Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-16T15:13:34.211Z Has data issue: false hasContentIssue false
  • English
  • Français

Latent profile analysis reveals overlapping ARFID and shape/weight motivations for restriction in eating disorders

Published online by Cambridge University Press:  27 May 2024

Sophie R. Abber Open the ORCID record for Sophie R. Abber [Opens in a new window] ,
Kendra R. Becker Open the ORCID record for Kendra R. Becker [Opens in a new window] ,
Casey M. Stern Open the ORCID record for Casey M. Stern [Opens in a new window] ,
Lilian P. Palmer Open the ORCID record for Lilian P. Palmer [Opens in a new window] ,
Thomas E. Joiner Open the ORCID record for Thomas E. Joiner [Opens in a new window] ,
Lauren Breithaupt Open the ORCID record for Lauren Breithaupt [Opens in a new window] ,
Paraskevi Evelyna Kambanis Open the ORCID record for Paraskevi Evelyna Kambanis [Opens in a new window] ,
Kamryn T. Eddy Open the ORCID record for Kamryn T. Eddy [Opens in a new window] ,
Jennifer J. Thomas Open the ORCID record for Jennifer J. Thomas [Opens in a new window]  and
Helen Burton-Murray Open the ORCID record for Helen Burton-Murray [Opens in a new window]
Sophie R. Abber
Affiliation:
Department of Psychology, Florida State University, Tallahassee, FL, USA
Kendra R. Becker
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Casey M. Stern
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Lilian P. Palmer
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Thomas E. Joiner
Affiliation:
Department of Psychology, Florida State University, Tallahassee, FL, USA
Lauren Breithaupt
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Paraskevi Evelyna Kambanis
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Kamryn T. Eddy
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Jennifer J. Thomas*
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Helen Burton-Murray
Affiliation:
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
*
Corresponding author: Jennifer J. Thomas; Email: jjthomas@mgh.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

DSM-5 differentiates avoidant/restrictive food intake disorder (ARFID) from other eating disorders (EDs) by a lack of overvaluation of body weight/shape driving restrictive eating. However, clinical observations and research demonstrate ARFID and shape/weight motivations sometimes co-occur. To inform classification, we: (1) derived profiles underlying restriction motivation and examined their validity and (2) described diagnostic characterizations of individuals in each profile to explore whether findings support current diagnostic schemes. We expected, consistent with DSM-5, that profiles would comprise individuals endorsing solely ARFID or restraint (i.e. trying to eat less to control shape/weight) motivations.

Methods

We applied latent profile analysis to 202 treatment-seeking individuals (ages 10–79 years [M = 26, s.d. = 14], 76% female) with ARFID or a non-ARFID ED, using the Nine-Item ARFID Screen (Picky, Appetite, and Fear subscales) and the Eating Disorder Examination-Questionnaire Restraint subscale as indicators.

Results

A 5-profile solution emerged: Restraint/ARFID-Mixed (n = 24; 8% [n = 2] with ARFID diagnosis); ARFID-2 (with Picky/Appetite; n = 56; 82% ARFID); ARFID-3 (with Picky/Appetite/Fear; n = 40; 68% ARFID); Restraint (n = 45; 11% ARFID); and Non-Endorsers (n = 37; 2% ARFID). Two profiles comprised individuals endorsing solely ARFID motivations (ARFID-2, ARFID-3) and one comprising solely restraint motivations (Restraint), consistent with DSM-5. However, Restraint/ARFID-Mixed (92% non-ARFID ED diagnoses, comprising 18% of those with non-ARFID ED diagnoses in the full sample) endorsed ARFID and restraint motivations.

Conclusions

The heterogeneous profiles identified suggest ARFID and restraint motivations for dietary restriction may overlap somewhat and that individuals with non-ARFID EDs can also endorse high ARFID symptoms. Future research should clarify diagnostic boundaries between ARFID and non-ARFID EDs.

Keywords

anorexia nervosaavoidant/restrictive food intake disorderbulimia nervosa
Type
Original Article
Information
Psychological Medicine , First View , pp. 1 - 11
Check for updates
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Co-senior authors

References

Akaike, H. (1973). Maximum likelihood identification of Gaussian autoregressive moving average models. Biometrika, 60(2), 255–265. doi: 10.1093/biomet/60.2.255CrossRefGoogle Scholar
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: American Psychiatric Association Publishing. doi: 10.1176/appi.books.9780890425787Google Scholar
Barney, A., Bruett, L. D., Forsberg, S., & Nagata, J. M. (2022). Avoidant restrictive food intake disorder (ARFID) and body image: A case report. Journal of Eating Disorders, 10(1), 1–3. doi: 10.1186/s40337-022-00583-0CrossRefGoogle ScholarPubMed
Bazelmans, T., Jones, E. J., Ghods, S., Corrigan, S., Toth, K., Charman, T., & Webb, S. J. (2023). Identifying phenotypic and physiological subgroups of preschoolers with autism spectrum disorder. Psychological Medicine, 53(4), 1592–1602. doi: 10.1017/S0033291721003172CrossRefGoogle ScholarPubMed
Becker, K. R., Breithaupt, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2020). Co-occurrence of avoidant/restrictive food intake disorder and traditional eating psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 59(2), 209. doi: 10.1093/biomet/60.2.255CrossRefGoogle ScholarPubMed
Becker, K. R., Keshishian, A. C., Liebman, R. E., Coniglio, K. A., Wang, S. B., Franko, D. L., … Thomas, J. J. (2019). Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa. International Journal of Eating Disorders, 52(3), 230–238. doi: 10.1002/eat.22988CrossRefGoogle ScholarPubMed
Billman Miller, M. G., Zickgraf, H. F., Murray, H. B., Essayli, J. H., & Lane-Loney, S. E. (2024). Validation of the youth-nine item avoidant/restrictive food intake disorder screen. European Eating Disorders Review, 32(1), 20–31. doi: 10.1002/erv.3017CrossRefGoogle ScholarPubMed
Bozdogan, H. (1987). Model selection and Akaike's information criterion (AIC): The general theory and its analytical extensions. Psychometrika, 52(3), 345–370. doi: 10.1007/BF02294361CrossRefGoogle Scholar
Burton-Murray, H., Coniglio, K., Hartmann, A. S., Becker, A. E., Eddy, K. T., & Thomas, J. J. (2017). Are eating disorders “all about control?” The elusive psychopathology of nonfat phobic presentations. International Journal of Eating Disorders, 50(11), 1306–1312. doi: 10.1002/eat.22779CrossRefGoogle Scholar
Burton-Murray, H., Dreier, M. J., Zickgraf, H. F., Becker, K. R., Breithaupt, L., Eddy, K. T., … Thomas, J. J. (2021). Validation of the nine item ARFID screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. International Journal of Eating Disorders, 54(10), 1782–1792. doi: 10.1002/eat.23520CrossRefGoogle ScholarPubMed
Charpignon, M. L., Vakulenko-Lagun, B., Zheng, B., Magdamo, C., Su, B., Evans, K., … Sheu, Y.-H. (2022). Causal inference in medical records and complementary systems pharmacology for metformin drug repurposing towards dementia. Nature Communications, 13(1), 7652. doi: doi: 10.1038/s41467-022-35157-wCrossRefGoogle ScholarPubMed
Christian, C., Bridges-Curry, Z., Hunt, R. A., Ortiz, A. M. L., Drake, J. E., & Levinson, C. A. (2021). Latent profile analysis of impulsivity and perfectionism dimensions and associations with psychiatric symptoms. Journal of Affective Disorders, 283, 293–301. doi: 10.1016/j.jad.2021.01.076CrossRefGoogle ScholarPubMed
Crum, K. I., Aloi, J., Blair, K. S., Bashford-Largo, J., Bajaj, S., Zhang, R., … Filbey, F. M. (2023). Latent profiles of substance use, early life stress, and attention/externalizing problems and their association with neural correlates of reinforcement learning in adolescents. Psychological Medicine, 53(15), 7358–7367. doi: 10.1017/S0033291723000971CrossRefGoogle ScholarPubMed
Elran-Barak, R., Sztainer, M., Goldschmidt, A. B., Crow, S. J., Peterson, C. B., Hill, L. L., … Le Grange, D. (2015). Dietary restriction behaviors and binge eating in anorexia nervosa, bulimia nervosa and binge eating disorder: Trans-diagnostic examination of the restraint model. Eating Behaviors, 18, 192–196. doi: 10.1016/j.eatbeh.2015.05.012CrossRefGoogle ScholarPubMed
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press.Google ScholarPubMed
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363–370. doi: 10.1002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-%233.0.CO;2-#>CrossRefGoogle ScholarPubMed
Forbush, K. T., Wildes, J. E., Pollack, L. O., Dunbar, D., Luo, J., Patterson, K., … Watson, D. (2013). Development and validation of the Eating Pathology Symptoms Inventory (EPSI). Psychological Assessment, 25(3), 859–878. doi: 10.1037/a0032639CrossRefGoogle ScholarPubMed
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O'Neal, L., … Kirby, J. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. doi: 10.1016/j.jbi.2019.103208CrossRefGoogle ScholarPubMed
Haynos, A. F., Wang, S. B., LeMay-Russell, S., Lavender, J. M., Pearson, C. M., Mathis, K. J., … Crow, S. J. (2021). An empirical taxonomy of reward response patterns in a transdiagnostic eating disorder sample. Eating Behaviors, 42, 101531. doi: 10.1016/j.eatbeh.2021.101531CrossRefGoogle Scholar
Izquierdo, A., Plessow, F., Becker, K. R., Mancuso, C. J., Slattery, M., Burton-Murray, H., … Eddy, K. T. (2019). Implicit attitudes toward dieting and thinness distinguish fat-phobic and non-fat-phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents. International Journal of Eating Disorders, 52(4), 419–427. doi: 10.1002/eat.22981CrossRefGoogle ScholarPubMed
Lambek, R., Sonuga-Barke, E., Tannock, R., Sørensen, A. V., Damm, D., & Thomsen, P. H. (2018). Are there distinct cognitive and motivational sub-groups of children with ADHD? Psychological Medicine, 48(10), 1722–1730. doi: 10.1017/S0033291717003245CrossRefGoogle ScholarPubMed
Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. (2004). Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42(5), 551–567. doi: 10.1016/S0005-7967(03)00161-XCrossRefGoogle ScholarPubMed
Norris, M. L., Spettigue, W., Hammond, N. G., Katzman, D. K., Zucker, N., Yelle, K., … Obeid, N. (2018). Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder. International Journal of Eating Disorders, 51(2), 170–173. doi: 10.1002/eat.22814CrossRefGoogle ScholarPubMed
Nylund, K., Asparouhov, T., & Muthén, B. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling, 14, 535–569. doi: 10.1080/10705510701575396CrossRefGoogle Scholar
Pinhas, L., Nicholls, D., Crosby, R. D., Morris, A., Lynn, R. M., & Madden, S. (2017). Classification of childhood onset eating disorders: A latent class analysis. International Journal of Eating Disorders, 50(6), 657–664. doi: 10.1002/eat.22666CrossRefGoogle ScholarPubMed
Pliner, P., & Hobden, K. (1992). Development of a scale to measure the trait of food neophobia in humans. Appetite, 19(2), 105–120. doi:10.1016/0195-6663(92)90014-WCrossRefGoogle ScholarPubMed
Rosenberg, J. M., Beymer, P. N., Anderson, D. J., Van Lissa, C., & Schmidt, J. A. (2019). tidyLPA: An R package to easily carry out latent profile analysis (LPA) using open-source or commercial software. Journal of Open Source Software, 3(30), 978. https://doi.org/10.21105/joss.00978CrossRefGoogle Scholar
Santonicola, A., Siniscalchi, M., Capone, P., Gallotta, S., Ciacci, C., & Iovino, P. (2012). Prevalence of functional dyspepsia and its subgroups in patients with eating disorders. World Journal of Gastroenterology, 18(32), 4379. doi: 10.3748/wjg.v18.i32.4379CrossRefGoogle ScholarPubMed
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6, 461–464. http://www.jstor.org/stable/2958889CrossRefGoogle Scholar
Scrucca, L., Fop, M., Murphy, T. B., & Raftery, A. E. (2016). Mclust 5: Clustering, classification and density estimation using Gaussian finite mixture models. The R Journal, 8(1), 289.CrossRefGoogle ScholarPubMed
Thomas, J. J., Becker, K. R., Breithaupt, L., Burton-Murray, H., Jo, J. H., Kuhnle, M. C., … Hauser, K. (2021a). Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder. Journal of Behavioral and Cognitive Therapy, 31(1), 47–55. doi: 10.1016/j.jbct.2020.10.004CrossRefGoogle ScholarPubMed
Thomas, J. J., Becker, K. R., & Eddy, K. T. (2021b). The picky eater's recovery book: Overcoming avoidant/restrictive food intake disorder. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
Thomas, J. J., Becker, K. R., Kuhnle, M. C., Jo, J. H., Harshman, S. G., Wons, O. B., … Liebman, R. E. (2021c). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents. International Journal of Eating Disorders, 53(10), 1636–1646. doi: 10.1002/eat.23355CrossRefGoogle Scholar
Thomas, J. J., & Eddy, K. T. (2019). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Children, adolescents, and adults. New York, NY: Cambridge University Press.Google Scholar
Thomas, J. J., Hartmann, A. S., & Killgore, W. D. (2013). Non-fat-phobic eating disorders: Why we need to investigate implicit associations and neural correlates. International Journal of Eating Disorders, 46(5), 416–419. doi: 10.1002/eat.22098CrossRefGoogle ScholarPubMed
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/restrictive food intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19, 1–9. doi: 10.1007/s11920-017-0795-5CrossRefGoogle ScholarPubMed
van Hulst, B. M., De Zeeuw, P., & Durston, S. (2015). Distinct neuropsychological profiles within ADHD: A latent class analysis of cognitive control, reward sensitivity and timing. Psychological Medicine, 45(4), 735–745. doi: 10.1017/S0033291714001792CrossRefGoogle ScholarPubMed
Waller, G., Turner, H., Tatham, M., Mountford, V., & Wade, T. (2019). Brief cognitive behavioural therapy for non-underweight patients: CBT-T for eating disorders. New York, NY: Routledge.CrossRefGoogle Scholar
Zickgraf, H. F., & Ellis, J. M. (2018). Initial validation of the nine item avoidant/restrictive food intake disorder screen (NIAS): A measure of three restrictive eating patterns. Appetite, 123, 32–42. doi: 10.1016/j.appet.2017.11.111CrossRefGoogle Scholar
Zickgraf, H. F., Lane-Loney, S., Essayli, J. H., & Ornstein, R. M. (2019). Further support for diagnostically meaningful ARFID symptom presentations in an adolescent medicine partial hospitalization program. International Journal of Eating Disorders, 52(4), 402–409. doi: 10.1002/eat.23016CrossRefGoogle Scholar
Zucker, N. L., & Bulik, C. M. (2020). On bells, saliva, and abdominal pain or discomfort: Early aversive visceral conditioning and vulnerability for anorexia nervosa. International Journal of Eating Disorders, 53(4), 508–512. doi: 10.1002/eat.23255CrossRefGoogle ScholarPubMed