growth (e.g., defined as in anorexia nervosa, or by crossing weight/growth percentiles); nutritional deficiencies (defined by laboratory assay or dietary recall); dependence on tube feeding or nutritional supplements (≥50% of daily caloric intake or any tube feeding not required by a concurrent medical condition); and/or psychosocial impairment. CONCLUSIONS: This article offers definitions on how best to operationalize ARFID criteria and assessment thereof to be tested in existing clinical populations and to guide future study to advance understanding and treatment of this heterogeneous disorder.
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