Avoidant Restrictive Food Intake Disorder (ARFID): Psychological Interventions and Outcomes

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In this In Conversation podcast, we are joined by Dr. Emma Willmott and Dr. Tom Jewell, from the South London and Maudsley NHS Trust and King’s College London, to discuss their recently published scoping review on psychological interventions for Avoidant Restrictive Food Intake Disorder (ARFID).

Discussion points include:

  • The main aims of the review into psychological interventions for ARFID.
  • How many studies were identified and the main findings.
  • Different intervention modalities for ARFID.
  • The lack of consistency when measuring change in patients with ARFID and how best to measure recovery for patients with ARFID.
  • Recommendations on next steps to advance knowledge of ARFID and effective treatments.
  • Advice and resources for non-specialist eating disorder clinicians.

This is the second episode of a two-part series on ARFID with Dr. Emma Willmott and Dr. Tom Jewell. Episode one can be found here: ‘Avoidant Restrictive Food Intake Disorder (ARFID): Prevalence and Implications’.

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Other resources

  • Podcast ‘Avoidant Restrictive Food Intake Disorder (ARFID): Prevalence and Implications’ with Dr. Emma Willmott and Dr. Tom Jewell. This is the first episode of a two-part series on ARFID with Dr. Emma Willmott and Dr. Tom Jewell.
  • Blog ‘An Overview of Psychological Interventions for Avoidant Restrictive Food Intake Disorder (ARFID)’ with Dr. Emma Willmott and Dr. Tom Jewell
  • Scoping Review ‘A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID)’, International Journal of Eating Disorders, Vol. 57, Iss. 1 (2023), Emma Willmott DClinPsy, Rachel Dickinson BSc, Celine Hall MSc, Kevser Sadikovic BSc, Emily Wadhera, Nadia Micali MD, PhD, Nora Trompeter PhD, Tom Jewell PhD
Dr. Emma Willmott
Dr. Emma Willmott

Dr. Emma Willmott is a Senior Clinical Psychologist who works with young people experiencing ARFID and their families across community-based and national and specialist NHS CAMHS services. Emma has worked at the Feeding and Eating Disorder Service at Great Ormond Street Hospital (GOSH) and currently works at the ARFID Service at Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED) at SLAM. Emma has recently published a scoping review exploring psychological interventions and outcomes for ARIFD and is interested in the links between neurodiversity and eating disorders.

Dr. Tom Jewell
Dr. Tom Jewell

Dr. Tom Jewell is a Lecturer in Mental Health Nursing at King’s College London, with a clinical and research interest in adolescent eating disorders. He is a mental health nurse and family therapist and works clinically at Great Ormond Street Hospital.


[00:00:01.449] Clara Faria: Hello, welcome to the In Conversation podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Clara Faria, an ACAMH Young Person Ambassador, and in today’s episode I have the pleasure to talk to Dr. Emma Willmott and Dr. Tom Jewell, from the South London and Maudsley NHS Trust and King’s College London, to discuss avoidant restrictive food intake disorder, ARFID, and their recently published scoping review on psychological interventions for this condition. So, welcome again, Emma and Tom. Lovely to be speaking with you again.

[00:00:44.190] Dr. Emma Willmott: Hi, Clara.

[00:00:45.210] Dr. Tom Jewell: Thanks for having us back.

[00:00:46.840] Clara Faria: So, in the first episode, we tried to lay some of the foundations for your scoping review, looking at avoidant restrictive food intake disorder, how it presents, how common it is and how it differs from other eating disorders. In this episode, we are really going to focus on the scoping review itself. How did you have the idea of doing the systematic review? Did your clinical experiences influence you somehow, and can you tell us a little bit about the review’s main aims?

[00:01:15.100] Dr. Emma Willmott: Yes, so, I guess, to say, Tom and I were thinking about this a little bit, kind of, earlier on today, and how much, kind of, back story and history to give. And I suppose, for me, it’s quite a long story that starts when I was a teenager, and I originally watched a programme called “The House of Tiny Tearaways,” with a Clinical Psychologist called Dr. Tanya Byron. And essentially, it was a bit like the Big Brother house, for families who were struggling to support their children with some kind of difficulty. And I remember watching an episode where a young boy would only eat yoghurts, and I don’t know, this really fascinated me. And I was just so amazed that through the Psychologist, kind of, talking alone and supporting the parents, they were able to make a huge shift in the young person’s diet, and in his and his family’s life. And it was at that point that I decided I wanted to be a Clinical Psychologist.

And then my first experiences as an Assistant Psychologist were mainly in neurodevelopmental assessments, and I was meeting with lots of families to complete developmental history interviews. And a common theme was that often, children have very selective and limited diets, and that really interested me, that lots of children who were, kind of, undergoing assessments for autism and other neurodevelopmental conditions seemed to have, kind of, a bit of a common pattern. And then on my Clinical Psychologist training, I completed a project on ARFID as part of my thesis, and when I qualified, I ended up working at the Feeding and Eating Disorders Service at Great Ormond Street Hospital, which is when I met Tom.

[00:02:39.210] Dr. Tom Jewell: So, yeah, when I met Emma, I heard about her interest in ARFID, and the – in the, sort of, few years before meeting Emma, I’d been working mainly in outpatient eating disorders, so mainly working with young people with anorexia nervosa in my clinical work. So, I was very used to having a, kind of, a clear recommended treatment, knowing what was the NICE guideline recommended treatment, and working in that sort of way.

So, I think, for me, when I started to work at Great Ormond Street, and I was seeing patients with ARFID, there was this, kind of, question for me, but I think for other team members, which is, you know, what is best practice? What are the best treatments for ARFID? And so, I guess when I met Emma, we talked about her interest in ARFID, and the work she’d been doing already to, kind of like, look at the literature, so, I encouraged Emma to try and publish the work she’d been doing, and we developed into a scoping review with several other people.

So, just to explain, like, a scoping review is a particular type of review that you do when there’s not that much literature, or when the literature is, kind of, at quite an early stage. So, I guess, to summarise, we were, kind of, influenced by our interest clinically in ARFID, and the need to, kind of, understand more about what’s been done, so to, kind of, find studies that describe psychological interventions for ARFID. And that was going to be not just for children and adolescents, but across, you know, the whole lifespan, across any clinical settings. And then, the other thing that we were aiming to do was to look at how outcomes are measured. So, what I mean by that is, if you do a study of ARFID treatment or intervention, how are you measuring change? So, we wanted to look at that, as well.

[00:04:20.900] Clara Faria: That’s such a cool story, and I’m glad you guys met and did this review, because it’s such an important and understudied topic in the literature. How many studies did you identify in your review, and can you tell us a bit more about the studies that you have included?

[00:04:34.460] Dr. Tom Jewell: So, we found 50 studies in our review, but almost half of them were case studies. So, I guess, it really just highlighted the fact that the, kind of, the evidence base is still, you know, at a very early stage. And I guess, what we found, as well, that’s worth saying, is that a lot of the studies came from Western countries, so from Europe and North America, the majority, in fact, were from the US and Canada. And like a lot of areas of eating disorder research, we found that samples were made up of, like, mainly white participants, often with, kind of, higher socioeconomic status, and almost all of them were with children, so I think 42 out of the 50.

[00:05:15.640] Clara Faria: Can you highlight for us what were the main findings of the review?

[00:05:19.259] Dr. Emma Willmott: So, I suppose in terms of our main finding, we found that there are a range of psychological interventions that can be applied, and that are applied, to patients with ARFID across the lifespan and across clinical settings. Although as Tom said, the majority of those were applied to children and young people. So, I think only six out of the 50 studies focused on adults. We also identified that some specific manualised interventions for ARFID have been developed. So, CBT, cognitive behavioural therapy, AR, CBT-AR, and FBT, family-based treatment, for ARFID, have been developed, but not all studies that are drawing upon those approaches use those manualised interventions.

I suppose, overall, a key finding was that interventions for ARFID look very, very different. I think we’ve talked about the heterogeneity of the ARFID diagnosis, and people’s experience of it itself, but the interventions themselves are also very heterogeneous, as well. So, in terms of the main treatment modality, the length of treatment and the delivery of the treatment, too.

So, I suppose we found, kind of, a range of modalities, that are commonly used in practice, and we separated these out into behavioural interventions, CBT interventions, family-based treatments for interventions, but many were also mixed and drew upon a variety of different treatment approaches. One of the things that we found that the behavioural interventions were more often applied to younger patients, aged from, kind of, two to 15, and the family-based treatments were often applied to those aged 21 and under, and CBT had the broadest age range. So, the youngest patient who received CBT for ARFID was ten and the oldest was 55.

In terms of the delivery of the interventions, they really varied. So, some were in the home, and they almost had daily support from a Therapist, even at multiple times a day, often, kind of, alongside each mealtime. Some were delivered virtually, and some were day-patient, or even inpatient programmes. So, it really varied, the, kind of, the delivery of the intervention itself. The treatments also really varied in length. I believe the longest was two years in length, so really quite a lengthy intervention. And the treatments, kind of, varied as to whether there were any adjunctive or additional treatments alongside the psychological intervention. So, some received, kind of, medication, pharmacological medications, or psychol – psychiatric medications to support the overall intervention. Some of the younger children might have received speech and language therapy, and dietetic support was really common, as well, so things like meal plans, multivitamins and supplements.

I suppose what we found is that, also, a multidisciplinary approach is really, really common across interventions for ARFID, and seems like a very important factor. So, there might have been, kind of, a lead Therapist, like a Psychologist or a CBT Therapist, but often, Psychiatrists were involved, Dieticians, and sometimes other professionals, such as, Speech and Language Therapists or Occupational Therapists.

[00:08:19.479] Clara Faria: Was there any findings from the review that surprised you?

[00:08:23.419] Dr. Emma Willmott: I think the heterogeneity in interventions wasn’t particularly a surprise, because the review was really broad and open and exploratory. We were, kind of, looking at any psychological intervention, like Tom said, across the lifespan and across different settings, rather than focusing more specifically. However, I think it was really surprising just how variable practice is for ARFID, and just how much variation there are between interventions. It was very hard to, kind of, separate out, and even decide what was the main therapeutic modality, and be able to, kind of, make meaningful comparisons between different types of interventions.

I was particularly interested in, kind of, how we’re measuring outcomes during these psychological interventions, and I was really surprised that there seemed to be quite a lack of measures for psychological changes, so using measures, such as to measure mood or anxiety, and a lack of ARFID specific outcome measures. It seems to me that there’s a bit of an overreliance on using weight and nutrition as measures of change across psychological interventions for ARFID, which makes me wonder whether they’re, kind of, in – the main goal of the intervention was to support weight gain or nutritional adequacy, or whether they’re just easier things to measure.

So, yeah, not necessarily a surprise, because it matches up with my, kind of, experience, that interventions often look different from person to person. But I also think something that was really interesting to me was that – you know, just how different the goals of the intervention could be, as well. So, in one paper, a goal was to introduce a nutritional supplement, and in the other study or paper, the goal was for the young person to no longer require a nutritional supplement.

[00:09:53.550] Clara Faria: Thank you so much, Emma, and in your review, you and Tom identified different intervention modalities for ARFID, as you just mentioned, as well. And currently, according to the NICE guidelines, there are no evidence-based treatment recommendations to guide care for patients with the condition. Could you tell us a little bit more about the different interventions that you identified in the review?

[00:10:15.620] Dr. Emma Willmott: Yeah, so, I suppose as I’ve said before, it’s very heterogeneous, and we tried to – when we were thinking about the best way to synthesise these 50 studies, we tried to think about the, kind of, main psychological modality or approach. So, we separated them out into, kind of, behavioural interventions, cognitive behavioural therapy interventions, family-based treatment or family therapy, and then combinations of those approaches, or additional types of approaches. But I think, just to say, that was really challenging, and sometimes feels a little bit artificially distinct to separate them out in that way.

Behavioural interventions were the most common, so we found 16 out of 50 studies were – kind of, had a main behavioural component to the intervention. And these were mostly parent-led, so the Therapist, kind of, supporting the parents, and skilling up or training, the parents, perhaps modelling a feeding approach or providing, kind of, direct feedback as they’re feeding their children. And much of the focus in, kind of, behavioural interventions is on reinforcement strategies. So, there’s something called “differential reinforcement,” where the Therapist might encourage parents to praise behaviours that they want to see more of, so a bite of food that’s accepted, and ignore other behaviours, like pushing food away, in the hope that that behaviour will become less frequent.

Contingent reinforcement was also really common in behavioural studies, so children being given something good based on a desired behaviour, like, again, accepting, or trying a new food. So, there might be, kind of, more time on an iPad, or a token reward system for trying new food. Behavioural interventions also often included a meal hygiene component. So, that’s, kind of, considering the overall mealtime environment, thinking about how everyone, kind of, tries to remain as calm as possible during mealtimes, having a set routine for mealtimes, and time limits for meals, as well.

Just to say, there are some slightly more controversial techniques, I think, as well, within these behavioural interventions. So, there’s a technique called “escape extinction,” in which food is essentially represented until it is accepted, which, my sense, clinically, at least in the UK, is that that’s – that practice isn’t particularly encouraged. And generally, behavioural interventions were applied to younger children with ARFID, which matches up with, kind of, previous literature. But I suppose, in our review, we found that they were applied to children aged, kind of, two to 15, so perhaps a little bit of a broader age range than people have previously, kind of, identified. And of those where they were, kind of, of an older age range, many had developmental or intellectual disabilities.

In terms of cognitive behavioural therapy, that covered the broadest age range, so for children aged ten years to adults aged 55 years. And those interventions used a combination of common cognitive and behavioural strategies that we see for many other, kind of, conditions, so cognitive restructuring, behavioural experiments and lots of exposure to feared foods. And often, the cognitive behavioural interventions included broader anxiety management strategies, the use of diaries, setting homework.

And as I say, with the cognitive behavioural therapy, as well, it often focused on a specific driver that was contributing to the limited intake. So, if there was a fear of choking, the cognitive work would be around, kind of, tackling the maintaining cognitions and safety seeking behaviours around that, kind of, fear of choking specifically. And I would say, you know, even though cognitive behavioural therapy, people might think of it as a bit more of an individual therapy, we noticed that, kind of, involving families was really common in these interventions, even for adult patients. And as I said before, a manual has been developed by Thomas and Eddy, CBT-AR, and some of the studies did use those, but not all of them. And again, some were led by specific cognitive behavioural trained Therapists, but that wasn’t necessarily the case across all studies. Tom, do you want to talk about the family therapy ones?

[00:14:02.230] Dr. Tom Jewell: Yeah, I’ll just touch on it briefly, thanks. So, I think, as Emma said, I mean, I think many of the interventions for families with children and adolescents with ARFID, so many of them have quite a strong, sort of, component in terms of working with parents. But there were some that we, I guess, we categorised as, like, family therapy or family interventions, and they were ones which usually, kind of, came, often, from, I guess adaptation of the family therapy treatment model for adolescent anorexia nervosa.

So, as some people will know, there is this phrase, “family-based treatment” to describe, sort of, one, like, manualised version of that. So, some of the work done by James Lock and his colleagues is essentially, sort of, adapting that kind of a model for ARFID. But I mean, in terms of the overall picture, there was only, I think, six studies which were, sort of, categorised as family therapy specific models, but we did see, sort of, family interventions or family components coming up quite a lot.

[00:15:06.519] Clara Faria: Across all these different interventions, did you notice any commonalities among them?

[00:15:11.170] Dr. Tom Jewell: Yeah, so we’ve spoken about the, kind of, the parental, or the family, involvement, so that was a big one. I think another big one, as well, was psychoeducation. So, almost all of these treatments have an element of psychoeducation about ARFID, they might include other bits, as well. So, it’s maybe psychoeducation about nutrition, psychoeducation about anxiety. Another big one was food exposure. So, many of the different treatments involved a young person or a patient with ARFID eating in the session, with the Clinician in the room, and that was very common. And then there was, also, kind of, anxiety management strategies, so they came up quite a bit. I don’t know if you want to chip in on that, Emma?

[00:15:52.089] Dr. Emma Willmott: Yeah, I suppose, just another thing that I noticed as we were, kind of, looking through all the various studies, is often, kind of, the homework component being quite fundamental. So, whatever was, kind of, happening in terms of the, kind of, therapy itself, that children or young people or families were encouraged to, kind of, go away and put things into practice. So, that might be, kind of, when they’re eating in the home setting, but also, other things, like going out to cafés or restaurants, so to, kind of, really broaden out that – kind of, it’s not all directed around food and eating directly, but thinking about the broader aspects of life that involves food, as well.

[00:16:28.330] Clara Faria: In your review, you highlight the lack of consistency when measuring change in patients with ARFID, making treatment modalities hard to compare. Could you talk a bit more about this heterogeneity, and if there is any consensus on how to best measure recovery for patients with ARFID?

[00:16:44.310] Dr. Tom Jewell: So, yeah, so one of the things that really struck us was that there is this heterogeneity, so there were lots of studies that were measuring different outcomes, and sometimes there were – studies were not even using, sort of, a measure, as such, so not a questionnaire or something like that, but maybe looking at, you know, how many more foods was a child eating, something like that. There was, also – which is, you know, interesting and, in some ways, a little bit – I guess, a little bit odd on a way, is that often, BMI was used, so body mass index. And I guess, for people working, or people familiar with treatment of anorexia nervosa, I guess that’s quite familiar that there is a debate about the importance of body mass index as an outcome measure. But I think for ARFID, it’s particularly interesting, because it’s not there in the criteria. Like, there doesn’t need to be – like, a young person or a patient doesn’t need to be underweight.

So, I guess it really struck us that this is quite difficult to get consensus, because different patients are going to have different goals, as Emma was saying earlier. But one thing, I guess, to comment on is that we noticed that there wasn’t that much use of, like, psychological measures, at all, and there are some recommended ones. So, I think in the last couple of years – the paper came out in 2023, but I think that the findings have been out maybe a little bit longer, so there was a big, sort of, international, I guess, project to try and get consensus on how to measure outcomes in eating disorders across the board.

So, that project’s called ICHOM, and so, like, the International Consortium for Health Outcome Measurement, and they did pick out a couple of measures for ARFID. So, the details are in the paper, but just to mention briefly, so one’s called the EDY-Q, and the other one is the NIAS, which is the Nine Item ARFID Screen. So, there are some measures that have been recommended, but I guess, looking at the field, there isn’t, kind of, consensus yet in the literature. So, a lot of people are just measuring ARFID in different ways, and it would be helpful if there could be a bit more consensus on how to do that.

[00:18:52.890] Dr. Emma Willmott: And I think, you know, Clara, your question was interesting about, kind of, consensus on how best to measure recovery for patients with ARFID, and as Tom said, you know, consensus around those outcome measures would be helpful, yet also, it’s very difficult to achieve consensus for a condition which is so heterogeneous in its nature. But I think an interesting part of the question, as well, is even, you know, what do we many by recovery in ARFID?

So, I mean, in 2018, a multidisciplinary, kind of, team of international experts in feeding and eating disorders came together. They’re known as the Radcliffe ARFID Workgroup, to, kind of, think about the ARFID diagnostic criteria. And they discussed a definition of recovery, so that we can think about, kind of, how we might evaluate treatments and consider their efficacy. And their, kind of, criteria for recovery involved five main things. So, somebody eating foods from all the major food groups, weight not being in an underweight range, and height and growth and physical development being resumed, or not being delayed. There being no nutritional deficiencies, no more than one nutritional supplement drink per day, and no longer avoiding requiring major accommodation or experiencing significant distress in social eating situations.

So, I think that’s really interesting that there’s been an attempt to, kind of, think about what recovery would look like in ARFID, but I think we still need further discussion around those things, and is it, kind of, one of those things, or all five, that would be necessary for someone to be considered recovered from ARFID?

[00:20:23.870] Clara Faria: Thank you so much, Emma and Tom, and what do you think are the next steps in terms of ARFID research? What needs to happen next to advance our knowledge of this condition, and which treatments are more effective?

[00:20:35.570] Dr. Tom Jewell: Yeah, so I think, overall, we’re a long way from being able to answer questions like, “What is the best treatment?” So, maybe I’ll come back to that in a minute. But I think one thing that struck me, looking through all the studies that have been done so far, is that there’s not been, from what I can see, a huge amount of work to involve people with lived experience of ARFID, like in the design of a study or, you know, as part of the development of the treatment manuals themselves. So, I think, in general, there is a move towards, kind of, having more patient/public involvement, PPI, in research. But I think, at the moment, it, kind of, seems like there hasn’t been a lot of that in ARFID, so far, and there hasn’t been a lot of that in eating disorders, either, but I think it is getting better.

So, I think, in the short-term, I would really like to see more PPI happening in ARFID, so more involvement of people with lived experience, and parents/carers of people with ARFID. And I think it would be really interesting to do things like to have qualitative studies, which could inform our understanding of things like recovery, which we touched on there. Because in the eating disorder, the wider eating disorder field, there is a lot more research on, you know, just that very topic, so recovery. There’s a pretty huge literature on what does recovery mean? Different views on recovery, but I don’t really see that yet in ARFID.

I think, also, we would, ideally, like to see studies which, kind of, speak to issues, like, you know, how do treatments work? And I think qualitative studies could help in the short-term, so speaking to people who’ve been through a treatment like CBT or family therapy, what did they find helpful about it? How did they think it worked? But I think, in the longer term, I guess, if we’re going to get to a point where you’ve got a NICE guideline saying, “Okay, the recommended treatment for ARFID is Treatment X,” over time, you’re going to want to have studies, like randomised controlled trials, where you put one treatment against another.

But I do think probably, a lot needs to happen before that, because – I’m not sure. So, for example, you know, you could imagine a trial comparing CBT and family therapy for ARFID, but actually, it does depend on the, like, the patient characteristics. So, for example, would they be kids who are underweight, or would they be kids with different characteristics? So, I think one of the big problems for ARFID is just that heterogeneity in the presentation, so, having a, sort of, a one size fits all treatment, where you could just say, “Okay, everyone with ARFID goes into this RCT, randomised controlled trial,” that does look a little bit like a lot more work needs to happen before we can get there.

[00:23:17.460] Dr. Emma Willmott: I would say, from my perspective, as well, given that the majority of studies were on, kind of, ARFID interventions for children and young people, there’s a real underrepresentation of adults in research. And I think it’s really important to think about adults with ARFID, because one of the reasons ARFID was introduced as a diagnosis was to, kind of, reflect a, kind of, life course approach to eating difficulties. So, I think it’s important to think about how ARFID might be presenting for adults, but also, what interventions they might respond, kind of, well to.

I think, also, as we mentioned at the beginning, that lots of the studies are predominantly from Western countries, with predominantly white samples. So, having, kind of, further research that spans a range of, kind of, countries, ethnicities and socioeconomic backgrounds, would be really important. And that’s important generally, but I also think it’s really important because eating’s often a very, kind of, cultural phenomenon. I think, as well, I would really like to see, kind of, the development of low intensity interventions for ARFID, and also, to be thinking about early intervention in ARFID. So, how can we support, kind of, perhaps, early feeding, and who might be well placed to support infants and young children and their parents with those sorts of interventions? So, perhaps, kind of, thinking about skilling up Health Visitors, for example.

I think, also, as we’ve, kind of, been saying, we need more discussion and development and consensus around, kind of, outcome measurement itself, but also, what we mean by recovery in ARFID. And then, also, perhaps, kind of, I would be keen to see further reviews of psychological interventions for ARFID, but I think they might need to be a bit narrower in their focus, to, kind of, disentangle what types of psychological interventions might be best suited to those, kind of, specific ARFID, kind of, population. So, perhaps what might those with a predominantly, kind of, fear of aversive consequences driver respond best to, compared to those with, kind of, a more sensory sensitive presentation, or those with a lack of interest? And I would also be really keen to see, kind of, more studies on groups for patients with ARFID themselves, or perhaps carers or loved ones.

[00:25:26.190] Clara Faria: Also, I think it’s important to highlight, and this has been repeatedly flagged by young people with lived experience of eating disorders, how often in our healthcare professional training we receive little guidance on eating disorders. Do you have any advice, or could you suggest any resources you would like to point out to non-specialist eating disorders Clinicians?

[00:25:47.990] Dr. Emma Willmott: Yeah, thanks, Clara. So, I mean, as we’ve mentioned before, currently, according to NICE guidelines, there are no evidence-based treatment recommendations to guide the care of patients with ARFID. So, it’s tricky, I think sometimes Clinicians can find it very, kind of, challenging to know what to do and how to help, and I suppose that was one of the, kind of, reasons behind our review, and we hope that our review is helpful in summarising some interventions that are currently being applied in practice.

I suppose, from, kind of, our evidence so far, and consistent with previous literature, from our review, we concluded that an individualised approach to patients with ARFID is needed. So, it’s, you know, helpful if Clinicians are really guided by a psychological formulation that would take into consideration lots of different factors, like the patient’s age, any physical nutritional risks, any comorbidities in their presentation, and what the patient goals or priorities are. So, some psychological interventions may be more, kind of, appropriate than others, based on the patient’s age or developmental stage.

I think an MDT approach is often vital. So, whilst our focus was on psychological interventions, patients often, with ARFID, need physical investigations, or physical health monitoring, or nutritional assessments and support. So, I would encourage Clinicians to, kind of, think about what their role is, perhaps, in supporting a young person or adult with ARFID, but also, you know, who else might be suitable to involve in the care, as well? So, perhaps, someone like a Dietician.

And I would encourage, I suppose, Clinicians to think about, you know, any – there are specialist interest groups that exist for ARFID, so I certainly know that there’s one for Dieticians, there’s one for Psychologists, and there’s one for, kind of, a broader mix disciplines, as well. So, if Clinicians are working with lots of young people with ARFID, or working with ARFID quite regularly, or even if it’s something that they’re coming across every so often, they can be really useful spaces for, kind of, further advice and support as to how to best manage a young person presenting with ARFID.

[00:27:48.730] Clara Faria: Thank you so much, Emma and Tom, for highlighting such an important, yet relatively unknown, condition. Thank you so much for sharing your research with us today. For more details on Emma and Tom’s work, please visit the ACAMH website, www.acamh.org, and our Twitter @ACAMH. ACAMH is spelt A-C-A-M-H. Do keep an eye out for other podcasts in the In Conversation series, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.

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