=Avoidant restrictive food intake disorder.

Extreme fussy eating, low appetite, slow eating, rigid eating behaviours eg brand-specific or position of food on plate. Often related to sensory issues (texture, colour, temperature) but also anxiety about potential choking or vomiting (emetophobia). But often food/eating is the only issue.

BPSU study 2024 described 300 cases across the UK. Slightly more boys than girls, 71% white. Comorbidity (anxiety and autism spectrum disorder) common.

Case definition from BPSU was:

• Nutritional deficiency that requires additional clinical investigation or treatment (e.g., anaemia, micronutrient deficiency, weight loss or poor growth, not fully accounted for by poverty or neglect, cultural practice or an existing medical condition or another mental disorder
• AND/OR Interference with day-to-day functioning due to eating behaviour
• Not explained by ANY of the following:
  • Lack of available food (e.g., from poverty, famine, or neglect)
  • Culturally sanctioned practice (e.g., endorsed religious and cultural practice)
  • Other known diagnosis e.g., Allergy, Constipation, Swallowing difficulties, anorexia/bulimia

If known medical/mental disorder, the severity of eating disturbance should exceed that routinely associated with the particular condition/disorder.

In practice, consider where:

• Weight for age or weight for height <2SDs below median
• Absence of entire food groups from diet
• Reliance on nutritional supplementation
• Extreme/frequent distress about eating
• Unable to eat at school, with peers, or out of home