Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: Comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms
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BACKGROUND: One presentation of Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by picky eating, i.e., selective eating based on the sensory properties of food. The present study has two aims. The first is to describe distress and impairment in individuals with ARFID secondary to picky eating. The second is to determine whether eating behaviors hypothesized to be specific to picky eating can differentiate picky eaters with and without ARFID from typical eaters (e.g., individuals not reporting picky or disordered eating) and individuals who strongly endorse attitudes associated with anorexia and bulimia (eating disordered attitudes). METHODS: 81). Participants were grouped based on endorsement of picky eating, ARFID symptoms, and elevated eating disordered attitudes on the Eating Attitudes Test (EAT-26). The resulting four eating behavior groups were compared on measures of distress and impairment (e.g., anxiety/depression and, obsessive compulsive disorder symptoms, eating-related quality of life) and on measures of eating behaviors associated with picky eating (e.g., food neophobia, inflexibility about preparation and presentation of preferred foods, sensitivity to sensory stimuli, and eating from a very narrow range of foods). The groups were compared using one way ANOVA with post-hoc Tamhane's T2 tests. RESULTS: On measures of distress and impairment, participants with ARFID reported higher scores than both typical eaters and picky eaters without ARFID, and comparable scores to those with disordered eating attitudes. Three of four measures of picky eating behavior, eating inflexibility, food neophobia, and eating from a range of 20 or fewer foods, distinguished picky eaters with and without ARFID form typical eaters and those with disordered eating attitudes. Picky eaters with ARFID reported greater food neophobia and eating inflexibility, and were more likely to eat from a narrow range of foods, compared to picky eaters without ARFID. CONCLUSIONS: Adult picky eaters can be differentiated from those with symptoms of anorexia and bulimia by their stronger endorsement of food neophobia and inflexible eating behaviors, and by eating from a very narrow range of foods. Picky eaters with ARFID symptoms can be differentiated from picky eaters without these symptoms on the basis of these three eating behaviors, and by their higher endorsement of internalizing distress, OCD symptoms, and eating-related quality of life impairment. This study provides evidence that ARFID symptoms exist independently of symptoms of other eating disorders and are characterized by several distinct eating behaviors. In a clinical analogue sample of disordered eaters, ARFID symptoms were associated with distress and impairment at levels comparable to symptoms of anorexia and bulimia.
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ARFID symptoms in adults are severe and impairing.
“The few studies that have examined ARFID and associated psychopathology in adults suggest that its symptoms are severe and impairing (e.g., Nakai, Nin, Noma, Teramukai, & Wonderlich, 2016); Zickgraf, Franklin, & Rozin, 2016)”
From Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder (2021) · cites this paper as Zickgraf et al., 2016
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Multidisciplinary Assessment and Management of Functional Dysphagia
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- Authors
- Zickgraf, H. F., Franklin, M. E., & Rozin, P.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- Zickgraf, Hana F.
- Venue
- Journal of Eating Disorders
- Published
- 2016-10-29
- Volume
- 4
- Issue
- 1
- Pages
- 26-26
- ISSN
- 2050-2974 (ISSN-L)
- PMC
- PMC5086050
- OpenAlex
- W2542600389
- Cited by
- 142
- References
- 35
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 17 · 2023: 16 · 2022: 9 · 2021: 14 · 2020: 6 · 2019: 14 · 2018: 33 · 2017: 4 · 2016: 1
- FWCI
- 23.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Eating Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- University of Pennsylvania
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- picky eating, avoidant/restrictive food intake disorder, food neophobia, dietary habits, anorexia, bulimia nervosa, obsessive-compulsive symptoms, comorbidities, adults, Eating Attitudes Test
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