A Cognitive-Behavioral Family-Based Protocol for the Primary Presentations of Avoidant/Restrictive Food Intake Disorder (ARFID): Case Examples and Clinical Research Findings

Avoidant/restrictive food intake disorder (ARFID) is a feeding and eating disorder with evidence for distinct but overlapping presentations characterized by avoidance of eating or narrow dietary range related to poor appetite, selective eating, or fear of aversive consequences of eating. The current paper describes a flexible, cognitive-behavioral, family-oriented treatment approach that has been applied to each of these ARFID presentations within a larger partial hospitalization program (PHP) for eating disorders. We provide composite case examples for the presentations and retrospective outcome data on a sample of 81 patients treated with the protocol. Overall, patients with ARFID exhibited significant increases in body weight and the number of foods accepted, and significant decreases on measures assessing food fears, oral control behavior, anxiety, and depression. At baseline, patients with co-occurring poor appetite and selective eating exhibited significantly lower body weight than those with fear of aversive consequences, while the latter group of patients were eating significantly fewer foods and feared a larger number of foods according to parent report. Patients with the fear of aversive consequences presentation also experienced greater increases in the number of foods they were willing to eat and greater decreases in the number of foods they feared over the course of treatment relative to the other two groups. Our findings provide preliminary support for the effectiveness of our family-centered, cognitive-behavioral PHP for children and adolescents with ARFID. Future studies with more sophisticated methods, including randomized controlled designs and ARFID-specific measures, are recommended to help establish evidence-based psychosocial interventions for this clinical population.