The diagnosis of avoidant restrictive food intake disorder in the presence of gastrointestinal disorders: Opportunities to define shared mechanisms of symptom expression.
The diagnosis of avoidant restrictive food intake disorder in the presence of gastrointestinal disorders: Opportunities to define shared mechanisms of symptom expression.
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DOI：
10.1002/eat.23536
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Zucker NL
中科院分区：
文献类型：
--
作者：
Nicholas JK;van Tilburg MAL;Pilato I;Erwin S;Rivera-Cancel AM;Ives L;Marcus MD;Zucker NL
患有胃肠道（GI）疾病的个体经常改变他们的饮食来控制GI症状，这增加了理解导致食物避免/限制的不同动机的复杂性。当存在胃肠道疾病时，DSM-5指出，只有当饮食失调超过预期时，才能诊断出避免/限制性食物摄入障碍（ARFID）。做出这一决定的指导有限。本研究试图通过描述有和没有自我报告的胃肠道疾病的成人ARFID的表现来解决这一差距。参与者是2，610名年龄在18-44岁之间的成年人，他们自认为是“挑食者”。参与者报告了避免食物的动机，对食物的情感体验和感知障碍。比较了四组的反应：GI问题和可能的ARFID（L-ARFID/GI），仅L-ARFID，仅GI和无ARFID/无GI。患有GI疾病的组（L-ARFID/GI，仅GI）报告比没有GI疾病的组更害怕进食的厌恶后果，而患有L-ARFID的组（L-ARFID，L-ARFID/GI）表现出对食物的感觉厌恶和对食物或进食的漠不关心，对食物的负面情绪反应和整体厌恶敏感性，以及进食相关的损害。考虑胃肠道疾病与ARFID的相互作用可以增加病例概念化的精确度。避免食物可能是试图管理对胃肠道症状史所增强的厌恶后果的恐惧，而对食物的感官厌恶和负面情绪反应可能在ARFID中更高。这些研究结果强调，有必要考虑ARFID诊断胃肠道疾病的患者，以优化护理。
Individuals with a gastrointestinal (GI) disorder often alter their diet to manage GI symptoms, adding complexity to understanding the diverse motivations contributing to food avoidance/restriction. When a GI disorder is present, the DSM-5 states that Avoidant/Restrictive Food Intake Disorder (ARFID) can be diagnosed only when eating disturbance exceeds that expected. There is limited guidance to make this determination. This study attempts to address this gap by characterizing the presentation of ARFID in adults with and without a self-reported GI disorder. Participants were 2,610 adults ages 18–44 who self-identified as “picky eaters.” Participants reported on motivations for food avoidance, affective experiences towards food, and perceived impairment. Responses were compared across four groups: GI issues and likely ARFID (L-ARFID/GI), L-ARFID-only, GI-only, and No-ARFID/No-GI. Groups with a GI disorder (L-ARFID/GI, GI-only) reported more fear of aversive consequences of eating than those without a GI disorder, while groups with L-ARFID (L-ARFID, L-ARFID/GI) evidenced significantly greater sensory aversion to food and indifference to food or eating, negative emotional reactions to food and overall disgust sensitivity, and eating related impairment. Consideration of the interplay of a GI disorder with ARFID can add precision to case conceptualization. Food avoidance may be attempts to manage fears of aversive consequences that are augmented by a history of GI symptoms, while sensory aversions and negative emotional reactions towards foods may be more elevated in ARFID. These findings emphasize the need to consider an ARFID diagnosis in patients with GI disorders to optimize care.
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