- weight loss (or in children, failure to grow taller or gain weight as developmentally expected)
- nutritional deficiencies
- dependence on oral or enteral nutritional supplements
- psychosocial impairment (difficulty functioning in one or more important social roles).
Because it was at the time the only measure of ARFID symptoms, a lot of people adopted the NIAS, and it’s been translated into multiple languages and is now being validated in clinical samples with ARFID (I only had access to convenience samples when I developed it). However, my colleagues who work with GI clinical populations had some concerns that the fear subscale of the NIAS wasn’t appropriate for their populations. I come from an anxiety and OCD background, and when I was developing the NIAS I was thinking of fear-ARFID as being driven by anxiety disorders like choking and vomiting phobia, obsessive compulsive disorder focused on food quality or safety, or functional GI disorders like IBS or globus. In all of these populations, food avoidance and restriction is inherently maladaptive, because there is no underlying physical/medical reason why people with these disorders would be more likely to experience their feared outcomes of eating than the general population. But when people tried to use the NIAS to measure fear-ARFID in populations with digestive diseases or food allergies, it became difficult to tell whether patients’ reported food avoidance on the NIAS was driven by “real” fears and reasonable or medically necessary eating restrictions, or by fear of eating and restrictive eating that went beyond what could be explained by, and what was appropriate to manage, GI diseases. ARFID should only be diagnosed in the latter case. We recently developed the Fear of Food Questionnaire in the hopes of measuring fear-ARFID symptoms in more detail, and with more discrimination between “real” and “disordered” fears.
Fear of Food Questionnaire, click on link for PDF> 18-item FFQ FEAR of FOOD
Kate-Clinical cut off values for this instrument are not yet available, but these questions are suitable to use as a screening (not diagnostic) tool for food fear in GI populations.
Reference: Zickgraf HF, Loftus P, Gibbons B, Cohen LC, Hunt MG. “If I could survive without eating, it would be a huge relief”: Development and initial validation of the Fear of Food Questionnaire. Appetite. 2022 Feb 1;169:105808. doi: 10.1016/j.appet.2021.105808. Epub 2021 Nov 16. PMID: 34798226.
Kate: I am particularly interested in avoidant /restrictive food intake disorder in GI conditions. Can you explain what ARFID is—and how it may appear in various subtypes in GI conditions?