Avoidant/restrictive food intake disorder (ARFID) in a one-year-old infant
Abstract
Avoidant/Restrictive Food Intake Disorder (ARFID) represents a pathological selectivity or restriction of food intake. Along with Pica (eating non-nutritious or non-food substances) and Rumination Disorder (repeated regurgitation of eaten food), it makes a relatively new diagnostic category of "Feeding and Eating Disorders" in the DSM-5 (2013) and ICD-11 (2020). The typical age of onset is considered to be infancy and early childhood, but these disorders are also observed in older children, adolescents, and adults. This article presents a clinical case, in which the manifestations of ARFID developed in early childhood and led to characteristic consequences — chronic malnutrition, weight loss (protein-energy deficiency, dystrophy), retardation of growth and psychomotor development of the child (psychomotor development at one year is at the level of six months of age), the need for a gastrostomy to ensure the intake of nutrients into the body (with a characteristic negative impact on the psychosocial functioning of the family). In the paradigm of infant psychiatry, the etiopathogenesis of this case of ARFID is traced to the mother's unconscious rejection of the child (against the background of the unwillingness of the father and his family to have a child), lack of orientation of the mother in the needs of the baby and, as a result, delegation of a significant part of the child care to medical personnel.
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Washington, DC: American Psychiatric Association; 2013:334–38.
Балахонова Я.И., Гречаный С.В. Избегающе-ограничительное расстройство пищевого поведения: новый диагноз допубертатных расстройств пищевого поведения у детей (краткий обзор литературы). Children’s Medicine of the North-West. 2021;9(2):28–37. EDN: IEAUKK.
Stein D.J., Szatmari P., Gaebel W. et al. Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Med. 2020:18–21. DOI: 10.1186/s12916-020-1495-2.
Кощавцев А.Г. Клинико-этиологические аспекты расстройств пищевого поведения и сна в раннем детском возрасте. В кн.: Клиническая психотерапия (инстинктивно-поведенческие и нейропсихологические модели). Шевченко Ю.С., ред. М.: Медицинское информационное агентство. 2018:159–78.
Микиртумов Б.Е., Кощавцев А.Г., Гречаный С.В. Клиническая психиатрия раннего детского возраста. Краткое руководство. СПб.: Питер; 2001. EDN: RQCRGV.
Bourne L., Bryant-Waugh R., Cook J., Mandy W. Avoidant/restrictive food intake disorder: A systematic scoping review of the current literature. Psychiatry Res. 2020:288–293. DOI: 10.1016/j.psychres.2020.112961.
Thomas J.J., Becker K.R., Kuhnle M.C., Jo J.H., Harshman S.G., Wons O.B., Keshishian A.C., Hauser K., Breithaupt L., Liebman R.E., Misra M., Wilhelm S., Lawson E.A., Eddy K.T. Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents. Int J Eat Disord. 2020;53(10):1636–46. DOI: 10.1002/eat.23355.
