Co‐Occurring Weight‐ and/or Shape‐Motivated Restriction in 5747 Adults With Probable Avoidant/Restrictive Food Intake Disorder

Objective According to DSM‐5‐TR, avoidant/restrictive food intake disorder (ARFID) cannot be diagnosed alongside anorexia nervosa (AN), bulimia nervosa (BN), or any other body image disturbance. This does not accurately reflect real‐world symptomatology and recent research, indicating the potential need to revise DSM‐5‐TR Criteria. We investigated the co‐occurrence of weight‐ and/or shape‐motivated restriction (WSR) in adults who screened positive for ARFID, providing evidence to inform such changes. Method The sample comprised 5747 adults who consented to participate in the ARFID‐Genes and Environment (ARFID‐GEN) research study, screened positive for ARFID on the NIAS and PARDI‐AR‐Q, and completed the EDE‐Q. We placed our participants into four groups: groups one and two screened positive for AN (ARFID‐AN; n = 147) or BN (ARFID‐BN; n = 193), group three endorsed WSR without meeting AN or BN criteria (ARFID‐WSR; n = 2159), and group four endorsed ARFID symptoms only (ARFID‐nWSR; n = 3248). We used generalized linear models to test group differences on the NIAS, PARDI‐AR‐Q, and EDE‐Q. Results Where significant differences were present, ARFID‐nWSR demonstrated lower scores than all other groups across ARFID dimensions on the NIAS and PARDI‐AR‐Q, and lower odds of meeting DSM‐5‐TR Criteria A1 to A3 (i.e., weight loss; nutritional deficiencies; dependence on nutritional supplements). Discussion These findings indicate a mixed phenotype with features of both ARFID and WSR associated with more severe ARFID symptomatology. The DSM‐5‐TR Criteria may not capture complex real‐world symptomatology in adults with probable ARFID, potentially precluding those with the most severe symptoms from receiving accurate diagnoses and appropriate care.