Inadequate nutritional intake may exacerbate the associated features (e.g., irritability, de- velopmental lags) and further contribute to feeding difficulties. Associated factors include to feeding. Coexisting parental psychopathology, or child abuse or neglect, is suggested if feeding and weight improve in response to changing caregivers. In infants, children, and prepubertal adolescents, avoidant/ restrictive food intake disorder may be associated with growth delay, and the resulting malnutrition negatively affects development and learning potential. In older children, adolescents, and adults, social functioning tends to be ad- versely affected. Regardless of the age, family function may be affected, with heightened stress at mealtimes and in other feeding or eating contexts involving friends and relatives.
in adults, and there may be a long delay between onset and clinical presentation. Triggers for presentation vary considerably and include physical, social, and emotional difficulties.
Temperamental. Anxiety disorders, autism spectrum disorder, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder may increase risk for avoidant or restrictive feeding or eating behavior characteristic of the disorder.
Environmental. Environmental risk factors for avoidant/ restrictive food intake disor- der include familial anxiety. Higher rates of feeding disturbances may occur in children of mothers with eating disorders.
Genetic and physiological. History of gastrointestinal conditions, gastroesophageal re- ﬂux disease, vomiting, and a range of other medical problems has been associated with feeding and eating behaviors characteristic of avoidant/restrictive food intake disorder.
Presentations similar to avoidant/restrictive food intake disorder occur in various popu- lations, including in the United States, Canada, Australia, and Europe. Avoidant/restrictive food intake disorder should not be diagnosed when avoidance of food intake is solely re- lated to specific religious or cultural practices.
Avoidant/restrictive food intake disorder is equally common in males and females in in- fancy and early childhood, but avoidant/restrictive food intake disorder comorbid with autism spectrum disorder has a male predominance. Food avoidance or restriction related to altered sensory sensitivities can occur in some physiological conditions, most notably pregnancy, but is not usually extreme and does not meet full criteria for the disorder.
Diagnostic markers include malnutrition, low weight, growth delay, and the need for ar- tificial nutrition in the absence of any clear medical condition other than poor intake.
Functionai Consequences of Avoidanthestrictive
Associated developmental and functional limitations include impairment of physical de- function.
Appetite loss preceding restricted intake is a nonspecific symptom that can accompany a number of mental diagnoses. Avoidant/restrictive food intake disorder can be diagnosed concurrently with the disorders below if all criteria are met, and the eating disturbance re- quires specific clinical attention.
Other medical conditions (e.g., gastrointestinal disease, food allergies and intoler- ances, occult malignancies). Restriction of food intake may occur in other medical condi- tions, especially those with ongoing symptoms such as vomiting, loss of appetite, nausea, ab- dominal pain, or diarrhea. A diagnosis of avoidant/ restrictive food intake disorder requires that the disturbance of intake is beyond that directly accounted for by physical symptoms con- sistent with a medical condition; the eating disturbance may also persist after being triggered by a medical condition and following resolution of the medical condition.
Underlying medical or comorbid mental conditions may complicate feeding and eating.
Because older individuals, postsurgical patients, and individuals receiving chemotherapy often lose their appetite, an additional diagnosis of avoidant/restrictive food intake dis— order requires that the eating disturbance is a primary focus for intervention.