目的:使用前瞻性纵向设计来表征ARFID的缓解和持久性,以评估基线时9-23岁青年完全和亚阈值回避/限制性食物摄入障碍(ARFID)的2年疗程和结局。评估诊断交叉,并确定结果的预测因子。我们假设每个ARFID配置文件的严重程度更高-感觉敏感性,害怕令人厌恶的后果,缺乏兴趣-会预测疾病持续的可能性更大,控制年龄,性别,BMI百分位数,ARFID治疗状态,和基线诊断。
方法:我们跟踪参与者(N=100;年龄9-23岁;49%为女性,91%白人)超过两年。我们用了皮卡,ARFID,和三个时间点的沉思障碍访谈(基线,1年,2年)测量每个ARFID配置文件的严重程度,并评估疾病的持续性或缓解,和DSM-5的饮食失调评估来评估诊断交叉。
结果:在2年的随访期内,一半的样本坚持他们最初的诊断,3%的参与者经历了神经性厌食症的诊断转变。感觉敏感性的严重程度和缺乏兴趣的情况与仅在第1年的ARFID持续的可能性更高相关;对厌恶后果的恐惧程度的严重程度与仅在第2年的ARFID缓解的可能性更高相关。
结论:研究结果强调了ARFID与其他饮食失调的独特性,并强调其持续2年以上。结果还突出了ARFID配置文件的预测有效性和预后价值(即,感官敏感性,害怕令人厌恶的后果,缺乏兴趣)。
OBJECTIVE: To evaluate the 2-year course and outcomes of full and subthreshold avoidant/restrictive food intake disorder (ARFID) in youth aged 9 to 23 years at baseline using a prospective longitudinal design to characterize the remission and persistence of ARFID, evaluate diagnostic crossover, and identify predictors of outcome. Greater severity in each ARFID profile-sensory sensitivity, fear of aversive consequences, and lack of interest-was hypothesized to predict greater likelihood of illness persistence, controlling for age, sex, body mass index percentile, ARFID treatment status, and baseline diagnosis.
METHODS: Participants (N = 100; age range, 9-23 years; 49% female; 91% White) were followed over 2 years. The Pica, ARFID, and Rumination Disorder Interview was used across 3 time points (baseline, year 1, year 2) to measure the severity of each ARFID profile and evaluate illness persistence or remission, and the Eating Disorder Assessment for DSM-5 was used to evaluate diagnostic crossover.
RESULTS: Across the 2-year follow-up period, half the participants persisted with their original diagnosis, and 3% of participants experienced a diagnostic shift to anorexia nervosa. Greater severity in the sensory sensitivity and lack of interest profiles was associated with higher likelihood of ARFID persistence at year 1 only; greater severity in the fear of aversive consequences profile was associated with higher likelihood of ARFID remission at year 2 only.
CONCLUSIONS: Findings underscore the distinctiveness of ARFID from other eating disorders and emphasize its persistence over 2 years. Results also highlight the predictive validity and prognostic value of the ARFID profiles (ie, sensory sensitivity, fear of aversive consequences, lack of interest).