Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network

Int J Eat Disord. 2015 Jul;48(5):464-70. doi: 10.1002/eat.22350. Epub 2014 Aug 20.


Objective: Few published studies have evaluated the clinical utility of new diagnostic criteria for avoidant/restrictive food intake disorder (ARFID), a DSM-5 reformulation of feeding and eating disorder of infancy or early childhood. We examined the prevalence of ARFID and inter-rater reliability of its diagnostic criteria in a pediatric gastrointestinal sample.

Method: We conducted a retrospective chart review of 2,231 consecutive new referrals (ages 8-18 years) to 19 Boston-area pediatric gastroenterology clinics for evidence of DSM-5 ARFID.

Results: We identified 33 (1.5%) ARFID cases; 22 of whom (67%) were male. Most were characterized by insufficient intake/little interest in feeding (n = 19) or limited diet due to sensory features of the food (n = 7). An additional 54 cases (2.4%) met one or more ARFID criteria but there was insufficient information in the medical record to confer or exclude the diagnosis. Diagnostic agreement between coders was adequate (κ = 0.72). Common challenges were (i) distinguishing between diagnoses of ARFID and anorexia nervosa or anxiety disorders; (ii) determination of whether the severity of the eating/feeding disturbance was sufficient to warrant diagnosis in the presence of another medical or psychiatric disorder; and (iii) assessment of psychosocial impairment related to eating/feeding problems.

Discussion: In a pediatric treatment-seeking sample where ARFID features were common, cases meeting full criteria were rare, suggesting that the diagnosis is not over-inclusive even in a population where eating/feeding difficulties are expected.

Keywords: DSM-5; avoidant/restrictive food intake disorder; feeding disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anorexia Nervosa / diagnosis
  • Anxiety / diagnosis
  • Child
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Feeding and Eating Disorders of Childhood / diagnosis*
  • Feeding and Eating Disorders of Childhood / epidemiology*
  • Female
  • Gastroenterology
  • Humans
  • Male
  • Prevalence
  • Reproducibility of Results
  • Retrospective Studies