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A 10-year-old boy is brought by his parents for evaluation of severely restricted eating. He eats only five specific foods, plain white rice, chicken nuggets, plain pasta, crackers, and apple juice, and has done so since age 3. He refuses all other foods based on their texture, reporting they make him gag. He has fallen to the 3rd percentile for weight, and his pediatrician has documented nutritional deficiencies in iron and vitamin D. He expresses no concern about body weight or shape and states he wishes he could eat more foods but 'they feel disgusting in my mouth.'
Explanation
ARFID is distinguished from anorexia nervosa by the complete absence of body image disturbance or weight/shape concerns. ARFID encompasses three motivational profiles for food avoidance: sensory sensitivity to food characteristics, apparent lack of interest in eating, and concern about aversive consequences of eating. The diagnosis requires that the eating disturbance leads to nutritional deficiency, weight loss, dependence on supplemental nutrition, or marked psychosocial interference.
Key Takeaway
ARFID involves clinically significant food restriction without body image disturbance or fear of weight gain, distinguishing it from anorexia nervosa through the absence of weight/shape preoccupation.