Prevalence of DSM‐5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network

Objective Few published studies have evaluated the clinical utility of new diagnostic criteria for avoidant/restrictive food intake disorder (ARFID), a DSM‐5 reformulation of feeding and eating disorder of infancy or early childhood. We examined the prevalence of ARFID and inter‐rater reliability of its diagnostic criteria in a pediatric gastrointestinal sample. Method We conducted a retrospective chart review of 2,231 consecutive new referrals (ages 8–18 years) to 19 Boston‐area pediatric gastroenterology clinics for evidence of DSM‐5 ARFID. Results We identified 33 (1.5%) ARFID cases; 22 of whom (67%) were male. Most were characterized by insufficient intake/little interest in feeding ( n  = 19) or limited diet due to sensory features of the food ( n  = 7). An additional 54 cases (2.4%) met one or more ARFID criteria but there was insufficient information in the medical record to confer or exclude the diagnosis. Diagnostic agreement between coders was adequate (κ = 0.72). Common challenges were (i) distinguishing between diagnoses of ARFID and anorexia nervosa or anxiety disorders; (ii) determination of whether the severity of the eating/feeding disturbance was sufficient to warrant diagnosis in the presence of another medical or psychiatric disorder; and (iii) assessment of psychosocial impairment related to eating/feeding problems. Discussion In a pediatric treatment‐seeking sample where ARFID features were common, cases meeting full criteria were rare, suggesting that the diagnosis is not over‐inclusive even in a population where eating/feeding difficulties are expected. © 2014 Wiley Periodicals Inc. (Inc. Int J Eat Disord 2015; 48:464–470)