TOPLINE:

A systematic review finds that avoidant/restrictive food intake disorder (ARFID) occurs in patients with gastrointestinal (GI) disorders, but inconsistent diagnostic methods may overestimate its prevalence.

METHODOLOGY:

• ARFID is a relatively new eating disorder diagnosis added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. Its symptoms often overlap with those of GI conditions, complicating diagnosis.
• Researchers conducted a systematic review of 23 studies published between 2020 and 2025 to examine how ARFID was identified and defined and to characterize patients with ARFID and comorbid GI disorders.
• The review included data from 6211 individuals with various GI disorders; 18 studies involved adults (age range, 17-90 years), four focused on pediatric populations (age range, 1-18 years), and one included both groups.
• Studies were predominantly cross-sectional (20 studies) and conducted in tertiary specialized clinics or hospitals in the United States, using self-reported surveys, retrospective chart reviews, or both.
• Study quality was assessed using a validated 13-item tool developed for systematic reviews of heterogeneous study designs.

TAKEAWAY:

• Of 23 studies, 14 used the full DSM‑5 criteria to identify ARFID, whereas nine relied on symptom screening alone; overall, 1975 cases of ARFID were identified, but only 651 (33%) met full DSM-5 criteria.
• Fear of aversive GI consequences was the most commonly reported ARFID symptom (nine studies); eight studies reported concurrent manifestations and overlapping symptoms (eg, lack of appetite and fear of aversive consequences); and four identified fear of nausea, bloating, abdominal pain, and vomiting as key, often coexisting drivers. None assessed whether symptoms were directly attributable to underlying GI disorder.
• Medical consequences such as weight loss or inability to gain weight, nutritional deficiencies, and need for supplementary feeding were documented in 10 studies; 15 studies reported BMI (generally within the normal range); 13 reported functional or psychosocial impairment affecting academics/work, social life, and relationships; and seven reported psychiatric comorbidities of anxiety and/or depression.
• Reported ARFID prevalence varied widely, from 6.3% to 82% in adults and 8% to 66.7% in pediatric populations ; studies using self‑reported surveys showed higher rates (11%-76.6%) than those using DSM‑5-based chart review (6.3%-33%).

IN PRACTICE:

"These findings highlight the importance of healthcare professionals recognizing ARFID symptoms and the necessity for additional longitudinal studies to establish the temporal relationship between GI symptoms and ARFID," the authors wrote.

SOURCE:

The study was led by Sissel Bekker Henriksen, Research Unit Psychiatry South West (Aabenraa), Department of Regional Health Research, University of Southern Denmark, Odense. It was published online in the Journal of Human Nutrition and Dietetics.

LIMITATIONS:

Data extraction by a single author, although verified by others, may have introduced bias. Minimal variation in study quality limited the assessment tool's discriminatory value. Most studies were conducted in highly specialized US tertiary care settings, which may limit generalizability.

DISCLOSURES:

No specific funding was reported. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.