Rogers researchers and clinicians are working to make diagnosis and treatment of a relatively new eating disorder diagnosis clearer, within the system and beyond.
As leading voices in better understanding Avoidant/Restrictive Food Intake Disorder, or ARFID, Rogers team members authored a scholarly paper recently published in the peer-reviewed journal International Journal of Eating Disorders. Authors of the publication include Rogers’ Hana Zickgraf, PhD, research psychologist; Sam Cares, PhD, Adult Residential Eating Disorder Recovery clinical psychologist; Rachel Schwartz, PhD, associate research psychologist; and Nicole Stettler, PhD, clinical executive director of Eating Disorder Services, along with Courtney Breiner, PhD, co-director of Bites of Treatment PLLC.
The published paper argues current ARFID criteria are inadequate for research and diagnosis, aiming to clear confusion with new proposed criteria that could enhance both research and clinical diagnosis and subsequent treatment.
“Under the current diagnostic criteria, ARFID easily overlaps with a lot of other disorders that might influence someone’s eating, but aren’t really eating disorders, such as severe contamination OCD where someone is very afraid of ingesting germs,” Dr. Zickgraf says. “That affects eating, but it is better understood and treated as OCD. it’s really important that the diagnostic criteria we have to standardize our assessments actually capture the condition we are trying to treat.”
“It matters too, because evidence-based interventions for ARFID are still very much in their infancy,” Dr. Cares says. “Clarifying diagnosis can bring us a long way in figuring out how to maximize the interventions that we are doing.”
ARFID was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. While ARFID has been a diagnosis for more than a decade, it remains relatively unknown within the general public, and it takes time for researchers, too, to better understand the condition and how to diagnosis and treat it.
“This is a perfect time to reexamine the diagnostic criteria and look at the clinical presentations and treatments,” Dr. Stettler says. “Just a few years ago, hardly anyone had heard of ARFID. Though it is still lesser known than other eating disorders such as anorexia and bulimia, I’m seeing much more awareness about ARFID, through blogs, articles, and on social media, as well as from patients and families. If we can get even more clear on the specific presentations of ARFID and the factors and symptoms involved, as well as and the most effective treatments, that’s going to be even more helpful for patients and families.”
Dr. Stettler says Rogers’ current clinical practices already align with the treatment implications of the stance taken within the publication.
“This published paper is a reflection of Rogers’ leadership and expertise in the area,” Dr. Stettler says.
That expertise makes a difference. For example, Dr. Cares pointed out that Dr. Zickgraf is a developer of one of the few ARFID symptom measures that is used in the field. Additionally, Rogers has treated more than 400 patients with ARFID since 2018, which Dr. Zickgraf says provides the largest sample of ARFID patients yet for any research study. With that data, she says we can learn even more to better understand the eating disorder.
“Our measurement-based care is a huge part of that, based upon the idea that treatment should target the mechanisms, such as thoughts and behaviors, that actually maintain symptom severity,” Dr. Zickgraf says. “Rogers is in a great position to make big contributions to the field of describing ARFID and also treating it.”
You can read the paper, “Toward a Specific and Descriptive Definition of Avoidant/Restrictive Food Intake Disorder: A Proposal for Updated Diagnostic Criteria,” here.
