Avoidant/restrictive food intake disorder (ARFID) is diagnosed when a person’s avoidance or restriction of food intake is associated with conditions including significant weight loss or nutritional deficiency, dependence on tube feeding or oral nutritional supplements, or marked challenges with psychosocial functioning. In 2013, the American Psychiatric Association added ARFID to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Its inclusion has spurred research into how chronic food avoidance affects people across the lifespan.
Investigating how food avoidance affects adults has led researchers to note that many people who had challenges with food avoidance and restriction since early childhood were not identified and likely received little assistance with these challenges beyond their parents’ feeding strategies.
To address this, researchers at Duke University in a recent study asked a group of adults who identified themselves as “picky eaters” to reflect on their parents’ feeding strategies when they were children to better understand which strategies were perceived as helpful and which weren’t. The research team was led by Nancy Zucker, Ph.D., Juan Matias Di Martino, Ph.D., Guillermo Sapiro, Ph.D., and Young Kyung Kim, M.S. The study was supported in part by the National Institute of Mental Health.
Published in the International Journal of Eating Disorders, the study included 19,239 adult participants who self-identified as “picky eaters” and did not meet diagnostic criteria for eating disorders such as anorexia nervosa, bulimia nervosa, or binge-eating disorder. The participants included adults with self-identified symptoms of ARFID as shown through psychosocial functioning, weight loss or sustained low weight, or nutritional deficiency, as well as adults without ARFID. In a survey, participants were asked whether there were things their parents did or rules their parents had that helped or improved their eating, and if there were things their parents did that contributed to or worsened their picky eating.
The researchers used machine learning to objectively quantify and understand subjective memories to categorize parent feeding strategies as helpful or not helpful. They found that participants thought feeding strategies seen as coercive were not helpful in increasing their food variety. Coercive strategies included being forced to eat something, parents becoming angry due to their food avoidance, and not being allowed to leave the table until they finished eating. On the other hand, participants thought parent strategies seen as encouraging and expressing an understanding of their challenges were helpful in expanding their food variety, increasing pleasure around food, and improving their enjoyment—or decreasing their stress—in social eating situations. Participants expressed this even if they continued to have some form of food avoidance in adulthood.
From these findings, the researchers concluded that creating a positive emotional context surrounding food and eating with others may help reduce psychosocial impairment and increase food variety in people with severe food avoidance. In addition, the researchers suggested that novel approaches like the machine learning used in this study have the potential to improve our understanding of challenges like ARFID and aid in the development of data-driven and evidence-based interventions.
The researchers acknowledged limitations of the study, including that the participants were all selective eaters, ARFID was diagnosed via self-report, and data relied on recollections of experiences that occurred many years prior to the study and are subject to biases and inaccuracies. Still, the researchers said their findings show clear patterns that distinguish helpful and unhelpful parent intervention strategies. Their findings suggest additional tools are needed to improve parent strategies and individuals’ capacity to try foods they’ve avoided and cope with challenging eating situations.