Search

The diagnostic criteria for avoidant/restrictive food intake disorder (ARFID) have been the source of confusion since its introduction to the DSM in 2013. In the current state, ARFID is diagnosed based on impairment, with no requirement that a specific pattern of behavioral or cognitive/affective symptoms be present. In this paper, we make the case for more positive etiologically based criteria for ARFID wherein Criterion A defines the psychopathology of ARFID. We propose a framework for DSM criteria involving food avoidance that is maintained by beliefs/hedonic reactions that are temporally close to and realistically/functionally associated with a specific food or eating occasion, characterized by one or more of the following expected aversive responses: disgust/distaste, anhedonia/uncomfortable fullness, and acute fear/panic. Our proposed Criterion B retains the four manifestations of impairment in the current definition as necessary, but not sufficient, for the ARFID diagnosis. When both Criteria A and B are met, our revised Criteria D (ARFID vs. other restrictive eating disorders) and E (ARFID vs. other medical/psychiatric conditions) state that ARFID should be diagnosed regardless of co-occurring/comorbid conditions. We discuss how this positive definition of ARFID would impact clinical diagnosis and subsequent treatment, with specific considerations for differential diagnosis between ARFID and other eating disorders, other forms of psychopathology, and relevant medical conditions. Additionally, we discuss how it might enhance research opportunities by providing increasingly homogeneous samples through which researchers could better understand the etiological mechanisms of ARFID., (© 2025 Wiley Periodicals LLC.)

The Behavioral Susceptibility Theory posits that food approach/avoidance traits are key genetic contributors to obesity and disordered eating. The genetic tendency to approach/avoid food may manifest with emotional eating (i.e., over or under eating in response to emotional cues). Research indicates that emotional eating (EE) affects long-term success after bariatric surgery, but findings focus mainly on the tendency to overeat in response to negative emotions. The current study examined the role of both emotional over- and under-eating within a pre-bariatric sample, and their association with psychosocial outcomes. Using Latent Class Analysis, responses from 446 participants (74.3% female; 71.5% White, 12.1% African American, 10.3% Hispanic, 4.1% multiracial, 1.1% Other/Unreported; M Age = 42.38, M BMI = 49.15 kg/m 2 ) on the emotional eating subscales of the Adult Eating Behavior Questionnaire were analyzed to identify EE patterns. Participants also responded to measures of emotional distress, quality of life, and disordered eating (e.g., night eating, binge eating, and avoidant/restrictive food intake disorder). A four-class solution emerged: (a) emotional over- and undereating (EOE-EUE; 14.4%), (b) emotional overeating (EOE; 25.3%), (c) emotional undereating (EUE; 26.0%), and (d) non-emotional eating (non-EE; 34.3%). Consistent with previous research, the EOE-EUE class exhibited high levels of psychosocial impairment, and emotional eating classes exhibited higher levels of disordered eating compared to the non-emotional eating class. These findings provide a more nuanced understanding of EE within a pre-bariatric population by identifying patterns of both over- and under-eating within individuals and differentially identifying risk factors associated with such patterns. Limitations include the lack of a non-surgery seeking comparison group, potential for response biases, and the reliance on cross-sectional data., Competing Interests: Declaration of Competing Interest The authors report there are no competing interests to declare., (Copyright © 2025. Published by Elsevier Ltd.)

The presentation of avoidant/restrictive food intake disorder (ARFID) characterized by fear of aversive consequences of eating (fear-ARFID) has both phenomenological and mechanistic similarities to panic disorder. In this narrative review, we propose a shared model of the pathogenesis of the two disorders, centered on interoceptive sensitivity as the key maintenance mechanism. We review the evidence that fear-ARFID, which involves restrictive eating motivated by a desire to avoid aversive events (e.g., choking, vomiting, abdominal pain) related to the gastrointestinal tract, onsets with an unexpected event and develops through catastrophic misinterpretation of the probability or significance of the event reoccurring, heightened awareness of minor interoceptive sensations associated with the feared event (i.e., interoceptive sensitivity), escalating anxiety and increasingly frequent experience of minor interoceptive sensations, and increasingly extensive avoidant behavior. Given the support for shared maintenance mechanisms with panic disorder, we suggest a program of clinical research evaluating the adaptation of elements of Panic Control Therapy (PCT), a well-established empirically supported treatment for panic disorder, to treat fear-ARFID. Developing and testing new intervention strategies based on PCT could expand ARFID patients' access to appropriate care by enabling anxiety-experienced clinicians to use their existing competencies to treat fear-ARFID using a disorder-specific evidence-based treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study, which is a longitudinal extension of previous cross-sectional studies in Chinese and American college students and general adults (Dixit, He, Whited, Ellis, & Zickgraf, 2023; He, Chen, Wu, Niu, & Fan, 2020; Xu et al., 2024), used latent profile and latent transition analyses to investigate negative emotional eating patterns and the stability of these patterns in 1462 Chinese adolescents (41% boys, aged 11-17 years) at baseline and 18 months later. We also explored baseline demographic predictors of negative emotional eating patterns and the associations between these patterns and outcome variables measured 18 months later. Negative emotional eating was measured with the Adult Eating Behavior Questionnaire (emotional undereating and emotional overeating subscales). Latent profile analysis (LPA) replicated the four patterns of negative emotional eating in each wave of assessment: low emotional eating (Low-EE), emotional overeating (EOE), emotional undereating (EUE), and emotional over- and under-eating (EOE-EUE). Latent transition analysis (LTA) showed that the EE patterns had transition probabilities of <55% remaining in the same class across 18 months. Furthermore, relative to adolescents in the stable Low-EE group, adolescents in all other stable or unstable emotional eating groups in LTA were linked to higher eating disorder psychopathology and psychological distress measured 18 months later. Thus, emotional eating, regardless of type (i.e., EOE, EUE, and EOE-EUE) and stability (i.e., stable or unstable), may be a viable research and treatment target in improving adolescents' eating behaviors and mental health., Competing Interests: Declaration of Competing Interest The authors have no conflict(s) of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The primary aim of this expert narrative review is to unravel the complexities of feeding and eating disorders in the gastroenterology practice setting. We aim to critically assess current assessment screening tools for eating and feeding disorders to gain a comprehensive understanding of how these tools may be misconstrued in the context of gastrointestinal conditions. Additionally, our objective is to highlight the potential for over-pathologizing and under-pathologizing eating behavior in this patient population. Further, we address the potential risk factors that gastroenterology clinicians should be aware of when assessing for disordered eating risk reduction. We hope to elucidate the "gray area" related to eating behaviors in patients with known physiological food intolerance such as FODMAP-related immune activation in irritable bowel syndrome and gluten-related reactions in celiac disease in the gut and beyond, that prompt behaviors that are deemed maladaptive in healthy individuals but may be at times adaptive responses in gastrointestinal conditions., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Objective: The present longitudinal study examined sex-specific, symptom-level relationships among emotion regulation (ER), interpersonal problems (IP), and eating disorder (ED) psychopathology in a large sample of Chinese adolescents., Method: Data were from a project with four waves of data collection (N = 1540; 710 boys and 830 girls) at 6-month intervals over 18 months. Questionnaires assessed ED psychopathology, ER, and IP at each wave of data collection. Longitudinal network analyses were conducted separately for boys and girls. Sex differences in the network structures were also examined., Results: The results revealed pronounced heterogeneity in the presentation of ED psychopathology, ER, and IP across Chinese adolescent boys and girls longitudinally and intra-individually. For example, weight/shape preoccupation in ED psychopathology and awareness in ER emerged as important nodes in the temporal network for boys. However, weight/shape preoccupation and dissatisfaction in ED psychopathology were identified as the most important nodes in the temporal network for girls. Regarding bridge strength, awareness in ER emerged as the node with the highest connectivity in the temporal network for boys. At the same time, weight/shape dissatisfaction in ED psychopathology was the node with the highest connectivity for girls., Discussion: The current study extended network theory to better understand the longitudinal interplay among ER, IP, and ED psychopathology in Chinese adolescents and their sex differences in the importance of symptoms. Such insights may pave the way for developing targeted prevention and treatment strategies for adolescent boys and girls in China., (© 2024 Wiley Periodicals LLC.)

Objective: Research on psychiatric comorbidities associated with avoidant/restrictive food intake disorder (ARFID) primarily compares ARFID versus anorexia nervosa (AN). Little is known about comorbidities associated with mixed ARFID/other eating disorder (ED) history or ARFID comorbidities relative to EDs beyond AN. This study assessed lifetime and current psychiatric factors in a large college sample with varying ED histories., Method: Participants were United States students from the 2021/2022 Healthy Minds Study who endorsed lifetime professionally diagnosed EDs (N = 4657). Chi-square tests compared lifetime ED groups (ARFID, ARFID + Non-ARFID ED, Non-ARFID ED) on lifetime neurodevelopmental, anxiety, obsessive-compulsive, trauma/stressor-related, and depressive disorder prevalence, and suicidality and counseling/therapy receipt. Multivariate analysis of variance evaluated current depressive, anxiety, and ED symptom differences., Results: Lifetime neurodevelopmental and anxiety disorders were less prevalent in "Lifetime Non-ARFID ED" than ARFID groups. Lifetime depressive, trauma/stressor-related, and obsessive-compulsive disorders were relatively more prevalent in "Lifetime ARFID + Non-ARFID ED." This group demonstrated relatively greater current depressive symptoms and past-year suicide attempts. Lifetime ARFID groups demonstrated relatively greater current anxiety. All groups differed on current ED symptoms. Effects were small., Discussion: Historical ARFID is associated with neurodevelopmental disorders and historical/current anxiety. Mixed ARFID/non-ARFID ED history may indicate increased propensity toward varied psychopathology., Public Significance Statement: This study replicated findings that ARFID is associated with neurodevelopmental and anxiety disorders in the lifespan through young adulthood. Extending prior work, results suggest a history of ARFID is associated with increased anxiety in young adulthood. Finally, a history of both ARFID and other eating pathology is associated with increased risk for a wide range of psychiatric difficulties (e.g., obsessive-compulsive symptoms, suicide attempts) in the lifespan through young adulthood., (© 2024 Wiley Periodicals LLC.)

Background: Picky eating (PE) is common in early childhood, peaking between ages 1 and 5 years. However, PE may persist beyond this normative period and pose threats to health and psychosocial functioning. Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by appetite, preference/selectivity, and/or fear of eating, leading to significant medical and/or psychosocial impairment. This retrospective study examined the relation between early childhood PE onset/duration and ARFID eating restrictions and symptoms., Method: Parents of children ages 6-17 (N = 437) completed a survey about their child's eating behavior, including the Nine-item ARFID Screen (NIAS) and questions about PE onset and impacts. Children were then categorized into groups based on PE onset (before or after age 5) and duration: never picky, normative picky, persistent picky, and late-onset picky., Results: The groups differed (all p < .05) in mean NIAS subscales (picky eating, NIAS-PE; appetite, NIAS-A; fear, NIAS-F) and total scores (NIAS-T). Tukey post-hoc tests found that persistent PEs had significantly higher NIAS-PE, NIAS-A, and NIAS-T scores than never or normative PEs (all p < .05). Chi-Square tests found that persistent PEs were significantly more likely than all other groups to endorse ARFID criteria., Conclusion: Findings from this study suggest that PE that persists beyond or is identified after the normative period is associated with elevated ARFID symptoms compared to normative and never PEs. Persistent PE increases risk of impairment from PE and other ARFID eating restrictions. Given the health and psychosocial risks associated with ARFID, early identification and intervention for this group is warranted., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: This study evaluates the psychometric properties of the Turkish version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) in a population of Turkish adolescents., Method: The NIAS, designed to screen for ARFID symptoms, including picky eating, fear-related eating behaviors, and low appetite, was administered to secondary school students between 13 and 18 ages in Muğla, Turkiye., Results: Based on a sample of 268 adolescents, the NIAS's reliability and validity in this demographic are supported. The research utilized confirmatory factor analysis to verify its three-factor structure and various reliability tests, including Cronbach's alpha and test-retest reliability, confirming the scale's internal consistency and temporal stability. The descriptive analysis highlighted significant differences in NIAS scores across BMI categories, with underweight adolescents scoring higher, suggesting a potential link between ARFID symptoms and lower body weight. Criterion validity was supported by significant correlations between NIAS subscales and measures of anxiety, depression, and eating behaviors, indicating the scale's effectiveness in reflecting relevant psychopathological features., Conclusion: Overall, the study establishes the Turkish NIAS as a useful tool for identifying ARFID in Turkish adolescents, aiding early detection and intervention in this at-risk age group. Further research is recommended to explore the scale's utility across different clinical settings and refine its diagnostic accuracy, enhancing our understanding of ARFID's impact on youth mental health and nutritional status., (© 2024. The Author(s).)

Objective: Measures assessing appetitive traits (i.e., individual differences in the desire to consume food) and disordered eating have generally been developed in predominantly food-secure populations. The current study aims to test measurement invariance (MI) for a measure of appetitive traits and a measure of Avoidant Restrictive Food Intake Disorder (ARFID) symptomology across food security status., Method: Data from a sample of mothers (n = 634) and two undergraduate samples (n = 945 and n = 442) were used to assess MI for the Adult Eating Behavior Questionnaire (AEBQ), which measures appetitive traits, and the Nine Item ARFID Screen (NIAS), which measures ARFID symptomology. Current food security was assessed using the 18-item USDA Household Food Security Survey Module, which was dichotomized into two groups: 1) the 'food insecure' group included marginal, low, and very low food security and 2) the 'food secure' group included high food security. Overall and multi-group confirmatory factor analyses were conducted separately for each measure in each sample., Results: Results demonstrated scalar (i.e., strong) MI for both measures across samples, indicating that these measures performed equivalently across food-secure and food-insecure individuals., Conclusion: Findings suggest that differences in appetitive traits by food security status observed in prior research are not artifacts of measurement differences, but instead reflect true differences. Additionally, past mixed results regarding the relationship between food insecurity (FI) and ARFID symptomology are not likely driven by measurement error when using the NIAS., Competing Interests: Declaration of competing interest The authors have no conflicts to disclose., (Published by Elsevier Ltd.)

Objectives: To examine whether higher weight status is associated with increased eating disorder risk in athletes., Design: Study 1 used cross-sectional (N = 942) and longitudinal (N = 483) data collected over a five-year period from Division I athletes at a Midwestern university. Study 2 used cross-sectional data from athletes competing at various levels at universities across the United States (N = 825)., Methods: Weight and height were measured in Study 1 and self-reported in Study 2; higher weight was defined as body mass index ≥ 25 kg/m 2 . Eating disorder risk was assessed with preliminary (Study 1) and final (Study 2) versions of the Eating Disorders Screen for Athletes. Study 1 examined weight status in relation to both concurrent and one-year changes in Eating Disorder Screen for Athletes score. Study 2 examined weight status in relation to both the Eating Disorders Screen for Athletes score and elevated eating disorder risk using the established Eating Disorders Screen for Athletes cut-off. All models adjusted for gender and sport type; Study 2 additionally adjusted for race/ethnicity, age, and competition level., Results: Across studies, higher weight status was significantly associated with increased eating disorder risk among athletes. This association was observed both cross-sectionally and longitudinally, and the prevelence of elevated eating disorder risk was 43 % greater among athletes with higher weight status than among those without higher weight status., Conclusions: Despite existing stereotypes that eating disorders tend to occur with low weight status, findings highlight the importance of screening all athletes for eating disorders, regardless of their weight status., Competing Interests: Declaration of interest statement The authors of this manuscript have no declarations of interest to disclose., (Published by Elsevier Ltd.)

Avoidant/restrictive food intake disorder (ARFID) is diagnosed when food avoidance leads to clinically significant nutritional, weight/growth, or psychosocial impairment. As many as 81.5% of children and adolescents diagnosed with ARFID have a history of a medical condition associated with pain, fatigue, or malaise. ARFID is diagnosed and treatment begins after the medical condition is resolved but food avoidance remains. Effective treatment involves repeated exposure to eating food and related stimuli aimed at creating inhibitory learning to counteract learned fears and aversions. Treatment usually involves positive reinforcement of food approach behavior and escape extinction/response prevention to eliminate food avoidant behavior. To shed light on the neural mechanisms that may maintain ARFID and to identify candidate pharmacological treatments for adjuncts to behavioral interventions, this paper systematically reviews research on drug treatments that successfully reduce conditioned taste aversions (CTA) in animal models by disrupting reconsolidation or promoting extinction. The mechanism of action of these treatments, brain areas involved, and whether these CTA findings have been used to understand human eating behavior are assessed. Collectively, the results provide insight into possible neural mechanisms associated with resuming oral intake following CTA akin to the therapeutic goals of ARFID treatment and suggest that CTA animal models hold promise to facilitate the development of interventions to prevent feeding problems. The findings also reveal the need to investigate CTA reduction in juvenile and female animals and show that CTA is rarely studied to understand disordered human feeding even though CTA has been observed in humans and parallels many of the characteristics of rodent CTA., Competing Interests: Declaration of competing interest None, (Copyright © 2023. Published by Elsevier Ltd.)

Background: The nine item avoidant/restrictive food intake disorder screen (NIAS) is a short and practical assessment tool specific to ARFID with three ARFID phenotypes such as "Picky eating," "Fear," and "Appetite". This study aimed to evaluate the psychometric properties of the Turkish translation of the NIAS parent form and to investigate the relationship between ARFID symptoms and anxiety, depression symptoms, and eating behaviors in a sample of Turkish children., Method: Parents were asked to provide their children's sociodemographic data and to complete the NIAS, Eating Disorder Examination Questionnaire-Short (EDE-QS), Children's Eating Behavior Questionnaire (CEBQ), and Revised Child Anxiety and Depression Scale (RCADS) scales., Results: The sample included 440 participants between 6 and 12 ages. Turkish NIAS demonstrated good internal consistency. The three-factor model of the Turkish NIAS was in an acceptable structure. The Turkish NIAS scale was shown to be valid and reliable. NIAS scores were shown to be higher in underweight participants. The NIAS-parent version subscales showed expected convergent and divergent validity with the CEBQ, EDEQ-S, and RCADS scales in children, except CEBQ emotional overeating and desire to drink subscales were correlated with NIAS., Conclusion: The Turkish version of the NIAS is valid and reliable in evaluating ARFID symptoms in children., (© 2024. The Author(s).)

Objective: This study assessed the factorial, divergent, and criterion-related validity of the Youth-Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (Y-NIAS) in a paediatric clinical sample at initial evaluation for an eating disorder (ED)., Method: Participants included 310 patients (82.9% female, 77.4% White, Age M = 14.65) from a tertiary ED clinic. Confirmatory factor analysis (CFA) evaluated the three-factor of the Y-NIAS. One-way analysis of variance compared Y-NIAS scores across diagnoses. A receiver operating curve analysis assessed the ability of each subscale to identify ARFID presentations from the full sample. Two logistic regressions assessed the criterion-related validity of the obtained Y-NIAS cut-scores., Results: CFA supported the original three-factor structure of the Y-NIAS. Clinically-elevated scores were observed in all diagnostic groups except for binge-eating disorder. Subscales were unable to discriminate ARFID cases from other ED diagnoses. Cut scores were identified for picky eating subscale (10) and Fear subscale (9), but not for Appetite subscale. In combination with the ED Examination Questionnaire (EDE-Q), classification accuracy was moderate for ARFID (62.7%) and other EDs (89.4%)., Discussion: The Y-NIAS demonstrated excellent factorial validity and internal consistency. Findings were mixed regarding the utility of the Y-NIAS for identifying clinically-significant ARFID presentations from other ED diagnoses., (© 2023 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: There is a lack of reliable and valid parent-report measures assessing eating disorder (ED) pathology in children and adolescents. This study aimed to develop and provide preliminary validation of a new parent-report measure, the 12-item Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P)., Method: The EDE-QS-P was completed by 296 parents seeking treatment for their child at an ED clinic. Children (ages 6-18, N  = 296) completed the Eating Disorder Examination-Questionnaire (EDE-Q), the seven-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9)., Results: After removing item 10, the 11-item version of the EDE-QS-P showed borderline adequate fit to the one factor solution and strong internal consistency (α = 0.91). This measure also demonstrated strong convergent validity with child scores on the EDE-Q ( r  = .69), and moderate convergent validity with child scores on the GAD-7 ( r  = .37) and PHQ-9 ( r  = .46). The EDE-QS-P was able to differentiate children with EDs characterized by body image disturbances (e.g. anorexia nervosa) from those with avoidant/restrictive food intake disorder, who do not experience shape or weight concerns., Discussion: The 11-item EDE-QS-P may be a promising parent-report measure of ED pathology in children and adolescents.

Emotional eating (EE) has been consistently associated with obesity, weight gain, and certain eating disorders (EDs). Given the cultural influence on food consumption and eating styles, comparison of EE patterns of individuals in culturally distinct nations (e.g., USA and China) could yield interesting differences in findings. However, given the increasing convergence in eating practices between the above-mentioned nations (e.g., higher reliance on outdoor eating at restaurants among Chinese adolescents), EE patterns might share significant similarities. The present study examined EE patterns of American college students and is a replication of the study done by He, Chen, Wu, Niu, and Fan (2020) on Chinese college students. Responses of 533 participants (60.4% women, 70.1% White, aged 18-52 (mean age = 18.75, SD = 1.35), mean self-reported body mass index = 24.22 kg/m 2 and SD = 4.77) on the Adult Eating Behavior Questionnaire (Emotional overeating and emotional undereating subscales) were examined using Latent Class Analysis to identify specific patterns of EE. Participants also completed questionnaire measures of disordered eating and associated psychosocial impairment, depression, stress, and anxiety symptoms, and a measure of psychological flexibility. A solution with four classes emerged, i.e., emotional over- and undereating (18.3%), emotional overeating (18.2%), emotional undereating (27.8%), and non-emotional eating (35.7%). Current findings replicated and extended findings from He, Chen, et al. (2020) in that the emotional over- and undereating class exhibited the highest risks for depression, anxiety, stress, and psychosocial impairment due to disordered eating symptoms as well as lower psychological flexibility. Individuals who have difficulty with awareness and acceptance of their emotions appear to engage in the most problematic form of EE and could benefit from Dialectical behavior therapy and Acceptance and commitment therapy skills training., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Despite emerging evidence that food insecurity (FI) is associated with elevated rates of eating pathology, little is known about the lasting impact of FI on eating behaviors. Studies that have explored the association between FI during childhood and eating behavior in adulthood have not accounted for current FI. The present study explored differences in disordered eating (DE) and related appetitive traits among four groups of cisgender female mothers: individuals who (1) endorsed childhood FI only (n = 96), (2) endorsed current FI only (n = 134), (3) endorsed both childhood and current FI (n = 257), and (4) denied both childhood and current FI (n = 146). Participants responded to online questionnaires including items from the USDA Household Food Security Survey Module, the 7-item Eating Disorder Examination-Questionnaire, the Eating Disorder Diagnostic Scale, and the Adult Eating Behavior Questionnaire. Adjusting for age and race/ethnicity, ANCOVAs explored mean differences between groups in DE and appetitive traits, and a modified Poisson regression model examined differences in binge-eating prevalence across the four FI groups. The "current FI only" group consistently endorsed the highest levels of DE and related appetitive traits followed by the "current and childhood FI" group, suggesting newly food-insecure women may be at highest risk for DE. Interestingly, across almost all constructs, the "childhood FI only" group did not differ significantly from the "no FI" group. These findings suggest that improved access to food may help offset risk for adult DE related to experiences of FI in childhood., Competing Interests: Conflict of interest Authors have no conflicts to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Avoidant/Restrictive Food Intake Disorder (ARFID) is defined by limited volume or variety of food intake motivated by the sensory properties of food, fear of aversive consequences, or lack of interest in food or eating associated with medical, nutritional, and psychosocial impairment. Currently, two of the most widely validated measures are The Eating Disturbances in Youth-Questionnaire (EDY-Q) and the Nine Item ARFID Screen (NIAS). The latter has proven valid and reliable for assessing this disorder., Objective: To validate a culturally sensitive adaptation of the NIAS instrument and evaluate its psychometric properties in Mexican youths., Method: The sample consisted of 800 participants aged 12-30 (M = 18.56, SD = 3.52) from Mexico City and Hidalgo public educational institutions., Results: The S-NIAS obtained a Cronbach's alpha of 0.84, adequate construct validity adjustment rates: CMIN = 1.88; GFI = 0.97; AGFI = 0.94; CFI = 0.98; RMR = 0.050; and RMSEA = 0.047. Measurement invariance by gender, age, and survey administration which show that construct is understood in the same way across both groups and despite the change from paper-and-pencil to online survey administration., Conclusion: The psychometric properties of the Spanish Nine Item ARFID Screen (S-NIAS) indicate that it is a valid and reliable instrument for evaluating symptoms associated with ARFID in this sample of youths., Public Significance: Although there are advances in studying ARFID, their epidemiological data comes mainly from a few countries. Furthermore, these data are scarcer due to the lack of validated screening and assessment instruments available in a variety of world languages; having instruments for the evaluation of ARFID symptoms is essential because it could function as an auxiliary means for the detection and prevention of people at risk., (© 2022 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Purpose: The purpose of the study was to provide initial evidence for the internal consistency and convergent validity of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in a sample of transgender and nonbinary (TGNB) youth and young adults., Methods: Returning patients at a Midwestern gender clinic ( n =164) ages 12-23 completed the NIAS, sick, control, one stone, fat, food (SCOFF), patient health questionnaire 9 (PHQ-9), and generalized anxiety disorder 7 (GAD-7) during their clinic visit. Age, sex assigned at birth, gender identity, weight, and height were also collected. Confirmatory factor analysis was used to establish the hypothesized three-factor structure of the NIAS in this sample. Relationships between the NIAS subscales and anthropometric data, SCOFF, PHQ-9, GAD-7, and sex assigned at birth were explored for convergent and divergent validity, and proposed screening cutoff scores were used to identify the prevalence of likely avoidant/restrictive food intake disorder (ARFID) in this population., Results: The three-factor structure of the NIAS was an excellent fit to the current data. Approximately one in five (22%) of the participants screened positive for ARFID. Approximately one in four participants scored above the picky eating (27.4%) or appetite (23.9%) cutoffs. Assigned female at birth participants scored significantly higher on the NIAS-Total, Appetite, and Fear subscales than those assigned male at birth. NIAS-Total was significantly related to all convergent validity variables other than age, with a moderate-strong correlation with other symptom screeners (SCOFF, PHQ-9, GAD-7), and a small negative correlation with body mass index percentile., Conclusions: Evidence supports the NIAS as a valid measure to screen for ARFID among TGNB youth and young adults., Competing Interests: No competing financial interests exist., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Objective: Exposure therapy is a promising treatment for eating disorders (EDs). However, questions remain about the effectiveness of exposure to feared foods during the weight restoration phase of treatment, and the importance of between-session and within-session habituation., Method: We recruited 54 adolescents from a partial hospitalization program (PHP) for EDs which included daily food exposure. Throughout treatment, participants provided subjective units of distress (SUDS) ratings before and after eating a feared food, and completed measures of ED symptomatology., Results: Multilevel models found that pre-exposure SUDS decreased over time, providing some evidence that between-session habituation occurred. In contrast, the difference between pre-exposure and post-exposure SUDS did not decrease over time, indicating that within-session habituation did not occur. Weight gain predicted greater between-session habituation to feared foods, but did not predict within-session habituation. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes, including weight gain and improvements on the Children's Eating Attitudes Test and Fear of Food Measure., Discussion: Partial hospitalization programs that include daily exposure to feared foods may be effective at decreasing anxiety about foods for adolescents with EDs who are experiencing weight restoration. Further research is warranted to replicate our findings challenging the importance of within-session habituation, and to better understand between-session habituation and inhibitory learning as mechanisms of change when conducting food exposure for EDs., Public Significance: This study provides some evidence that PHPs that include food exposure may be useful for adolescents with EDs who are experiencing weight restoration. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes. Further research is needed to determine whether clinicians can disregard within-session habituation when conducting food exposure for EDs, and understand the importance of between-session habituation as a potential mechanism of food exposure., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Purpose: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included., Methods: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants., Results: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON., Conclusions: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel., Level of Evidence: Level V: opinions of expert committees., (© 2022. The Author(s).)

Background: Orthorexia nervosa (ON) involves obsessive thoughts about healthy eating and distress related to this obsession. There is still dispute over whether ON should be considered on the obsessive-compulsive spectrum, the eating disorder (ED) spectrum, or as its own disorder. Based on current research, orthorexic behaviors seem to be closely related to eating disorder behaviors. However, given the range of instruments used to measure ED and ON, and the lack of consistency in the specific ED domains explored, a review of the current literature is warranted., Objective: The objective of this study was to review the literature relating ON and ED symptoms in an effort to understand the nature of their relationship, and to identify ED symptom domains most closely related to ON., Methods: A search was conducted on PubMed, Science Direct, and Web of Science using the term "orthorexia" and at least one of the following: "anorexia nervosa," "bulimia nervosa," "eating disorder," "arfid," "restrictive," "body image," "weight concern," "shape concern." After exclusion criteria were applied, 42 articles were included in the review., Results: The results indicated that ON is consistently related to both trait and disordered restrictive eating symptoms of anorexia nervosa, and weight control motivations for food choice. However, ON was less consistently related to binge-spectrum eating disorder symptoms, emotional eating, uncontrolled eating, or body dissatisfaction/shape and weight concerns., Conclusion: The finding that ON symptoms are related to restraint and weight loss efforts, but not to body dissatisfaction or dysregulated eating suggests that ON may represent a distinct ED., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective : Selective or "picky" eating (SE) refers to rejection of a wide range of familiar and unfamiliar foods based on aversions to their sensory properties. When severe, SE can cause symptoms of avoidant/restrictive food intake disorder (ARFID), including weight loss, nutritional deficiencies, and/or psychosocial impairment. SE is highly prevalent in autism spectrum disorder (ASD) compared to both typical development and other developmental disorders. A possible explanation for the high prevalence of SE in ASD is the effect of core ASD symptoms, repetitive/restrictive behaviors (e.g., rigidity), and sensory sensitivity on feeding behaviors. These traits are found not only in ASD but also in other clinical groups and the general population, albeit often at subclinical levels. Identifying mechanisms of SE across various populations is critical to inform intervention approaches. Methods : In 263 unselected children ages 5-17, 534 unselected college students ages 18-22, 179 children with anxiety/obsessive spectrum disorders ages 5-17, and 185 children with ASD ages 4-17, we explored the unique contributions of sensory (i.e., oral texture and olfactory) sensitivities and rigidity as predictors of self/parent-reported SE. Results : In each sample, rigidity and oral texture sensitivity, controlling for olfactory sensitivity, age, and gender, emerged as significant, independent predictors of SE. Conclusions : This is the first study to highlight the importance of cognitive/behavioral rigidity to SE, and one of the first to illustrate the domain-specificity of the relationship between sensory sensitivity and SE.

Parental feeding practices in childhood have been shown to contribute to childhood eating habits, behaviors, and weight status. Less understood is the longitudinal impact of parental feeding practices on these variables in adulthood. Therefore, the aim of the present work was to validate a modified, brief, Comprehensive Feeding Practices Questionnaire (CFPQ) reformatted to account for retrospective recollections of parental feeding practices experienced in childhood among a sample of adults with obesity. Adults (n = 719, mean age = 44.3 years, mean BMI = 47.1 kg/m 2 ) completed a modified, brief, retrospective CFPQ containing seven pre-defined subscales of the original CFPQ. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) procedures were used to evaluate survey factor structure and associations with gender, BMI, and self-reported race. An EFA derived six-factor model demonstrated better model fit and reliability than the originally proposed seven-factor model. Gender and self-reported race were not correlated with subscales of the brief, retrospective, CFPQ, while BMI was positively correlated with the Food as Reward subscale. This six-factor, brief, retrospective, CFPQ can be used to provide insight into the potential origins of individual eating behaviors, and warrants use in future work attempting to clarify the relationships between parental feeding practices and eating behaviors in adulthood., Competing Interests: Declaration of competing interest Dr. Caitlyn G. Edwards declares no conflict of interest. Dr. Hana F. Zickgraf declares no conflict of interest. Dr. Travis D. Masterson declares no conflict of interest. Dr. Andrea Rigby declares no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Orthorexia nervosa (OrNe) is a pattern of disordered eating behavior characterized by excessive preoccupation with overvalued ideas about healthy eating. Healthy orthorexia (HeOr) refers to a non-pathological interest in healthy eating and nutrition. Despite converging evidence that OrNe is correlated with measures of psychopathology and personality traits, there is relatively little empirical data relating OrNe and HeOr to eating and health-promoting behavior., Methods: Aim 1: exploratory structural equation modeling was used to evaluate the factor structure of an English-language version of the Teruel Orthorexia Scale, the only measure of OrNe that also assesses HeOr in two samples (Yoga practitioners, N = 469, and Mechanical Turk workers, N = 453). Aim 2: conducted in the Mechanical Turk sample, partial correlation and linear regression analyses were used to evaluate the relationships of OrNe and HeOr with other symptoms of, and clinical impairment from, disordered eating, food choices, diet quality, body mass index (BMI), nutrition knowledge, alcohol/tobacco/vaping use, and sedentary behavior., Results: The two-factor structure of the TOS was replicated. HeOr and OrNe had opposing relationships with measures of disordered eating behavior and distress, food choices, diet quality, and nutrition knowledge. HeOr was negatively related to BMI, whereas OrNe was positively related to substance use and sedentary behavior., Conclusions: OrNe and HeOr are distinct latent constructs, with the latter reflecting non-pathological behavior. Only OrNe is related to elevated disordered eating and clinical impairment. Despite involving obsessions and compulsions related to healthy eating, OrNe was associated with relatively unhealthy eating and other lifestyle behaviors., Level of Evidence: Level V, descriptive cross-sectional study., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: Food insecurity is associated with elevated eating disorder (ED) pathology, yet commonly used ED measures may not fully capture ED pathology in the context of food insecurity. The present study used differential item functioning (DIF) analyses to explore whether item endorsement on two commonly used ED questionnaires differed by food security status., Methods: Participants were 634 cisgender women recruited through Amazon's Mechanical Turk. DIF was explored for items on the Short Eating Disorder Examination Questionnaire (S-EDE-Q) and the Eating Disorder Diagnostic Scale for DSM-5 (EDDS-5). DIF analyses used a hybrid ordinal logistic regression/item response theory approach, with the presence of both statistical (p < .01) and clinical significance (pseudo ΔR 2  ≥ .035) indicating DIF., Results: There was no evidence of clinically significant DIF within the S-EDE-Q. Two items on the EDDS-5 exhibited statistically and clinically significant DIF, with moderate effect sizes. Specifically, compared to food-secure participants, food-insecure participants were more likely to report (1) eating large amounts of food when not physically hungry and (2) feeling disgusted, depressed, or guilty about overeating at lower levels of overall ED pathology but less likely to report these experiences at higher levels of overall ED pathology., Conclusions: Findings highlight a potential need to adapt ED measures to fully capture ED pathology in food-insecure populations., Level of Evidence: Level III, well-designed cohort study., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: Employing bibliometric methods, the present study aimed to map out the general landscape of existing research on eating disorders (EDs) over the past decades., Method: Using the Web of Science database, we retrieved 41,917 research articles related to EDs published from 1981 to 2020. After removing those without an abstract, a total of 37,446 articles were retained. The study outlined the distribution of scholarship by time, languages, regions, and countries, and identified major research lines by applying latent topic modelling., Results: Results revealed a general increasing trend in the number of publications on EDs research, and researchers from Western countries dominated the production of related scholarship. The distribution of published scholarship varied significantly by languages, regions, and countries. Seven main research topics emerged from past research (i.e., animal studies of food intake, risk factors and at-risk groups for eating disorders, body image in eating disorders, studies of cognition and brain in eating disorders, symptomatology and comorbidity of eating disorders, body weight and nutrition status in eating disorders, and treatment of eating disorders), with different topics showing unique research trends across the years., Conclusions: This bibliometric analysis presents the most complete up-to-date overview on published research on EDs. While there is an increasing trend for EDs research, the available research evidence is generally from Western countries; thus, it is suggested that cooperation on EDs research should be strengthened between Western countries and other countries in the future., (© 2022 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: To examine the association between food insecurity and eating disorder (ED) risk independent of co-occurring anxiety/depression., Method: Data were provided by 121,627 undergraduate/graduate students who participated in the 2020-2021 Healthy Minds Study (HMS). Participants responded to questionnaire measures of food insecurity and risk for EDs, depression, and anxiety. Established cut-offs were used to identify students with food insecurity and probable psychopathology. Separate modified Poisson regressions adjusted for age, gender, race/ethnicity, and socioeconomic background examined the association between food insecurity and each form of psychopathology. The association between food insecurity and probable ED was then examined in a regression further adjusted for probable depression and anxiety., Results: Food insecurity was significantly associated with all three forms of psychopathology when examined separately (prevalence ratios ranged from 1.41 to 1.54, all p's < .001). When accounting for probable depression/anxiety, food insecurity was significantly associated with 1.19 times greater prevalence of a probable ED (p < .001)., Discussion: The association between food insecurity and EDs was replicated in a large, national sample of university students. To our knowledge, this is the first study to examine the independence of this relationship after adjusting for depression/anxiety. This finding supports the hypothesis that specific mechanisms, rather than general psychological distress, likely underlie the food insecurity-ED relationship., (© 2022 Wiley Periodicals LLC.)

Background: Fear of food and behavioral avoidance of specific foods, food groups, and food related social situations can substantially reduce health related quality of life in individuals with a wide range of conditions that affect appetite, eating behavior, and digestion, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), vomit and choking phobias, and food allergies/sensitivities. When this avoidance leads to weight/nutritional and/or psychosocial impairment, the diagnostic criteria for Avoidant/restrictive food intake disorder (ARFID) are met. Fear of food is an important target for interventions designed to improve psychosocial functioning and quality of life in such individuals. The purpose of this research was to develop and validate a novel measure of fear of food., Methods: Participants (n = 1138) were recruited from ongoing clinical trials for both IBD and IBS, from Amazon's Mechanical Turk, from Reddit support forums for IBS, IBD, and vomit phobia, and from an undergraduate subject pool. Exploratory and confirmatory factor analysis, Pearson's correlations, one-way ANOVA, and intraclass correlation coefficients were used to assess the validity and reliability of the Fear of Food Questionnaire., Results: The final 18 item questionnaire showed excellent internal consistency, test-retest reliability, convergent validity, discriminative (known groups) validity, as well as good factor structure. Fear of food was highly correlated with visceral hypersensitivity, catastrophizing, GI symptom severity and health related quality of life, as well as with self-reported Fear-ARFID symptoms. Individuals meeting study criteria for Fear-ARFID reported the highest scores relative to control and other analogue clinical groups., Conclusion: The Fear of Food Questionnaire appears to be reliable and valid across populations and may be a valuable tool in the assessment and treatment of Fear-ARFID., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) has three subscales aligned with ARFID presentations but clinically validated cutoff scores have not been identified. We aimed to examine NIAS subscale (picky eating, appetite, fear) validity to: (1) capture clinically-diagnosed ARFID presentations; (2) differentiate ARFID from other eating disorders (other-ED); and (3) capture ARFID symptoms among individuals with ARFID, individuals with other-ED, and nonclinical participants., Method: Participants included outpatients (ages 10-76 years; 75% female) diagnosed with ARFID (n = 49) or other-ED (n = 77), and nonclinical participants (ages 22-68 years; 38% female, n = 40). We evaluated criterion-related concurrent validity by conducting receiver operating curve (ROC) analyses to identify potential subscale cutoffs and by testing if cutoffs could capture ARFID with and without use of the Eating Disorder Examination-Questionnaire (EDE-Q)., Results: Each NIAS subscale had high AUC for capturing those who fit versus do not fit each ARFID presentation, resulting in proposed cutoffs of ≥10 (sensitivity = .97, specificity = .63), ≥9 (sensitivity = .86, specificity = .70), and ≥ 10 (sensitivity = .68, specificity = .89) on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively. ARFID versus other-ED had high AUC on the NIAS-picky eating (≥10 proposed cutoff), but not NIAS-appetite or NIAS-fear subscales. NIAS subscale cutoffs had a high association with ARFID diagnosis, but only correctly classified other-ED in combination with EDE-Q Global <2.3., Discussion: To screen for ARFID, we recommend using a screening tool for other-ED (e.g., EDE-Q) in combination with a positive score on any NIAS subscale (i.e., ≥10, ≥9, and/or ≥10 on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively)., (© 2021 Wiley Periodicals LLC.)

The current study examined the factor structure, measurement reliability, measurement invariance across genders, and latent gender mean differences, of a new Chinese translation of the Adult Eating Behavior Questionnaire (C-AEBQ) in a Chinese young adult sample ( n = 1,068, 52.57% women). The associations between the appetitive traits assessed by the AEBQ and body mass index were also explored. The previously established eight-factor model of the AEBQ was supported in the present sample. The C-AEBQ had strong measurement invariance between genders. Cronbach's alpha estimates of the eight subscales of the C-AEBQ ranged from 0.76 to 0.97, and the test-retest reliability coefficients of the subscales ranged from 0.50 to 0.77. The C-AEBQ had adequate convergent and divergent validity, as supported by the theoretically expected correlations between C-AEBQ and the Three-Factor Eating Questionnaire. Furthermore, Satiety Responsiveness, Slowness in Eating, and Food Fussiness were inversely associated with body mass index. Overall, the C-AEBQ appears to be a psychometrically sound instrument as a comprehensive measure for appetitive traits for Chinese young adults.

Objective: Exposure therapy appears underutilized in the treatment of eating disorders (EDs), perhaps due to clinicians' concerns that patients will dislike exposure therapy. The present study aims to investigate the attitudes of child patients, adult patients, and parents of child patients with EDs toward exposure therapy relative to four other treatments for EDs., Method: A questionnaire was administered to patients and parents (N = 126) upon admission to a partial hospitalization program for EDs. Participants read vignettes describing five different treatments for EDs, and answered questions assessing attitudes about each treatment., Results: At admission, participants reported the most favorable attitudes toward cognitive therapy, and the least favorable attitudes toward psychiatric medication. Exposure therapy generally received similar scores as interpersonal and expressive art therapy, and was perceived as significantly more preferable and effective in the long-term than psychiatric medication. Relative to child and adult patients, parents reported greater preferences for all treatments except medication, and perceived all treatments as more credible except medication and art therapy. Preliminary findings from a subset of participants who also completed the questionnaire at discharge indicated that positive attitudes toward exposure therapy increased over the course of treatment., Discussion: Individuals with EDs and their parents may enter treatment with particularly favorable views toward cognitive therapy, and do not appear to have strong attitudes toward exposure therapy one way or the other. Clinicians' concerns that patients with EDs will dislike exposure therapy may be largely unfounded., (© 2021 Wiley Periodicals LLC.)

Objective: The current study aimed to provide initial psychometric evidence for a Chinese version of the Nine-Item ARFID Screen (C-NIAS), which measures the symptoms of avoidant/restrictive food intake disorder (ARFID), including picky eating, poor appetite/limited interest in eating, and fear of aversive consequences from eating. Method: The NIAS was translated into Chinese according to standard procedures. A total of 1,069 college students from mainland China responded to the C-NIAS. The factor structure was confirmed using confirmatory factor analysis. Convergent and divergent validity were assessed using regression analyses. Finally, measurement invariance was tested, and latent mean differences were compared, between Chinese and American college samples. Results: The measure's original three-factor structure was confirmed. Strong measurement invariance between college samples of the United States and China was supported, and Chinese students had significantly higher latent mean scores on all three factors. The subscales showed the expected patterns of correlations with other validity constructs. Conclusions: The C-NIAS shows good psychometric characteristics and holds promise to facilitate much-needed research on subclinical symptoms of this understudied eating disorder in Chinese-speaking adult populations. Moreover, Chinese college students demonstrate greater potential ARFID symptomatology than American counterparts. More attention to ARFID should be called for in China.

Objective: The relative stigmatization of various eating disorders (ED) remains understudied, and there is no research examining stigma toward avoidant-restrictive food intake disorder (ARFID) or adult picky eating. The present study examined the relative stigmatization of various EDs and the subthreshold eating behaviors that are risk factors for their development, and the relation of gender differences to stigma., Method: A sample of 1147 college students was recruited and completed the study online. Participants were randomized and presented with a vignette representing a clinical ED [anorexia nervosa (AN), binge-eating disorder (BED), ARFID] or a subthreshold eating presentation (restrained eating, emotional eating, picky eating). Participants completed measures of stigma and perceived psychopathology. A 6 (target eating behavior) × 2 (target gender) × 2 (participant gender) MANOVA and subsequent ANOVAs were employed., Results: Measures of stigma revealed significant main effects for eating presentation and participant gender. There were also significant interactions between eating presentation and participant gender. Men reported more stigmatizing views toward BED and AN compared to women. Overall, restraint was stigmatized less than the other targets, and AN received the greatest amount of stigma. Participants rated BED and AN as more pathological than all other targets, emotional eating and ARFID as more pathological than picky eating and restrained eating, and restrained eating as less pathological than all other targets., Conclusions: Future research should explore how the severity of eating behavior influences perceptions and at what level behaviors such as restriction are recognized as disordered., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The role of family and caregiver accommodation is a well-defined maintenance factor for anxiety disorders and OCD. Family accommodation for patients with eating disorders is beginning to be described and characterized, but gaps in the literature remain. The current project compares levels of accommodation in families of those with anorexia nervosa (AN) to those with avoidant/restrictive food intake disorder (ARFID). It additionally establishes whether accommodation changes over the course of treatment and the extent to which these changes are related to changes in eating disorder pathology., Methods: A total of 39 adolescents with ARFID and 59 with AN presenting to a partial hospitalization program were included, with measures completed at intake and discharge., Results: Caregivers of adolescents with AN and those with ARFID reported similar levels of accommodation, with the exception of the Reassurance Seeking subscale of the Accommodation and Enabling Scale for Eating Disorders (AESED). Additionally, accommodation decreased significantly from intake to discharge for both patient groups. Intake AESED scores were also significantly related to caregiver distress, and changes in AESED scores were related to decreases in relevant eating disorder psychopathology for both groups., Conclusions: The results of the current study highlight the importance of considering family accommodation for ARFID patients and point to the need for future research to capture changes in accommodation over the course of treatment in relation to the delivery of evidence-based interventions and subsequent changes in ED symptoms., (© 2020 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Previous research has suggested a link between vegetarianism, broadly defined, and symptoms of eating disorders (ED). However, the literature supporting this link is mixed and limited by possible measurement artifacts. Using data from a national sample of college students, the present study examines ED symptomatology among three groups: (a) vegetarians whose meat avoidance is motivated by weight concerns; (b) non-weight motivated vegetarians; and (c) nonvegetarians., Method: Participants include 9,910 students from 12 colleges and universities across the United States who participated in the web-based Healthy Bodies Study. ED symptomatology was measured using the Short-Eating Disorder Examination-Questionnaire (S-EDE-Q). First, multi-group confirmatory factor analysis was conducted to test measurement invariance (MI) of the S-EDE-Q across weight-motivated vegetarians, non-weight-motivated vegetarians, and nonvegetarians. Gender- and BMI-adjusted ANCOVA was used to compare S-EDE-Q scores across groups., Results: 9.3% of participants were vegetarian. Cis-women and gender minority students were more likely to be vegetarian; those who became vegetarians after entering college were more likely to report weight-related motivations. Strict MI was supported for the S-EDE-Q global and subscale scores. Weight-motivated vegetarians reported higher levels of restraint, shape/weight overvaluation, body dissatisfaction, and global ED psychopathology relative to other participants., Discussion: To our knowledge, this is the first to explicitly link weight motivations for vegetarianism to ED psychopathology in a large, representative sample of young adults. Results suggest that students presenting with ED symptoms should be assessed for their motivations for adopting a vegetarian diet, and this information should be considered in treatment decisions., (© 2020 Wiley Periodicals LLC.)

Objectives: In clinical trials of pediatric trichotillomania (TTM), three instruments are typically employed to rate TTM severity: (1) the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS), (2) the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS), and (3) the Trichotillomania Scale for Children (TSC). These instruments lack standardized definitions of treatment response, which lead researchers to determine their own definitions of response post hoc and potentially inflate results. We performed a meta-analysis to provide empirically determined accuracy measures for percentage reduction cut points in these three instruments. Methods: MEDLINE was searched for TTM clinical trials. A total of 67 studies were initially identified, but only 5 were clinical trials focused on TTM in pediatric populations and therefore were included in this meta-analysis ( n  = 180). A Clinical Global Impressions Improvement score ≤2 was used to define clinical response. Receiver operating characteristic principles were employed to determine accuracy measures for percentage reduction cut points on each one of the instruments. Meta-DiSc software was employed to provide pooled accuracy measures for each cut point for each instrument. The Youden Index and the distance to corner methods were used to determine the optimal cut point. Results: The optimal cut points to determine treatment response were a 45% reduction on the MGH-HPS (Youden Index 0.40, distance to corner 0.20), a 35% reduction on the NIMH-TSS (Youden Index 0.42, distance to corner 0.17), a 25% reduction on the TSC child version (TSC-C; Youden Index 0.40, distance to corner 0.18), and a 45% (distance to corner 0.30) or 50% reduction (Youden Index 0.33) on the TSC parent version (TSC-P). The TSC-C had less discriminative ability at determining response in younger children in comparison to older children; no age-related differences were observed on the TSC-P. Conclusions: This study provides empirically determined cut points of treatment response on three instruments that rate TTM severity. These data-driven cut points will benefit future research on pediatric TTM.

Objective: Picky eating (PE) is common across the lifespan and related to psychosocial impairment and limited dietary variety. However, research about PE in non-Western countries is limited. Because eating behaviors may differ by culture, operationalizing PE in non-Western countries (e.g., China) is needed. The present study aimed to replicate two previous studies identifying PE profiles in Western countries by using latent profile analysis (LPA) to classify and characterize adults reporting picky eating in a Chinese sample., Method: A sample of 1,068 Chinese young adults completed a battery of questionnaires including the adult eating behavior questionnaire (AEBQ). LPA was utilized to identify eating profiles. The three-step approach was used to examine predictors of latent memberships and profile differences on various self-reported measures., Results: The best fit was a four-profile solution, with two picky eating profiles emerging: picky eating and severe picky eating. Compared to those in the other two profiles, participants in the picky eating profile (19.4%) and severe picky eating profile (3.3%) had significantly higher scores on self-reported eating disorder symptoms and psychological distress, and lower scores on self-reported food-related life satisfaction. Relative to the picky eating profile, participants in the severe picky eating profile reported significantly greater self-reported eating disorder symptoms, psychological distress, and food-related dissatisfaction., Discussion: Characterizing PE profiles is an important step toward understanding eating behaviors among Chinese young adults. Identifying various eating profiles has implications for future research related to PE, including the development of diagnostic tools and interventions to address PE in a Chinese context., (© 2020 Wiley Periodicals, Inc.)

There are a number of studies that have conducted comparisons of body appreciation between males and females. However, findings are largely inconsistent, making it unclear whether there are actual gender differences in body appreciation. With a meta-analytic approach, the current study quantitatively reviewed and synthesized previous findings, published up to May 2019, on gender differences in body appreciation. After searching and screening potential studies in four databases (i.e., PubMed, PsycINFO, Web of Science, and ProQuest Dissertations & Theses Global), we identified 40 relevant articles published from 2008 to 2019. A random-effects model reveals an overall estimate of gender difference in body appreciation of d = 0.27 (95 % CI: 0.21, 0.33; p <  .001); that is, males generally have a higher level of body appreciation than females, with a small effect size. Survey method, type of sample (cohorts), and age were identified as significant moderators that have contributed to the variability in previous findings. Future research and interventions in body appreciation may consider gender differences in their designs., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Weight loss after bariatric surgery is largely predicted by adherence to diet and lifestyle changes. There is no validated measure of self-reported adherence to a range of behaviors including self-monitoring, portion control, healthy food choice, and awareness of hunger and satiety., Objectives: The goal of the present study was to develop and provide initial evidence for the validity of the Weight Management Skills Questionnaire, a measure of adherence to these changes, by identifying its factor structure and relating the total score and subscale scores to baseline BMI, weight change during a preoperative education program, dysregulated eating, and binge eating disorder (BED)., Setting: University hospital, USA., Methods: Four hundred twenty-two bariatric surgery candidates responded the WMSQ and measures of eating behavior. Weight collected at the beginning, midpoint, and end of the presurgical program was used to compute percent total weight loss (%TWL) prior to surgery. Hierarchical factor analysis was used to explore the factor structure of the WMSQ while allowing the items to load onto a single general factor reflecting overall adherence to behavioral weight management., Results: The WMSQ has three interpretable subfactors, with all items loading onto the general factor. All scales were unrelated to starting BMI; total score and subfactors measuring general and bariatric-specific weight management skills were associated with %TWL. The scale measuring hunger/satiety responsiveness was negatively related to dysregulated eating/BED., Conclusions: The WMSQ may be a useful tool in future research exploring the key weight management skills associated with successful weight loss before and after bariatric surgery.

Objective: To identify the prevalence and demographic characteristics of food insecurity in a presurgical bariatric population. To date there has been no research on food insecurity in a presurgical bariatric population., Design: Participants completed the ten-item adult food security survey module created by the US Department of Agriculture (USDA), with additional questions related to food shopping behaviours and perceived affordability of post-bariatric supplements. USDA scoring guidelines were used to classify participants as food secure, marginally food secure and food insecure., Setting: Academic medical centre bariatric surgery clinic in Central Pennsylvania, USA., Participants: Adult bariatric surgery candidates (n 174)., Results: There was a prevalence of 17·8 % for food insecurity and 27·6 % for marginal food security. Food insecurity was associated with younger age, higher BMI, non-White race/ethnicity, having less than a college education, living in an urban area, receiving Medicaid/Medicare and participating in nutrition assistance programmes. Food-insecure participants endorsed food shopping behaviours that could interfere with postsurgical dietary adherence and perceived post-bariatric supplies as unaffordable or inaccessible., Conclusions: These results highlight the importance of screening bariatric surgical patients for food insecurity. Further study of this important problem within the bariatric population should address effects of food insecurity and related shopping behaviours on postsurgical outcomes and inform the development of programmes to better assist these high-risk patients.

Background: Eleven percent of households in the United States experience food insecurity, which is a lack of access to adequate, desirable food for a healthy lifestyle. Although food insecurity is associated with increased risk of obesity and nonadherence to dietary management of chronic diseases such as diabetes, the correlates of food insecurity have not yet been studied in a bariatric surgery population., Objectives: To replicate, in a bariatric sample, previous findings that food insecurity is related to eating pathology and to test the hypothesis that this relationship is mediated by depressive symptoms., Setting: University hospital, United States., Methods: Two hundred forty bariatric surgery candidates responded to self-report measures of food insecurity and mood, night-eating, and binge-eating symptoms. The sample was 74% female and 71% white, with a mean age of 41.09 (11.84) years. Based on responses to the United States Department of Agriculture Adult Food Security Survey Model, 15.8% were categorized as food insecure and 25.8% as marginally food secure. Multiple regression models with bootstrapping for confidence interval estimates were used to explore mediation hypotheses., Results: Food insecurity was positively associated with symptoms of night eating and binge eating, and these relationships were cross-sectionally mediated by depressive symptoms., Conclusions: Food insecure bariatric candidates may be at increased risk of poorer postoperative outcomes because of lack of access to needed food and the detrimental mental health impact of this lack of access., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to translate, modify, and validate the Adult Picky Eating Questionnaire (APEQ) for use in China., Methods: Based on standard procedures, the APEQ was translated into Chinese. Four items were added in the final Chinese version of the APEQ (C-APEQ). For testing the psychometric properties of the C-APEQ, a total of 1069 participants (17-24 years; 52.57% women) were recruited from two universities in mainland China., Results: Exploratory factor analysis and confirmatory factor analysis supported the previous four-factor structure of the APEQ. Findings also showed that the C-APEQ had adequate internal consistency (α = 0.874) and test-retest reliability (ICC = 0.778). The C-APEQ demonstrated strong measurement invariance across gender. Furthermore, the C-APEQ composite score presented positive and significant correlations with eating disturbance, psychological distress, and psychological inflexibility. It also showed a negative and significant correlation with food-related life satisfaction., Conclusion: Findings suggested that the Chinese version of the APEQ demonstrated sound psychometric properties. Thus, the C-APEQ can be a useful tool in future studies to accurately assess picky eating among adult population and explore the relationships between picky eating and other physical and psychological outcomes in a Chinese context., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To identify potential presentations of avoidant/restrictive food intake disorder (ARFID) in a pediatric eating disorder partial hospitalization program (PHP) based on the nature of the eating restriction leading to core symptoms of ARFID., Method: A retrospective chart review of 83 patients ages 8-17 admitted to a PHP and diagnosed with ARFID. Charts were independently reviewed by two coders, with high inter-rater agreement (κ = 0.77). Distinct categories were identified and groups were compared on demographics, anthropometrics, comorbid psychopathology, and core ARFID symptoms., Results: We identified cases characterized by predominantly selective eating based on aversions to the sensory properties of foods, lack of interest in eating/low appetite, and fear of aversive consequences from eating. We also distinguished a subset of patients with eating restrictions consistent with both selectivity and limited interest/appetite. The four primary ARFID presentation groups differed on core ARFID criteria, symptom trajectory and illness duration, mood and medical comorbidities, age, gender, and parent-reported symptoms of psychopathology., Discussion: The present findings suggest that there are diagnostically meaningful ARFID subtypes that can be differentiated based on the nature of their eating restrictions, as well as other demographic, illness history features, and psychiatric comorbidity. As treatments for youth with ARFID are developed and refined, it will be important to take into consideration not only demographic differences, but also the variability in symptoms, as this might require distinct interventions and levels of care. Additionally, differing mechanisms that maintain different types of eating restrictions might necessitate unique psychological and psychiatric interventions., (© 2019 Wiley Periodicals, Inc.)

Objective: Although Avoidant/Restrictive Food Intake Disorder (ARFID) has existed since the publication of DSM-5 in 2013, research on the descriptive psychopathology of treatment-seeking patients with formal ARFID diagnoses is sparse, and limited to tertiary eating disorder-focused treatment settings where most patients present with weight loss/malnutrition. In these settings, the selective/neophobic symptom presentation is rare compared to other primary eating restrictions. We aimed provide initial descriptive psychopathology of ARFID primary selective/neophobic symptom presentation in an outpatient setting, and to explore the prevalence of the core ARFID symptoms and clinical differences among patients meeting criteria based on weight/nutritional symptoms versus psychosocial impairment only., Method: We reviewed the charts of 22 consecutive outpatients diagnosed with ARFID caused by selective/neophobic eating, and describe symptoms, impairment, illness trajectory, and demographic features. Patients who met ARFID criteria because of weight loss/nutritional problems were compared to those who met for psychosocial impairment only on demographic and clinical characteristics., Results: Patients were predominantly male (81.8%) and school-aged (4-11 years). 81.8% had no weight/nutritional symptoms documented by a medical provider. All met criteria for significant psychosocial impairment. There were few differences between patients who did versus did not meet weight loss/nutritional criteria for ARFID; they differed only in age and in the presence of appetite disturbances consistent with another proposed presentation of ARFID., Discussion: These results provide novel data on the clinical characteristics of individuals who present with a primary presentation of selective/neophobic ARFID, including support for psychosocial impairment as sufficient for fulfilling ARFID criterion A., (© 2019 Wiley Periodicals, Inc.)

Background: Orthorexia nervosa (ON) is characterized by obsessions about eating healthily and rigid adherence to a perceived healthy diet. This study uses the Eating Habits Questionnaire to investigate the relationship of ON symptoms with self-reported food intake, eating-related impairment, obsessive compulsive disorder symptoms (OCD), gender, and BMI while controlling for other eating disordered symptoms. The aim of this study is to provide further evidence for the construct of ON as distinct from other forms of disordered eating., Methods: The sample consisted of 449 adults recruited on Amazon's Mechanical Turk. Self-reported symptoms of currently recognized eating disorders (anorexia and bulimia nervosa, AN/BN, avoidant/restrictive food intake disorder, ARFID) were statistically controlled in correlational analyses and MANCOVA exploring the relationship of ON domains to comorbidity, eating behavior, gender, and weight., Results: Confirmatory factor analysis supported a three-factor solution for the EHQ, with factors representing normative healthy eating behaviors ("behaviors"), positive feelings associated with healthy eating ("feelings"), and interference/problems from rigid healthy eating ("problems"). Overall ON symptoms were more strongly related to AN/BN than to ARFID. Of the subscales, only Problems was related to other eating disorder symptomatology. Controlling for other eating disorder symptoms, overall ON symptomatology was not related to clinical impairment from eating or OCD, although it was related to higher self-reported intake of fruits/vegetables and lower intake of discretionary foods. When other eating disordered symptoms and ON domains were statistically controlled, Problems was related to clinical eating impairment, OCD symptoms, and higher intake of both fruits/vegetables and discretionary foods., Conclusions: The Problems scale of the EHQ appears to capture disordered eating symptomatology that is distinct from other eating disorders and from normative healthy eating behaviors, consistent with descriptions of ON., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The aim of this study was to validate the Adult Eating Behaviour Questionnaire (AEBQ), a measure of food approach and avoidant traits, for use in bariatric surgery candidates. Participants were 337 bariatric surgery candidates in the Mid-Atlantic United States. Confirmatory factor analysis suggested that one item did not load onto its original factor. A 34-item, eight-factor model had better fit than a seven-factor model; dropping the Hunger factor, as previously suggested, did not improve fit. The factors had good internal consistency and showed convergent/divergent validity with an existing measure of food approach traits. The emotional overeating scale was positively correlated with BMI at programme entry, whereas the slow eating scale was negatively correlated with baseline weight. The AEBQ scales had the same pattern of intercorrelations and similar means to those of two previously published samples. The AEBQ is a valid measure of appetitive traits in bariatric candidates., (© 2018 John Wiley & Sons, Ltd and Eating Disorders Association.)