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Overview of ARFID: Avoidant/Restrictive Food Intake Disorder


Saturday, March 25, 2017: 10:30 AM-12:00 PM

Background: This presentation will define and describe the DSM5 diagnosis Avoidant/Restrictive Food Intake Disorder (ARFID), and how to recognize and effectively manage. The majority of the presentation will focus exclusively on ARFID definition, prevalence, diagnosis, management and treatment outcomes. Discussion includes research and best practices to effectively treat this patient population.

Objectives: 1) Define and describe the DSM5 diagnosis for Avoidant/Restrictive Food Intake Disorder (ARFID). 2) Diagnose and effectively manage ARFID. 3) Implement best practices for treating this patient population.

  1. Overview
    1. Historical drift in symptoms variability and gender representation in eating related pathology
      1. i. Drive for Thinness
      2. ii. Historical Symptom Variability in EDs and Research References
      3. iii. Gender Representation in EDs
      4. iv. Acceleration of historical drift in ED presentations
      5. v. Somatic Anorexia
  2. ARFID
    1. Definition
      1. i. Challenges in DSM-IV
      2. ii. DSM-IV to DSM5
      3. iii. Criterion
      4. iv. ARFID is
      5. v. ARFID is not
      6. vi. ARFID goals
    2. Prevalence
      1. i. Research References
      2. ii. Is ARFID different from other ED?
    3. Diagnosis
      1. i. Case Study example
      2. ii. Research References
      3. iii. ARFID Types
        1. Avoidant
        2. Aversive
        3. Restrictive
        4. “ARFID Plus”
        5. Adult ARFID
    4. Management
      1. i. Step 1: Initial Assessment
      2. ii. Step 2: Specialty Assessments
        1. Medical
        2. Psychiatric
        3. Nutrition
        4. Psychotherapist
      3. iii. Step 3: Education of Patient and Parents
      4. iv. Step 4: Interventions
  3. ARFID Outcomes
    1. Research References
    2. ARFID vs. AN- Hospitalized Children
    3. Some new twists
    4. i. Anxiety-Laxity-Pain-Immune-Mood (ALPIM) Syndrome
  4. Conclusion

In this presentation, Dr. Ovidio Bermudez will define and describe the new diagnosis included in the DSM5, Avoidant/Restrictive Food Intake Disorder (ARFID), and how to effectively recognize and manage the illness. First, he will discuss the historical drift in symptoms variability and gender representation in eating related pathology including drive for thinness and research on these topics over the last two decades.

The remainder of the presentation will focus exclusively on ARFID definition, prevalence, diagnosis, management and treatment outcomes. Discussion of the definition of ARFID will include identification of challenges in the DSM-IV and contrast of the DSM Fourth Edition to Fifth Edition. He will outline the ARFID criterion and differentiate what ARFID is and is not, as well as listing goals in treating the illness. Prevalence discussion will include research references and a contrast of ARFID to other eating disorder types. Dr. Bermudez will present a case study to illustrate diagnosis of the illness, relevant research papers published within the last five years, and the definition of ARFID types including Avoidant, Aversive, Restrictive, “ARFID Plus,” and Adult ARFID. Finally, he will outline the four critical steps in managing the illness, which in include initial assessment, four types of specialty assessments (Medical, Psychiatric, Nutrition, and Psychotherapist), education of patient and parents, and interventions.

In conclusion, he will share research to illustrate treatment outcomes, and differences in ARFID and anorexia-hospitalized children, as well as identify new challenging twists to be aware of in treating ARFID, such as ALPIM Syndrome. Throughout the presentation, Dr. Bermudez will highlight best practices and recommendations to effectively treat this patient population. Presentation slides include citations regarding data available on epidemiology, disease course and prognosis.

Goals of the presentation include defining and describing the DSM5 diagnosis for ARFID; teaching participants how to diagnose and effectively manage ARFID; and educating participants on how to implement best practices for treating this patient population.

Presenter:
Ovidio Bermudez, MD, FAAP, FSAHM, FAED, F.iaedp, CEDS

Ovidio Bermudez, MD, is the Chief Clinical Officer and Medical Director of Child & Adolescent Services at Eating Recovery Center in Denver, Colorado. He holds academic appointments as Clinical Professor of Psychiatry and Pediatrics at the University of Oklahoma College of Medicine and Clinical Professor of Pediatrics at the University of Colorado School of Medicine. He is Board certified in Pediatrics and Adolescent Medicine.



Co-presenters:
Cindy Pikus, PhD, CEDS

Dr. Cindy Pikus has treated children, adolescents and adults with eating disorders for more than 17 years. Dr. Pikus received her Bachelor of Arts degree and doctorate in Clinical Psychology from UCLA. She currently serves as Clinical Director of Adult Inpatient and Residential Services and Associate Chief Clinical Officer at Eating Recovery Center in Denver, Colorado. She brings to this position her extensive experience and expertise in working with eating disorder patients in multiple treatment modalities and at multiple levels of care.



and Elizabeth Easton, PsyD

Elizabeth Easton, PsyD is Clinical Director of Child and Adolescent Services at Eating Recovery Center. As a Licensed Clinical Psychologist, Dr. Easton is a clinician, supervisor, and speaker passionate about educating and empowering patients and parents to engage in the treatment and recovery process for eating disorders. She graduated with a Doctorate in Psychology from The George Washington University in Washington, DC. Dr. Easton completed her pre-doctoral internship and post-doctoral fellowship at The Children’s Hospital of Denver, specializing in individual, family and group therapy with The Eating Disorders Program, Anxiety and Mood Disorder Outpatient Clinics, and General Psychiatry Inpatient Units.



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