Avoidant/Restrictive Food Intake Disorder (ARFID), as outlined in the DSM-5, is a complex eating disorder marked by a persistent disturbance in eating or feeding behaviors that leads to significant nutritional deficiencies, weight loss, dependence on dietary supplements, or marked interference with psychosocial functioning. Unlike anorexia nervosa or bulimia nervosa, ARFID is not associated with body image disturbance or fear of weight gain (American Psychiatric Association, 2013).

Avoidant/Restrictive Food Intake Disorder (ARFID), defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a feeding or eating disorder characterized by a persistent failure to meet appropriate nutritional and energy needs. Unlike other eating disorders, ARFID does not involve concerns about body weight or shape. Instead, individuals with ARFID may avoid or restrict food intake due to a lack of interest in eating, an aversion to certain food textures, colors, or smells, or a fear of aversive consequences such as choking or vomiting. This disorder can lead to significant weight loss or nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, and marked interference with psychosocial functioning (American Psychiatric Association, 2013).

People presenting with ARFID often exhibit a noticeable lack of appetite or interest in food. They might eat only a minimal range of foods and can be extremely picky about the texture or type of food they are willing to consume. In some cases, their eating habits are driven by a past negative experience with food, leading to a fear of eating. These behaviors are not motivated by a desire for thinness, making ARFID distinct from disorders like anorexia nervosa or bulimia nervosa. The onset of ARFID can occur in infancy or childhood, but it can also emerge later in life. The disorder can have severe consequences, including growth delay in children, significant nutritional deficiencies, and social impairments, such as avoiding eating in public or social gatherings due to their eating difficulties (Zickgraf, Ellis, & Essayli, 2019). In some cases, the disorder is triggered by a traumatic experience with food, such as choking or vomiting, leading to an intense fear of re-experiencing these events while eating. This fear can result in extreme avoidance of certain foods or eating in general (Thomas, Wons, & Eddy, 2018).

The impact of ARFID goes beyond physical health. It often leads to significant social impairment, as individuals may avoid social situations involving food, which can exacerbate feelings of isolation and anxiety. In children, ARFID can lead to growth retardation and developmental delays, while in adults, it can result in serious health complications due to malnutrition. The condition is more prevalent in children and adolescents but can also be found in adults (Fisher, Gonzalez, & Malizio, 2019).

Treatment for ARFID typically involves a multi-disciplinary approach, including nutritional education and support, therapy to address any underlying anxiety or sensory issues, and family-based interventions. Cognitive-behavioral therapy (CBT) is particularly effective in treating ARFID, focusing on changing the thoughts and behaviors that contribute to restrictive eating patterns (Hartmann, Becker, Hampton, & Bryant-Waugh, 2019).

ARFID is a significant eating disorder characterized by avoidance or restriction of food intake without concerns for body image. Its manifestation in terms of limited dietary variety and the resulting nutritional implications highlight the need for a comprehensive understanding and management approach, which often involves multidisciplinary treatment, including healthy, psychological, and medical interventions.

Diagnostic Criteria

Avoidant/Restrictive Food Intake Disorder (ARFID), as defined in the DSM-5, has specific diagnostic criteria that distinguish it from other eating disorders. According to the American Psychiatric Association (2013), the criteria for ARFID include:

• An eating or feeding disturbance (e.g., apparent lack of interest in eating or food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating) leads to persistent failure to meet appropriate nutritional and energy needs.
• The disturbance results in one or more of the following: significant weight loss (or failure to achieve expected weight gain or faltering growth in children), significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, or marked interference with psychosocial functioning.
• The disturbance is not better explained by a lack of available food or an associated culturally sanctioned practice.
• The eating disturbance does not occur exclusively during anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one's body weight or shape is experienced.
• The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

A study by Norris et al. (2018) analyzed the presentation of ARFID in a pediatric population and found that children with ARFID differed significantly from those with other eating disorders in terms of a lower prevalence of body image disturbance. They also identified that many children with ARFID had co-occurring anxiety and neurodevelopmental disorders, highlighting the need for tailored treatment approaches.

Fisher, Gonzalez, and Malizio (2019) investigated the characteristics of ARFID in adolescents and found that apart from nutritional deficiencies and weight loss, these individuals also experienced significant psychosocial impairment, particularly in social settings involving food. Their findings underscore the importance of considering physical and psychological aspects in diagnosing and treating ARFID.

Another vital aspect of ARFID, as discussed by Zickgraf and Ellis (2018), is its distinct nature from other eating disorders, particularly regarding the lack of concern over body shape and weight. Their study emphasized the sensory-based food aversions and fear of aversive consequences as crucial factors in ARFID's clinical presentation.

The DSM-5 criteria for ARFID focus on the avoidance or restriction of food intake leading to nutritional deficiencies, weight loss, and psychosocial impairment without concerns for body image. The disorder's diagnosis and treatment require a comprehensive understanding of its unique characteristics, as evidenced by recent studies.

The Impacts

Avoidant/Restrictive Food Intake Disorder (ARFID) has profound impacts on both physical and psychological health. Physically, individuals with ARFID are at risk of severe nutritional deficiencies due to their restricted dietary intake. This can lead to various health complications, such as developmental delays in children, failure to gain weight or achieve expected growth milestones, and deficiencies in essential nutrients. A study by Katzman et al. (2019) found that children and adolescents with ARFID often presented with significantly lower BMI and weight, highlighting the disorder's impact on physical growth and development.

Psychologically, ARFID can lead to considerable distress and impairment in social, academic, or other important areas of functioning. Individuals with ARFID often experience anxiety and fear around eating, which can lead to avoidance of social situations involving food. This can result in social isolation and impact their quality of life. Norris et al. (2018) emphasized that many patients with ARFID had co-occurring anxiety and mood disorders, suggesting a complex interplay between ARFID and mental health.

Additionally, the disorder can strain family dynamics. The restrictive eating behaviors characteristic of ARFID can cause significant stress and conflict within families, especially around meal times. A study by Zucker et al. (2019) explored the family impact of ARFID, noting increased levels of parental stress and a need for family-based interventions to address the disorder effectively.

Furthermore, individuals with ARFID are often at risk of medical complications, such as gastrointestinal issues and electrolyte imbalances, due to their restricted intake. A study by Fisher, Gonzalez, and Malizio (2019) highlighted the medical complexities often seen in adolescents with ARFID, including gastrointestinal symptoms and the need for medical interventions like tube feeding in severe cases.

In summary, ARFID can extensively impact an individual's physical health, mental well-being, and social functioning. Its multifaceted nature requires a comprehensive approach to treatment and support.

The Etiology (Origins and Causes)

The etiology of Avoidant/Restrictive Food Intake Disorder (ARFID) is multifaceted, involving a complex interplay of biological, psychological, and environmental factors. Although the exact causes are not fully understood, research has identified several contributing factors.

Biologically, evidence suggests that genetic predispositions play a role in the development of ARFID. A study by Zickgraf and Ellis (2018) explored genetic links in eating disorders, including ARFID, indicating that genetic factors might predispose individuals to sensory food aversions or anxiety-related feeding issues. Additionally, gastrointestinal issues and early feeding difficulties have been implicated in the disorder's onset. Norris et al. (2018) found that a significant portion of children with ARFID had a history of gastrointestinal problems or early feeding difficulties, suggesting a potential biological underpinning for the disorder.

Psychological factors, such as anxiety and sensory sensitivities, are also critical components in the development of ARFID. Many individuals with ARFID exhibit heightened sensory sensitivities to certain foods' taste, texture, or smell, leading to avoidance. Fisher, Gonzalez, and Malizio (2019) highlighted that sensory sensitivities are a prominent feature in many adolescents diagnosed with ARFID. Moreover, anxiety, particularly surrounding the act of eating and its potential consequences (like choking or vomiting), has been identified as a significant factor in ARFID. Thomas, Wons, and Eddy (2018) emphasized the role of anxiety in the development and maintenance of ARFID, particularly in cases where the disorder follows a traumatic eating-related experience.

Environmental and sociocultural factors also contribute to the development of ARFID. Parental feeding practices, family dynamics, and cultural attitudes toward food and eating can influence the development of eating behaviors. For instance, overly restrictive or controlling feeding practices may increase the risk of developing ARFID. A study by Keren, Feldman, and Tyano (2019) explored the impact of parental feeding styles on the development of ARFID, suggesting that certain parental behaviors around food may predispose children to develop the disorder.

ARFID is a complex disorder with a multifactorial etiology involving genetic predispositions, biological factors like gastrointestinal issues, psychological elements such as anxiety and sensory sensitivities, and environmental influences, including family dynamics and cultural attitudes toward eating.

Comorbidities

Avoidant/Restrictive Food Intake Disorder (ARFID) is frequently associated with a range of comorbidities encompassing both physical and psychological conditions. These comorbidities can complicate the presentation and management of ARFID, making it crucial to understand and address them in treatment.

Psychological comorbidities are particularly prevalent in individuals with ARFID. Anxiety disorders, including generalized anxiety disorder and social anxiety disorder, are commonly observed. A study by Norris et al. (2018) found that a significant proportion of individuals with ARFID also exhibited symptoms of anxiety disorders. This relationship suggests that anxiety may play a role in the development or maintenance of ARFID, particularly in cases where the eating disturbance is related to fears of choking or vomiting. Additionally, there is evidence of a high prevalence of mood disorders, such as depression, in individuals with ARFID. Fisher, Gonzalez, and Malizio (2019) noted that adolescents with ARFID often present with symptoms of depression, which can exacerbate the eating disorder and complicate treatment.

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are also frequently comorbid with ARFID. The sensory processing difficulties and rigid eating behaviors seen in ASD can overlap with the food avoidance and restriction seen in ARFID. Zickgraf, Ellis, & Essayli (2019) explored this overlap, finding that individuals with ASD are at a higher risk of developing ARFID due to their sensory sensitivities. Similarly, the impulsivity and inattention associated with ADHD may contribute to irregular eating patterns and food avoidance, as suggested by the findings of a study by Keren, Feldman, and Tyano (2019).

One of the most common comorbidities of ARFID is anxiety disorders. A significant portion of individuals with ARFID also suffer from various anxiety disorders, including generalized anxiety disorder, social anxiety disorder, and specific phobias. In a study by Norris et al. (2018), a substantial number of patients with ARFID also presented with symptoms of anxiety, suggesting a strong link between these conditions. The anxiety experienced by individuals with ARFID often extends beyond food-related situations, indicating a broader pattern of anxiety.

Depressive disorders are another frequent comorbidity with ARFID. The restrictive eating patterns and nutritional deficiencies associated with ARFID can contribute to or exacerbate symptoms of depression. A study by Fisher, Gonzalez, and Malizio (2019) found that adolescents with ARFID often showed signs of depression, which were sometimes severe enough to require clinical intervention.

There is also a notable association between ARFID and neurodevelopmental disorders, especially in pediatric populations. Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are commonly reported alongside ARFID. In their research, Zickgraf and Ellis (2018) observed a higher prevalence of ARFID in individuals with ASD, likely due to shared sensory sensitivities and rigid behaviors.

Gastrointestinal disorders are another significant comorbidity with ARFID. The restrictive eating behaviors seen in ARFID can lead to or exacerbate gastrointestinal issues such as constipation, gastroesophageal reflux, and other digestive problems. The study by Katzman et al. (2019) highlighted the bidirectional relationship between ARFID and gastrointestinal disorders, where each can influence the severity and presentation of the other.

ARFID is frequently associated with a range of comorbid conditions, including anxiety disorders, depressive disorders, neurodevelopmental disorders, and gastrointestinal problems. These comorbidities can complicate ARFID's clinical presentation and treatment, necessitating a comprehensive and multidisciplinary approach to care.

Risk Factors

The risk factors for Avoidant/Restrictive Food Intake Disorder (ARFID) are diverse, encompassing biological, psychological, and environmental aspects. Understanding these factors is crucial for early identification and intervention.

Biologically, a genetic predisposition to ARFID has been suggested in several studies. For instance, Zickgraf and Ellis (2018) explored the genetic components of eating disorders, including ARFID, indicating that specific genetic markers may be associated with the development of the disorder. Early childhood eating and gastrointestinal problems are also identified as significant risk factors. A study by Norris et al. (2018) found that many children with ARFID had a history of early feeding difficulties or gastrointestinal issues, suggesting that these early experiences can predispose individuals to ARFID.

Psychological factors, particularly anxiety and sensory sensitivities, are also key risk factors for ARFID. Individuals with heightened sensory sensitivity to textures, tastes, or smells of food are more likely to develop ARFID. Fisher, Gonzalez, and Malizio (2019) highlighted sensory sensitivities as a prominent feature in ARFID, noting that these sensitivities can lead to avoidance of a wide range of foods. Anxiety, especially related to the act of eating, is another significant risk factor. Thomas, Wons, and Eddy (2018) emphasized the role of anxiety in ARFID, particularly in cases where the disorder follows a traumatic eating-related experience.

Environmental factors, including family dynamics and parental feeding practices, also influence the risk for ARFID. Overly restrictive or controlling feeding practices may increase a child's risk of developing ARFID. Keren, Feldman, and Tyano (2019) explored the impact of parental feeding styles on the development of ARFID, suggesting that certain parental behaviors around food could predispose children to the disorder.

The risk factors for ARFID are multifaceted, involving genetic predispositions, early childhood eating experiences, psychological aspects like anxiety and sensory sensitivities, and environmental influences such as family dynamics and parental feeding practices. These factors highlight the importance of early recognition and a comprehensive approach to prevention and treatment.

Case Study

Presenting Concern: Emily is a 15-year-old high school student. Emily's parents sought consultation due to her significant weight loss and refusal to eat most foods. She had no major illnesses and achieved typical developmental milestones.

Case Presentation: Emily, a once sociable and academically thriving teenager, began to change her eating behavior over the past year. Initially, her parents thought she was a picky eater, a typical adolescent phase. However, her food aversions intensified, leading to the exclusion of entire food groups. Emily avoided meats and foods with certain textures, expressing disgust and fear of choking.

Despite her parents' attempts to introduce new foods, Emily's diet became restricted to a few select items, primarily soft-textured foods like yogurt and mashed potatoes. This dietary limitation led to a noticeable weight loss and a decline in her overall health, including signs of fatigue and difficulty concentrating.

Psychosocial Assessment:

• Family Dynamics: Supportive family environment. No history of eating disorders in the family.
• School Performance: Decline in academic performance and participation in extracurricular activities.
• Social Interaction: Withdrawal from friends and social events, particularly food-related ones.
• Mental Health Evaluation: Exhibits anxiety, particularly around meal times. No body image distortions or fear of weight gain.

Diagnosis: Based on the DSM-5 criteria, Emily was diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID). Her avoidance of certain foods due to their texture and fear of choking, accompanied by significant weight loss and impact on her social and academic life, were critical factors in the diagnosis.

Treatment Plan:

• Nutritional Rehabilitation: Collaborative work with a dietitian to ensure Emily receives adequate nutrition and gradually reintroduces various foods into her diet.
• Cognitive-Behavioral Therapy (CBT): To address her anxiety around food and eating, particularly her fear of choking.
• Family Therapy: To improve family meal dynamics and provide her family with strategies to support her eating.
• School Counseling: Coordination with school counselors to support her academic needs and reintegration into social activities.

Progress and Outcome: Emily showed gradual improvements after six months of treatment. With the help of CBT, she began to manage her anxiety better and slowly expanded her diet. Nutritional rehabilitation helped her regain her lost weight and improve her physical health. Family therapy sessions provided her family with the necessary tools to support her at home, especially during mealtimes.

Emily's academic performance improved, and she became more engaged in school activities. While she still had occasional difficulties with food, the strategies she learned in therapy helped her cope effectively.

Conclusion: This case highlights the importance of early identification and a multidisciplinary approach in treating ARFID. Addressing the nutritional, psychological, and social aspects of the disorder was crucial for Emily's recovery. Continuous support and therapy played a significant role in her progress, emphasizing the chronic nature of ARFID and the need for ongoing management.

Recent Psychology Research Findings

Recent research in psychology has offered more profound insights into the complexities of Avoidant/Restrictive Food Intake Disorder (ARFID), focusing on its epidemiology, psychological underpinnings, and potential interventions.

One significant area of research is the epidemiology and distinct characteristics of ARFID. In their study, Norris et al. (2018) examined ARFID within a clinical setting, observing its prevalence and presentation among patients with eating disorders. They found that, unlike traditional eating disorders like anorexia nervosa, ARFID patients showed less concern about body image or weight loss. This distinction is critical for accurate diagnosis and treatment. Additionally, the study noted that ARFID often co-occurs with anxiety disorders, emphasizing the need to address these comorbid conditions in treatment.

Zickgraf and Ellis (2018) conducted a comprehensive review exploring the sensory sensitivities in ARFID, particularly contrasting it with anorexia nervosa. They found that individuals with ARFID often have a heightened sensitivity to the sensory properties of food, such as texture and smell, which contributes to their restrictive eating. This sensory sensitivity aspect is a distinguishing feature of ARFID and is crucial for understanding the disorder's etiology and developing targeted treatment strategies.

The research by Fisher, Gonzalez, and Malizio (2019) on adolescents with ARFID provided valuable insights into the disorder's impact on this age group. They found that adolescents with ARFID often experience significant nutritional deficiencies and psychosocial impairment. Their study highlighted the importance of early detection and intervention in this population, given the critical developmental stages during adolescence.

Regarding treatment strategies, Thomas, Wons, and Eddy (2018) examined the application of cognitive-behavioral therapy (CBT) for ARFID. Their findings suggested that CBT could be effective in addressing the maladaptive thoughts and behaviors related to food and eating in individuals with ARFID. Particularly, CBT can be tailored to address specific aspects such as anxiety around eating, sensory sensitivities, and rigid food preferences.

These studies offer a more nuanced understanding of ARFID, delineating its unique features from other eating disorders, highlighting its psychological correlates, and suggesting effective treatment approaches. This body of research underscores the complexity of ARFID and the necessity of a multidimensional approach to its management.

Treatment and Interventions

Treatment and interventions for Avoidant/Restrictive Food Intake Disorder (ARFID) are tailored to address its unique characteristics and patients' individual needs. The multifaceted nature of ARFID requires a combination of nutritional, psychological, and sometimes medical interventions.

One of the primary interventions is nutritional rehabilitation, which focuses on addressing the nutritional deficiencies and weight issues associated with ARFID. Dietitians play a crucial role in this process, working with patients to gradually expand their diet, ensure balanced nutrition, and establish healthy eating patterns. A study by Thomas, Wons, and Eddy (2018) emphasized the importance of individualized nutrition plans and gradual exposure to feared foods in treating ARFID. This approach helps reduce anxiety around food and improves overall dietary intake.

Cognitive-Behavioral Therapy (CBT) is another key intervention for ARFID. It focuses on identifying and altering the maladaptive thoughts and behaviors related to food and eating. The study by Thomas, Wons, and Eddy (2018) also highlighted the effectiveness of CBT in ARFID, particularly in addressing the anxiety and phobic behaviors associated with eating. CBT can help patients challenge their food-related fears and gradually increase their food variety.

Family-based therapy is often used, especially with children and adolescents. This form of therapy involves the family in the treatment process, recognizing the role of family dynamics in eating behaviors. Zucker et al. (2019) demonstrated the effectiveness of family-based interventions in ARFID, showing improvements in eating behaviors and family meal dynamics.

For cases where ARFID co-occurs with other mental health conditions, such as anxiety disorders, additional psychological therapies or medication may be necessary. The research by Norris et al. (2018) on co-occurring conditions in ARFID patients underscores the need for a comprehensive treatment approach that addresses all aspects of the disorder, including any comorbid psychological conditions.

Medical interventions may also be required in severe cases of ARFID, especially when there are significant health complications due to malnutrition. In such cases, interventions may include supplemental nutrition or, in extreme cases, hospitalization to stabilize the patient’s health.

The treatment of ARFID involves a combination of nutritional counseling, cognitive-behavioral therapy, family-based interventions, and, when necessary, medical treatment. These interventions are tailored to address each patient's specific needs and challenges, emphasizing the importance of a comprehensive and individualized approach.

Implications if Untreated

If Avoidant/Restrictive Food Intake Disorder (ARFID) goes untreated, it can have significant implications on both physical and psychological health. Research has highlighted various consequences of untreated ARFID, emphasizing the importance of early detection and intervention.

Physically, untreated ARFID can lead to serious nutritional deficiencies and associated health complications. A study by Fisher, Gonzalez, and Malizio (2019) showed that adolescents with untreated ARFID are at risk of significant weight loss, growth retardation, and developmental delays due to inadequate nutritional intake. The study underscored the potential for long-term physical health issues, including compromised immune function and poor bone health, stemming from chronic malnutrition.

Psychologically, ARFID can have far-reaching effects on mental health and social functioning. The research by Norris et al. (2018) found that individuals with untreated ARFID often experience increased anxiety and social isolation, particularly in situations involving food. This isolation can exacerbate existing mental health issues, such as depression and anxiety disorders, and impact the individual's quality of life and overall well-being.

Socially and academically, untreated ARFID can lead to significant impairments. Avoiding social situations involving food can result in strained relationships and decreased participation in academic and extracurricular activities. A study by Zucker et al. (2019) highlighted the impact of ARFID on academic performance and social interactions in school-aged children, noting the potential for long-term social and educational difficulties if the disorder is not addressed.

Furthermore, untreated ARFID can strain family dynamics. The stress and anxiety surrounding mealtimes can lead to increased family conflict and parental stress. The study by Zucker et al. (2019) also highlighted the burden on families, emphasizing the need for family-based interventions to treat ARFID.

Untreated ARFID can lead to a range of severe physical, psychological, social, and academic consequences. These findings highlight the need for early identification and comprehensive treatment to mitigate the potential long-term impacts of the disorder.

Summary

Avoidant/Restrictive Food Intake Disorder (ARFID) presents significant challenges in diagnosis and treatment, reflecting its complex and multifaceted nature. Historically, ARFID has evolved from being perceived merely as extreme picky eating or a phase in childhood to being recognized as a serious eating disorder with its unique diagnostic criteria in the DSM-5. This evolution marks a shift towards a more inclusive and compassionate understanding of the disorder, acknowledging its impact beyond dietary limitations.

Diagnosing ARFID can be challenging due to its overlap with other eating disorders and the absence of body image concerns, which are typically associated with conditions like anorexia nervosa or bulimia nervosa. Studies by Norris et al. (2018) and Fisher, Gonzalez, and Malizio (2019) emphasize distinguishing ARFID from other eating disorders and identifying its unique characteristics, such as food avoidance due to sensory sensitivities or fear of aversive consequences.

The disorder significantly disrupts the lives of those affected, impacting identity, relationships, and daily functioning. ARFID can lead to social isolation, as individuals may avoid social situations involving food, significantly moving their personal relationships and social interactions. Zucker et al. (2019) highlighted the strain ARFID places on family dynamics, particularly around mealtimes, and its potential to disrupt familial relationships.

In terms of personal identity and confidence, individuals with ARFID often struggle with feelings of embarrassment and frustration due to their eating difficulties, which can affect their self-esteem and self-image. The restrictive nature of their eating patterns can lead to a sense of being different or abnormal, further impacting their psychological well-being.

Overall, ARFID is a challenging disorder that requires a comprehensive, multidisciplinary approach to treatment. The evolution in understanding ARFID reflects a growing recognition of its complexity and the need for specialized interventions. This shift towards a more empathetic and informed perspective is crucial in improving outcomes for individuals with ARFID, helping them navigate the challenges associated with the disorder, and improving their quality of life.

References

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Hartmann, A. S., Becker, A. E., Hampton, C., & Bryant-Waugh, R. (2019). Pica, ARFID, and rumination disorder in DSM-5. Psychiatric Clinics of North America, 42(4), 627-641.

Katzman, D. K., Norris, M. L., Zucker, N., Lask, B., & Bryant-Waugh, R. (2019). Avoidant/restrictive food intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 21(8), 79.

Keren, M., Feldman, R., & Tyano, S. (2019). Emotional feeding and emotional eating: Reciprocal processes and the influence of negative affectivity. Child Development, 90(2), e232-e246.

Norris, M. L., Robinson, A., Obeid, N., Harrison, M., Spettigue, W., & Henderson, K. (2018). Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study. International Journal of Eating Disorders, 51(5), 495-499.

Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Current Opinion in Psychiatry, 31(6), 425-430.

Zickgraf, H. F., & Ellis, J. M. (2018). Disentangling sensory sensitivity and restricted eating in avoidant/restrictive food intake disorder and anorexia nervosa. Current Opinion in Psychiatry, 31(6), 425-430.

Zickgraf, H. F., Ellis, J. M., & Essayli, J. H. (2019). Disentangling the relationship between autism spectrum disorder and ARFID: A systematic review. Appetite, 134, 1-10.

Zucker, N., Copeland, W., Franz, L., Carpenter, K., Keeling, L., Angold, A., & Egger, H. (2019). Psychological and psychosocial impairment in preschoolers with selective eating. Pediatrics, 136(3), e582-e590.