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PURPOSE OF REVIEW: This review summarizes recent developments in cognitive-behavioural therapy for eating disorders (CBT-ED). More specifically, the past five years were covered, with the latest UK and Dutch guidelines for eating disorders as a starting benchmark, and with special consideration of the past 18 months.RECENT FINDINGS: The new research can be divided into findings that have: (1) reinforced our existing understanding of CBT-ED's models and impact; (2) advanced our understanding and the utility of CBT-ED, including its application for the 'new' disorder Avoidant/Restrictive Food Intake Disorder (ARFID); (3) suggested new directions, which require further exploration in clinical and research terms. These include learning from the circumstances of the COVID-19 pandemic.SUMMARY: CBT-ED has developed substantially in the past 5 years, with consolidation of its existing evidence base, further support for real-life implementation, extension of methods used, and the development of new approaches for working with younger people - particularly in the form of treatments for ARFID. Over the past 18 months, even more promising changes in delivery occurred in response to the COVID19 pandemic, showing that we can adapt our methods in order to work effectively via remote means. Challenges remain regarding poor outcomes for anorexia nervosa.

Purpose of review \ud \ud This review summarizes recent developments in cognitive-behavioural therapy for eating disorders (CBT-ED). More specifically, the past five years were covered, with the latest UK and Dutch guidelines for eating disorders as a starting benchmark, and with special consideration of the past 18 months.\ud \ud \ud \ud Recent findings \ud \ud The new research can be divided into findings that have: (1) reinforced our existing understanding of CBT-ED's models and impact; (2) advanced our understanding and the utility of CBT-ED, including its application for the ‘new’ disorder Avoidant/Restrictive Food Intake Disorder (ARFID); (3) suggested new directions, which require further exploration in clinical and research terms. These include learning from the circumstances of the COVID-19 pandemic.\ud \ud \ud \ud Summary \ud \ud CBT-ED has developed substantially in the past 5 years, with consolidation of its existing evidence base, further support for real-life implementation, extension of methods used, and the development of new approaches for working with younger people – particularly in the form of treatments for ARFID. Over the past 18 months, even more promising changes in delivery occurred in response to the COVID19 pandemic, showing that we can adapt our methods in order to work effectively via remote means. Challenges remain regarding poor outcomes for anorexia nervosa.

BackgroundYoung children with disordered feeding may be at increased risk for problematic eating in the future. This retrospective study attempts to identify predictors of later feeding problems.ObjectivesChildren (N = 236) with disordered feeding, who refrained from behavioral treatment after consultation at a tertiary treatment center for feeding and eating problems were followed-up after, on average, 6 years and 3 months (timepoint 2).MethodLogistic regressions were carried out with characteristics taken at intake (timepoint 1)—sex, pre/dysmaturity, gastro-intestinal disease, history of age-adequate feeding, syndrome/developmental impairment, autism spectrum disorder, comorbidity, age, and several variables of a restrictive- and selective food intake—and duration between timepoint 1 and 2, as predictor variables, and age-appropriate food intake at t2 as the dependent variable.ResultsDespite improvement over time, 63% did not reach an age-adequate food intake at t2. Predictors of age-inadequate food intake were: (a) older age; (b) sex (male), (c) longer duration between timepoint 1 and timepoint 2; (d) autism spectrum disorder; (e) selective texture choices and (f) lack of varied nutritional intake.ConclusionThis study shows that most untreated young children's feeding problems do not improve over years. Besides the advice to seek help at an early age, it seems especially recommended to treat (male) children with autism spectrum disorder and selective feeding patterns.

This study sought to determine the frequency of possible cases of avoidant/restrictive food intake disorder (ARFID) in a Portuguese sample of school-aged children and to assess the associations with child's internalizing problems, BMI z-score and body dissatisfaction, and parents' eating habits, attitudes and practices. We assessed 330 children through child's and parents'measures. Fifty-one (15.5%) children were possible cases of ARFID based on their symptom's presentation. There were no association between sex and possible cases of ARFID, and no significant differences between possible cases of ARFID and nonpossible cases of ARFID regarding age. Lower BMI z-score and anxiety/depression were associated with possible cases of ARFID., (undefined)

Background This case report discusses the presentation and treatment of a nine-year-old female with a history of significant weight loss and food refusal using a combined approach of Family-Based Treatment (FBT) and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C). Case presentation The patient was diagnosed with avoidant/restrictive food intake disorder (ARFID), separation anxiety disorder, and a specific phobia of choking, and subsequently treated with a modified version of FBT, in conjunction with the UP-C. At the end of treatment, improvements were seen in the patient’s weight and willingness to eat a full range of foods. Decreases in anxiety regarding eating/choking, fears of food being contaminated with gluten, and fears of eating while being away from parents were also observed. Conclusions These findings highlight promising results from this combined treatment approach, referred to as FBT + UP for ARFID. Further research is needed to evaluate the use of this treatment in patients presenting with a variety of ARFID symptoms.

Background Avoidant/Restrictive Food Intake Disorder (ARFID) is a comparatively new DSM-5 diagnosis. In an effort to better understand this heterogeneous patient group, this study aimed to describe the physical and psychological attributes of children and adolescents with ARFID, and to compare them to patients with full-threshold or atypical anorexia nervosa (AN). Methods Children and adolescents aged 7-to-19 years (N = 193) were examined upon presenting at a pediatric eating disorder center between July 2015 and December 2017. Data included diagnosis assessed via the semi-structured Eating Disorder Examination interview along with measures of anthropometrics, depression, anxiety, self-esteem, perfectionism and clinical impairment. Results Compared to AN and atypical AN (n = 87), patients with ARFID (n = 106) were significantly younger (12.4 vs. 15.1 years, p p p = .04). Patients with ARFID were less likely to be bradycardic (4.7% vs. 24.1%, p p = .001), admitted to the hospital (14.2% vs. 27.6%, p = .02), and have a diagnosis of depression (18.9% vs. 48.3%, p p = .0001). On self-report measures, patients with ARFID reported significantly fewer symptoms of depression, anxiety, perfectionism, clinical impairment, concerns about weight and shape, and higher self-esteem than patients with AN or atypical AN (all ps Conclusions Study results highlight the clinical significance of ARFID as a distinct DSM-5 diagnosis and the physical and psychological differences between ARFID and AN/atypical AN. The novel finding that ARFID patients are more likely than those diagnosed with AN to experience chronic, rather than acute, weight loss suggests important related treatment considerations.

The primary purpose of this study was to examine differences among youth with avoidant/restrictive food intake disorder (ARFID) by age, weight status, and symptom duration. A secondary goal was to report the frequencies of ARFID using DSM-5 clinical presentations (i.e., fear of aversive consequences, lack of interest in food, sensory sensitivities). Participants (N = 102), ages 8&ndash, 18 years, were recruited through an eating disorder service within a pediatric hospital. They were evaluated using semi-structured interviews and questionnaires. Patients were assigned to groups according to age, weight status, and symptom duration. Frequencies of clinical presentations, including combinations of DSM-5 categories, were also examined. Our findings suggest that adolescents presented with higher rates of Depression (p = 0.04). Youth with chronic ARFID symptoms presented with significantly lower weight (p = 0.03), and those with acute symptoms rated significantly higher suicidal ideation and/or self- harm (p = 0.02). Half of patients met criteria for more than one ARFID symptom presentation. This study provides preliminary evidence that youth with ARFID differ in clinical presentation depending on age, weight status, and symptom duration, and highlights safety concerns for those with acute symptoms of ARFID. High rates of overlapping symptom presentations might suggest a dimensional approach in the conceptualization of ARFID.

Author(s): Reilly, Erin E; Brown, Tiffany A; Gray, Emily K; Kaye, Walter H; Menzel, Jessie E | Abstract: ObjectiveLiterature providing clinical characterizations of avoidant/restrictive food intake disorder (ARFID) has proposed the occurrence of three functions for food refusal: fear of negative consequences, lack of hunger, or sensory sensitivity. Recent studies have suggested that these functions may be used to subtype patients presenting with ARFID; however, other work suggests that these categories are not mutually exclusive and instead represent neurobiological dimensions that can cooccur. The current study explored the potential cooccurrence of behavioural phenotypes in patients with ARFID presenting to a partial hospitalization program.MethodTwo raters conducted a retrospective chart review of patients with ARFID presenting to treatment from June 2014 to May 2018 (N = 59).ResultsRegarding cooccurrence of symptoms consistent with behavioural phenotypes, raters showed excellent agreement, and over 50% of the sample endorsed symptoms consistent with more than one phenotype. The sensory sensitivity phenotype was most common in the sample and frequently cooccurred with both other phenotypes.DiscussionResults suggest that multiple functions for food avoidance may be present within one individual. Future work should aim to further characterize individuals presenting with singular versus multiple phenotype characteristics.

Objective Avoidant/restrictive food intake disorder (ARFID) is a new diagnosis in the DSM‐5 Feeding and Eating Disorders section, for which very limited treatment research has been carried out, yet. A new, 4‐week exposure based cognitive behavioral therapy (CBT) day treatment, which integrated the inhibitory learning principles, was developed for adolescents with ARFID, and tested in the current study. Method A nonconcurrent multiple baseline design was used in a clinical case series of eleven 10‐ to 18‐year‐old patients. After baseline, the 4‐week CBT followed. Measurements of DSM‐5 ARFID diagnosis, food neophobia and related measures such as body weight and length, were taken at baseline (t1), at the end of the 4‐week intensive day treatment (t2) and 3 months after treatment (follow‐up, t3). A food selectivity test, a 1‐week food diary, and behavioral measures on food intake were also taken at baseline and at 3‐month follow‐up. Furthermore, continuous measurements of believability of dysfunctional cognitions, anxiety, and food acceptance were taken throughout the 4‐weeks day treatment. Results At follow‐up, 10 out of 11 patients were in remission and had a healthy body weight and an average, age‐adequate nutritional intake. For most patients, food neophobia scores decreased to a nonclinical range. The belief in dysfunctional cognitions and anxiety levels decreased during treatment. Discussion This new exposure‐based CBT for adolescents with ARFID seems promising. These results may be very useful for clinical practice and stimulate further development of effective CBT interventions in the area of ARFID.