ARFID in ASD — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryARFID in ASDMRCPsych Paper B

A 6-year-old girl with autism spectrum disorder has eaten only five familiar foods for the past year, selecting them according to their texture and appearance. She becomes markedly distressed when unfamiliar foods are presented. Blood tests show iron and vitamin D deficiencies. She has no concerns about her weight or body shape, does not binge or use compensatory behaviours, and does not eat non-food substances. What is the most likely diagnosis?

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Correct answer: E — Avoidant/restrictive food intake disorder

The diagnosis is avoidant/restrictive food intake disorder (ARFID). Her severe restriction is driven by sensory characteristics of food and has caused objective nutritional deficiency. The absence of weight or shape concerns distinguishes ARFID from anorexia nervosa, while the absence of binge eating and compensatory behaviour excludes bulimia nervosa. Pica involves persistent ingestion of non-food substances rather than avoidance of ordinary foods. Developmentally typical picky eating does not usually produce substantial nutritional deficiency or this degree of distress and functional impairment. Sensory-related food avoidance is common in autism, but autism alone does not establish ARFID; the clinically significant nutritional consequences make ARFID the appropriate additional diagnosis.

Reference: Royal College of Psychiatrists. Avoidant/restrictive food intake disorder (ARFID), sections 'What is ARFID?', 'What are the signs of ARFID?' and 'Who is most likely to get ARFID?', 2022. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/avoidant-restrictive-food-intake-disorder-%28arfid%29