Frequency and Predictors of Shape/Weight Concerns and Objective Binge Eating in Avoidant/Restrictive Food Intake Disorder (ARFID)

Abstract

Objective: DSM-5 prohibits the diagnosis of avoidant/restrictive food intake disorder (ARFID) in the context of clinically significant shape/weight concerns. However, emerging data suggest that ARFID and shape/weight concerns may co-occur, and DSM-5-TR now permits comorbid binge-eating disorder alongside ARFID. We compared shape/weight concerns in adults with ARFID to healthy controls (HCs) and nonclinical norms; assessed the frequency of clinical-level shape/weight concerns and past-month objective binge episodes (OBE); and identified ARFID characteristics linked to elevated shape/weight concerns and OBEs. We hypothesized that individuals with ARFID would exhibit lower shape/weight concerns than HCs and nonclinical norms, that none would exhibit clinical-level shape/weight concerns, and that higher weight would predict greater shape/weight concerns. Our examination of OBEs was exploratory.

Method: Participants with ARFID (N = 83) and HCs (N = 41) completed the Eating Disorder Examination-Questionnaire (EDE-Q).

Results: Adults with ARFID scored significantly higher than HCs but significantly lower than nonclinical norms on shape/weight concerns. Two percent exhibited clinical-level shape/weight concerns, and 15% reported past-month OBEs. Higher weight uniquely predicted shape/weight concerns.

Discussion: Shape/weight concerns are lower in ARFID than in the general population, and a small proportion of adults with ARFID-particularly those at higher weights-may experience clinical-level shape/weight concerns and OBEs.

Keywords: Eating Disorder Examination—Questionnaire; avoidant/restrictive food intake disorder; body image dissatisfaction; body mass index; eating disorders; feeding and eating disorder; shape concern; weight concern; weight status.