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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
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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
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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Footnotes

*

Co-senior authors

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