Treatment of avoidant/restrictive food intake disorder: a systematic review

Objective: This study aimed to conduct a systematic review on the effects of available treatments for avoidant/restrictive food intake disorder (ARFID).

Methods: Literature searches, study selection, method development, and quality appraisal were performed independently by one author, and data were synthesized using a narrative approach. Studies published in English and in peer-reviewed journals that evaluated the outcomes of ARFID treatments in at least three participants were taken into consideration, while non-original studies, editorials and letters to the editor were excluded.

Results: The review had three main findings. First, in all of the studies by the end of the treatment there was a significant weight gain in the ARFID participants. Second, weight recovery was maintained at follow-up in a good percentage of participants with an associated improvement of eating behavior and a reduction in anxiety, depression, and fear for the adverse consequences of eating. Third, there was weak or missing evidence regarding the treatment of ARFID in adults and the difference in outcome in the three different ARFID profiles. Eighteen studies were selected and eleven were included.

Conclusion: The treatments for ARFID, although promising, have focused only on young participants and addressed the normalization of eating with behavioral procedures, but not the underlying psychopathology. Moreover, the lack of randomized controlled trials with adequate statistical power does not allow to draw conclusions on the difference in the effectiveness of the interventions tested.