Birgit Olsson Lecture 2017
Associate Professor Rachel Bryant-Waugh's lecture "Improving understanding of the avoidance and restriction of food intake: Picky eating, ARFID and Anorexia Nervosa"
About Associate Professor Rachel Bryant-Waugh
Associate Professor Rachel Bryant-Waugh is a world expert in feeding and eating disorders in children and adolescents and Consultant Clinical Psychologist at Great Ormond Street Hospital, London. Her research includes interventions relevant to feeding and eating disorders in children, the classification of childhood feeding and eating disorders, and mothers with eating disorders and their children. Rachel Bryant-Waugh was the primary architect behind the American Psychiatric Association’s DSM-5 Avoidant/Restrictive Food Intake Disorder (ARFID). She is the recipient of the British Psychological Society’s May Davidson Award for her outstanding contribution to the field of childhood eating disorders. Together with the late Professor Bryan Lask she has been the promotor of The London International Conference on Eating Disorders taking place every two years since 1993, when the meeting was inaugurated by the late Princess Diana.
"Improving understanding of the avoidance and restriction of food intake: Picky eating, ARFID and Anorexia Nervosa"
The focus of the lecture was, as the title implies, extremely avoidant and restrictive eating behaviour. Rachel Bryant-Waugh described the diagnosis Avoidant/Restrictive Food Intake Disorder (ARFID), introduced in DSM-5, and compared it with the diagnosis anorexia nervosa. The three cardinal symptoms that Rachel Bryant-Waugh pointed out as important in ARFID were “low interest”, “sensory” and “fear”. That there is a lack of interest in eating, that the avoidance of food is based on the food’s characteristics and that there is a fear of negative consequences of eating, e.g. fear of choking. Unlike in anorexia nervosa, people with ARFID do not have a distorted body image and their eating disorder is not rooted in a desire to get thinner or change their body shape. One of the consequences of extremely avoidant and restrictive eating behavior is inadequate nutritional intake, which in turn has adverse health effects. There are similarities between anorexia nervosa and ARFID, such as the prevalence of weight loss in both conditions (although less commonly in ARFID), limited food intake, frequent occurrence of conflicts in conjunction with meals, as well as increased risk of social isolation and impact on the family. However, there is a focus on body weight and avoidance of weight gain present in anorexia nervosa that is not present in ARFID. There is also a difference in that children with ARFID show abnormal eating behavior at an earlier stage than children with anorexia nervosa do. The focus of treatment depends on which cardinal symptom is most prominent. If the child shows “low interest”, they need structure and routines in feeding situations, if the main basis of the ARFID diagnosis is sensory sensitivity, perhaps the settings surrounding feeding situations must be mapped out in order to eliminate any disruptive stimuli, and if “fear” is prominent, a CBT approach with exposure and psychoeducation is often recommended.
In Rachel Bryant-Waugh’s personal clinical experience, a high number of children with ARFID also have concurrent ESSENCE problems.