A Systematic Review and Meta-Analysis of Psychological Therapies for Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents and Adults

Abstract

Objective: The efficacy of psychological therapies for adolescents and adults with avoidant/restrictive food intake disorder (ARFID) has yet to be rigorously analyzed through systematic review or meta-analysis.

Method: We identified articles from seven databases that presented psychological therapies for adolescents and adults with ARFID. First, our systematic review explored characteristics of psychological interventions, clinical team composition, changes in dietary intake, and methodological quality. Second, we conducted a meta-analysis to quantify effect sizes for two primary outcomes (ARFID psychopathology and weight gain) and two secondary outcomes (anxiety and depression) from pretreatment to posttreatment.

Results: Forty articles included in the systematic review identified a variety of psychological interventions that led to increased dietary variety. Most studies were of high quality. Of these, 17 articles met the inclusion criteria for the meta-analysis. Across studies, adolescents and adults with ARFID showed significant improvements from pretreatment to posttreatment including medium-size reductions in ARFID psychopathology (g = 0.63, p < 0.001), large increases in weight (g = 1.26, p < 0.001), medium-size reductions in anxiety (g = 0.42, p < 0.001), and small reductions in depression (g = 0.34, p < 0.05).

Discussion: This systematic review and meta-analysis highlights promising preliminary outcomes of psychological therapies for adolescents and adults with ARFID across multiple domains. However, the current evidence base is small and primarily reliant on case studies and case series, with very few quasi-experimental or randomized designs. As such, studies with larger sample sizes utilizing randomized control trial designs are needed to provide a more rigorous evaluation of psychological therapies for ARFID.

Keywords: ARFID; adults; avoidant/restrictive food intake disorder; cognitive‐behavioral therapy; family‐based treatment; feeding and eating disorders; meta‐analysis; systematic review; therapyadolescents.