When Food Avoidance Meets Compatible Diagnostic Criteria: Avoidant/Restrictive Food Intake Disorder Features in Irritable Bowel Syndrome

ABSTRACT Background Alone, the Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) only allows for ARFID‐like symptom detection, potentially overestimating its prevalence. We aimed to investigate the prevalence of ARFID‐like symptoms and DSM‐5‐compatible ARFID (based on medical chart review) in irritable bowel syndrome (IBS), and to compare characteristics associated with these definitions. Methods Adult patients with IBS according to Rome IV criteria, consulting in our tertiary care center between January 2024 and February 2025, were included. Patient data were collected using validated questionnaires, including NIAS‐Fr. ARFID‐like symptoms were defined as meeting the cut‐off for at least one NIAS‐Fr subscale (≥ 10 on “picky” or “fear,” or ≥ 9 on “appetite”). A medical chart review using our center's clinical data warehouse was conducted for detecting medical impairment and eating disorder (ED) diagnosis. Patients with a positive NIAS‐Fr, without ED, and with at least one medical/psychosocial impairment were considered to be in the “DSM‐5 compatible ARFID” group. Univariate and multiple logistic regression analyses were conducted. Key Results Among the 326 included patients, 47.5% had ARFID‐like symptoms, and 33.4% met DSM‐5‐compatible criteria for ARFID. Functional dyspepsia (FD) was prevalent in 60.4% of patients. Depressive symptoms, somatic symptom severity, and FD were independently associated with having ARFID‐like symptoms (Nagelkerke R 2  = 0.138). Depressive symptoms and IBS symptom severity were independently associated with DSM‐5 compatible ARFID (Nagelkerke R 2  = 0.203). Conclusions and Inferences ARFID‐like symptoms were more prevalent than DSM‐5‐compatible ARFID in our population. Applying DSM‐5‐compatible criteria was associated with more severe gastrointestinal and depressive symptoms. Standardized DSM‐5 ARFID assessment methods remain to be established.