Avoidant/Restrictive Food Intake Disorder Symptoms are Common and Impairing in Adults With Specific Phobia of Vomiting: An Exploratory Study in an Understudied Population

Patients with specific phobia of vomiting (SPOV) often avoid foods or restrict eating aiming to prevent vomiting. However, the prevalence and correlates of avoidant/restrictive eating characteristic of avoidant/restrictive food intake disorder (ARFID) in individuals with SPOV is unknown. We aimed to examine the frequency, correlates, predictors, and detection of ARFID secondary to SPOV in adults. Adults with SPOV recruited on vomit phobia Reddit forums (N = 276) completed measures of (1) eating restrictions associated with ARFID, (2) ARFID symptoms and their perceived causes, and (3) SPOV severity, clinical impairment from eating, depression and anxiety, and candidate predictors of ARFID in a SPOV population. Forty eight percent of participants met full self-reported ARFID criteria and 27.5% met criteria for subthreshold ARFID. Participants with full-ARFID reported significantly higher levels of SPOV, depression, and anxiety, while all ARFID-endorsing participants reported greater clinical impairment from eating and dimensional symptoms of fear- and appetite ARFID than participants with SPOV only. Fear of food was the only candidate predictor independently associated with ARFID status. ARFID symptoms were extremely common among adults with SPOV who seek support in online forums. ARFID symptomatology was associated with greater impairment and comorbidity compared to SPOV alone. Future research is needed to understand if targeting ARFID symptoms in treatment improves outcomes for SPOV.