ARFID — structured clinical viva

This is adult sensory-predominant ARFID: lifelong extreme selectivity, nutritional deficiencies, and marked psychosocial impairment (social meals, work placement) without shape/weight overvaluation. Near-normal BMI does not exclude ARFID — micronutrient deficiency and functional harm satisfy criteria pathways.[4][5][6]

Assessment. Structured history of accepted foods, sensory dimensions, body-image screen (to exclude AN), anxiety/autism screen, dietetic review. NIAS for dimensional presentation screening; PARDI when a semi-structured diagnostic interview is needed.[2][3] Labs already show iron and vitamin D deficiency — treat and expand diet rather than supplement forever without behavioural change.

Treatment. Adult CBT-AR proof-of-concept supports feasibility and clinical improvement (severity reduction, novel foods, weight gain when underweight subgroups studied).[1] Stages: psychoeducation/formulation, regular eating, graded exposure to novel foods (sensory hierarchy), relapse prevention. Address family accommodation — mother as sole meal preparer maintains the five-food repertoire; involve her in reducing accommodation collaboratively.[4]

Autism. Screen; sensory ARFID and ASD often co-occur; dual supports if present without assuming one explains all.[5]

Medication. No tablet “cures picky eating.” No licensed ARFID-specific first-line drug; pharmacotherapy is for comorbid anxiety/depression if indicated, always adjunctive to behavioural and nutritional care.[6]