Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Children's Multidisciplinary Feeding Program, Children's Healthcare of Atlanta, Atlanta, Georgia.
Int J Eat Disord. 2019 Apr;52(4):398-401. doi: 10.1002/eat.22987. Epub 2019 Jan 11.
Avoidant/restrictive food intake disorder (ARFID) is a diagnosis that sits squarely at the cross roads of feeding disorders and eating disorders. It is historically tied to feeding disorders as a replacement of the DSM-IV diagnosis of feeding disorder of infancy or early childhood. The revision process, however, extended the diagnostic umbrella by removing its predecessor's weight loss requirement and age of onset restriction (i.e., 6 years). Implications of this extension include capturing an older cohort of patients with ARFID accessing care at eating disorders clinics, as well as providing a diagnostic home to previously orphaned pediatric subgroups with feeding disorders that lacked a diagnostic home prior to DSM-5. While recognizing notable strengths of this now 5-year-old diagnostic entity, ARFID is largely recognized as a very heterogeneous condition that lacks specificity to best guide clinical and research activities. The current commentary discusses the implications of ARFID as a replacement and extension of the DSM-IV diagnosis of feeding disorder of infancy or early childhood and provides the rationale and guidance for developing a subtype taxonomy.
回避/限制型食物摄入障碍(ARFID)是一种位于喂养障碍和进食障碍交叉点的诊断。它在历史上与喂养障碍有关,是DSM-IV 婴儿或幼儿期喂养障碍诊断的替代诊断。然而,修订过程通过删除其前身的体重减轻要求和发病年龄限制(即 6 岁),扩展了诊断范围。这一扩展的影响包括将更多的 ARFID 患者纳入饮食障碍诊所的治疗中,以及为之前缺乏 DSM-5 之前诊断标准的患有喂养障碍的儿科亚群提供一个诊断归宿。尽管认识到这个已有 5 年历史的诊断实体的显著优势,但 ARFID 很大程度上被认为是一种非常异质的疾病,缺乏特异性,无法很好地指导临床和研究活动。本评论讨论了 ARFID 作为 DSM-IV 婴儿或幼儿期喂养障碍诊断的替代和扩展的意义,并为发展亚类分类提供了理由和指导。