Etoh Mika, Itonaga Tomoyo, Oguri Saori, Kiyota Akio, Ihara Kenji
Department of Pediatrics, Oita University Faculty of Medicine, Yufu, JPN.
Department of Child Psychiatry, Oita Rehabilitation Center, Oita, JPN.
Cureus. 2022 Dec 31;14(12):e33196. doi: 10.7759/cureus.33196. eCollection 2022 Dec.
Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by avoidance and aversion to food and eating. Food restriction is not due to a body image disturbance but rather to an anxiety or phobia of food and eating or abnormal hypersensitivity to food, such as its texture, taste, or smell, or a lack of interest in food/eating. We herein report a seven-year-old girl with dysphagia due to a fear of swallowing with a favorable outcome thanks to cognitive behavioral therapy using an anxiety hierarchy chart. After a scary experience of seeing her bother choking on a sausage, the patient struggled with a strong fear of eating, especially swallowing, and was diagnosed with ARFID. We constructed a hierarchical chart of food insecurity, listing her favorite sweets in order, from soft to hard. She picked out daily sweets and snacks from the list. She gradually learned to eat hard-shaped food, achieved an adequate oral calorie intake, and was discharged on the twenty-second hospital day. This case indicates that cognitive behavioral therapy using the anxiety hierarchy chart can be applied to the treatment of school-age children with ARFID.
回避性/限制性食物摄入障碍（ARFID）是一种饮食失调症，其特征是对食物和进食存在回避和厌恶。食物限制并非由于身体形象障碍，而是由于对食物和进食的焦虑或恐惧，或对食物（如质地、味道或气味）的异常超敏反应，或对食物/进食缺乏兴趣。我们在此报告一名七岁女童，因害怕吞咽而出现吞咽困难，通过使用焦虑等级图表的认知行为疗法取得了良好效果。在经历了看到哥哥被香肠噎住的可怕经历后，该患者对进食，尤其是吞咽产生了强烈恐惧，并被诊断为ARFID。我们构建了一个食物不安全感等级图表，按从软到硬的顺序列出了她最喜欢的糖果。她从列表中挑选每日的糖果和零食。她逐渐学会吃硬形状的食物，实现了足够的口腔热量摄入，并在住院第22天出院。该病例表明，使用焦虑等级图表的认知行为疗法可应用于治疗患有ARFID的学龄儿童。
