Parent-Facilitated Behavioral Treatment for Avoidant/Restrictive Food Intake Disorder: A Case Report

Avoidant/restrictive food intake disorder (ARFID), which was introduced in DSM-5, may be one of the most functionally impairing eating disorders, yet little is known regarding risk factors, prevalence, or efficacious treatment models for the disorder. With no empirically supported treatment for ARFID, it is important to investigate the clinical utility of innovative therapeutic approaches. Here we describe a novel parent-facilitated behavioral treatment for youth with ARFID (PBT-ARFID) that is grounded in learning theory, as well as components of well-established family-based treatment (FBT) for eating disorders. We propose a two-factor theory of avoidance learning within a biopsychosocial model to explain behavior in ARFID and utilize counterconditioning as a core intervention to reverse paired, classically conditioned association between food and aversive state (i.e., disgust and/or anxiety). This report details a step-by-step comprehensive treatment approach for ARFID that can be adapted to a broad range of youth and their families, along with a case study illustrating application of the model. This pilot case provides preliminary evidence that the PBT-ARFID model incorporating counterconditioning may be a powerful treatment for youth with ARFID. More case and pilot studies are needed to justify formally investigating its efficacy in a randomized controlled trial.