SCIENTIFIC
Avoidant-Restrictive Food Intake Disorder in a 68-Year-Old
AUTHORS : Blair Burnette , PhD 1 , 2
Adina Bowe , MD 2 , 3 , 4 Jessica Luzier , PhD , ABPP , CEDS-S 2 , 4
1
Charleston Area Medical Center
2
Department of Behavioral Medicine and Psychiatry , West Virginia University School of Medicine Charleston Division
3
Department of Internal Medicine , West Virginia University School of Medicine Charleston Division
4
Charleston Area Medical Center Institute for Academic Medicine
CASE PRESENTATION
A 68-year-old woman was referred to an outpatient feeding and eating disorder ( FED ) treatment clinic by her family medicine ( FM ) physician due to chronic nausea , abdominal pain , weight loss , and severely low body mass index ( BMI ). She experienced constant nausea and lack of interest in food and avoided eating as much as pos
ABSTRACT
Avoidant-restrictive food intake disorder ( ARFID ) is a feeding / eating disorder characterized by malnourishment due to highly restrictive eating patterns . Behaviors may be directly related to lack of interest in food , sensory / textural preferences , or fears of the aversive consequences of eating . The following is a case report of a 68-year-old woman who presented more than 30 times to a family medicine clinic within a 3.5 year time span for chronic nausea , abdominal pain , and weight loss . An extensive medical evaluation was unremarkable . Due to severely low body mass index and non-adherence with nutritional recommendations , the patient was referred to a specialty outpatient clinic that cared for individuals with disordered eating and was diagnosed with ARFID . In order to raise awareness about ARFID , the diagnostic criteria and screening / assessment information are provided . Special emphasis is placed on screening and early detection by primary care clinicians to ensure individuals with ARFID receive appropriate treatment in a timely manner . sible because she feared she would experience abdominal discomfort , vomiting , or gastrointestinal ( GI ) upset . The patient exhibited restricted and rigid eating patterns ( e . g ., inflexible schedule of what and when she ate each week ). At presentation , her typical daily diet consisted of a small sliver of cake for breakfast , a few bites of deli chicken salad for lunch , and a minuscule portion of a highly regimented dinner that varied based on the day ( e . g ., dish prepared by special request at specific restaurant on Monday , predetermined sandwich for dinner every Tuesday , etc ). She was fearful of eating during the day , so she ate dinner late in the evening and went to bed immediately afterward to “ avoid sensations of food in her stomach .” The patient consumed laxatives daily in hopes of controlling the timing of her bowel movements , and she admitted to worrying about several bowelrelated issues , such as needing to have a bowel movement at an inconvenient time , experiencing abdominal discomfort , developing a bowel obstruction requiring surgery , or needing to use a suppository .
BMI
17 16.5
16 15.5
15 14.5
14 13.5
13 12.5
12 11.5
FIGURE 1 : BMI at Family Medicine and Emergency Department Visits
12.40
12.77
12.43
11 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 Month of Visit
ER FM
12.74
12.67
12 . 94
Body mass index ( BMI ) at family medicine ( FM ) and emergency department ( ED ) visits . All BMI values indicate visits when a potential FED was mentioned in the provider note , and the underlined BMI value indicates that a referral for specialized FED care was initiated .
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