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ARFID — MRCPsych Paper B MCQ

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HardEating DisordersARFIDMRCPsych Paper B

A 26-year-old man has progressively excluded foods he considers processed, artificial or impure. He spends several hours each day researching, sourcing and preparing “clean” food, becomes markedly anxious and guilty if he breaches his dietary rules, and no longer attends social events involving food. He has developed iron and vitamin B12 deficiencies, although his BMI is within the healthy range. He will eat energy-dense foods if he regards them as natural and pure. The restriction is not driven by sensory characteristics, low appetite, fear of choking or vomiting, or concerns about weight, body shape or muscularity. Which emerging descriptive concept best captures this presentation?

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Correct answer: D — Orthorexia nervosa

Orthorexia nervosa is the best descriptive concept. Its proposed core features include pathological preoccupation with eating foods perceived as healthy or pure, rigid dietary rules, distress following rule violations, and resulting nutritional or psychosocial impairment. It remains an emerging construct rather than a standardised ICD-11 or DSM-5-TR diagnosis. ARFID can also cause nutritional deficiency and social impairment, but its characteristic motivations are sensory sensitivity, low interest or appetite, or fear of aversive consequences such as choking or vomiting; these are specifically absent. Muscle dysmorphia centres on perceived insufficient muscularity, not dietary purity. Binge-eating disorder requires recurrent binge episodes, while pica involves persistent consumption of non-food substances.

Reference: Donini LM et al. A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders, 2022. https://pubmed.ncbi.nlm.nih.gov/36436144/