For many years those with Avoidant/Restrictive Food Intake Disorder (ARFID) have been labelled as extreme 'fussy eaters'.
The disorder is characterised by a person avoiding certain foods or types of food, having restricted intake in terms of overall amount eaten, or both, to the extent that individuals are unable to meet their nutritional needs. ARFID is known to have a significant impact on physical and psychological wellbeing, but it was only in 2013 that it was formally recognised in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Now an international team of scientists from the Netherlands, Australia, the USA and the UK, led by the University of Aberdeen, has identified structural brain differences in children who show symptoms of ARFID.
Dr Michelle Sader, a post-doctoral research fellow at the University of Aberdeen working on the Eating Disorders and Autism Collaborative (EDAC) research network (EDACResearch.co.uk), said: “Many people may experience fussy eating at some point in their lives, while Individuals with ARFID experience severe health and psychological consequences resulting from their disordered eating.
“There are three main underlying drivers behind food restriction associated with ARFID, which include sensory sensitivities in relation to food, lack of interest in food and fear of aversive consequences associated with eating, such as choking or vomiting.
“Some symptoms associated with ARFID may include an individual struggling to identify when they are hungry, consistently eating the same meals, having low dietary diversity, anxiety during mealtimes, or needing supplements to meet nutritional needs. Importantly, food restriction associated with ARFID is not due to lack of food availability or cultural practice, and it is not attributed to another mental disorder or other eating disorders such as anorexia nervosa or bulimia nervosa. ARFID can present on its own, or it can co-occur with other conditions – most commonly with autism, ADHD and anxiety.
“Previous research has highlighted that ARFID exhibits adverse physiological effects similar to restrictive eating disorders such as anorexia nervosa, but it is regarded as far less dangerous and thus less important to tackle.”
The team analysed the brain scans of 1,977 ten-year-old children from Generation R, a population-based cohort study in the Netherlands. From 1,977 children, 121 (6%) presented with symptoms of ARFID.
Their findings, published in the Journal of Child Psychology and Psychiatry, showed significantly greater cortical thickness - a measurement of the depth of the outer layer of the brain - in certain areas compared to those without ARFID symptoms.
Changes were most evident in the frontal and superior frontal regions which are associated with executive function. This includes things such as cognitive flexibility, also known as fluid or flexible thinking, and inhibition control – the ability to steer or manage thoughts, emotions and actions.
Dr Sader added: “Since the introduction of the ARFID diagnosis in 2013, no structural neuroimaging studies have been conducted in ARFID or ARFID-like populations.
“Our findings demonstrate that children presenting with symptoms of ARFID showed significantly greater cortical thickness in certain areas of the brain compared to those without ARFID symptoms, specifically in the frontal and superior frontal regions. These brain regions are associated with executive function and are particularly important for anticipation of conflict and inhibition control.
“This work assists researcher and clinician understanding of ARFID by identifying brain regions associated with the feeding and eating disorder and has potential to inform on approaches for ARFID treatment, management and support.”
Dr Gordon Waiter, Director of the Biomedical Imaging Centre at the University of Aberdeen, added; “The University of Aberdeen has a long tradition of using neuroimaging to answer complicated clinical questions and we hope this study will provide the impetus for further research into ARFID.
“To our knowledge, this is the first structural imaging study associated with ARFID, and findings from this study will act as a foundation for future imaging-related ARFID research”
Tom Quinn, Director of External Affairs at Beat said: 'We welcome the University of Aberdeen’s recent report ‘Far From Fussy Eaters’. ARFID can sometimes be downplayed as a phase, which is incredibly unfair considering the real impact the disorder has on those who experience it. There can be devastating impacts on nutrition, quality of life and overall physical and mental health.
“Although the condition can develop at any age, some children experiencing the disorder may not enter puberty because they aren’t able to eat a wide enough range of foods to meet their nutritional needs. There is a significant impact on their lives. This might mean they can’t eat out or at school, or work for example.
“While we recognise the importance of the University of Aberdeen’s fantastic research, these statistics also highlight the need for further research to build on these findings. There is much more that we need to learn before we fully understand how best to treat and ultimately prevent ARFID and other eating disorders.”