In August of 2023, Feeding Matters gathered leaders from the avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) communities for a facilitated meeting to address issues related to the overlap of these diagnoses, including clinical confusion and research efforts. During the meeting, these experts identified and agreed upon consensus statements. Throughout 2024, those statements were refined and vetted, and recently they were published in a paper in the International Journal of Eating Disorders December 2024 edition.

As a result of these statements, Feeding Matters proposes changes be made related to how these diagnoses are used. We believe the following actions are needed:

• Diagnostic and Statistical Manual of Mental Health Disorders (DSM) text revisions
• shared feeding and eating disorder diagnosis
• education and advocacy to complement future revisions

As it relates to DSM revisions, Feeding Matters proposes the creation of a new stem—Criterion A—to define ARFID as involving a negative association with food that differs from weight/shape eating disorders such as anorexia. This negative association with food in this proposed Criterion A is driven by anticipated negative outcomes related to eating including any or any combination of:

• disgust/distaste
• anhedonia/uncomfortable fullness
• and acute fear/panic

As it relates to a shared feeding and eating disorder diagnosis, Feeding Matters proposes working together. As the only feeding and eating disorder in the DSM, ARFID sits at the intersection of two clinical and research communities with great synergistic potential to drive innovation and improve outcomes for patients. In short, patients will receive better care if the PFD and ARFID communities work together.

As it relates to a call for education and advocacy to complement future revisions, Feeding Matters proposes that PFD and ARFID leaders should focus on consensus, common terminology among disciplines, early identification to support triage to intervention, connecting families with qualified providers, and more. This work also includes an emphasis on continued collaboration between these two fields to answer the most pressing questions for our population. It will center the research agenda through patient and other stakeholder engagement to include those with lived experience who can provide important insight into how diagnostic refinement and treatment opportunities can evolve to better support long-term outcomes.

Feeding Matters aims to involve experts and community members in the continued efforts to navigate the overlap of PFD and ARFID, both in the United States and internationally. It will require many people, perspectives, and passions to take the steps Feeding Matters recommends in this piece.

Learn more about navigating the overlap of PFD and ARFID here.