I’m Dr Samuel Chawner, Research  Fellow at Cardiff University   Centre for Neuropsychiatric Genetics and Genomics,   and today, I’ll be talking about two feeding  and eating disorders, ARFID and pica [pause]. ARFID is short for avoidant/restrictive  food intake disorder, and it’s a feeding   and eating disorder that was introduced  as a diagnosis to the DSM-5 Psychiatric   Classification System in 2013. ARFID is marked  by food avoidance and the restriction of food   intake, however, ARFID should not be  mistaken for fussy or picky eating,   it is a serious condition. And as a  part of the ARFID diagnostic criteria,   symptoms have to seriously impact the individual  in one or more of the following areas, which   includes significant weight loss, compromised  growth, serious malnutrition, dependence on   nutritional supplements or tube feeding, and  significant impact on psychosocial functioning. ARFID differs from anorexia nervosa in that  dietary restriction is not motivi – not motivated   by body image or weight concerns. Avoidant and  restrictive eating have long been recognised by   Clinicians, but research and service development  has been hindered by uncertainties in diagnostic   classification. The lack of a formal and unified  diagnosis until 2013 means ARFID research is still   very much in its infancy, and very little is  known about its epidemiology and etiology.   Referrals for ARFID are increasing,  but inpatient and outpatient clinics   currently lack an evidence base to support  individuals with ARFID effectively [pause]. Three main drivers have been identified for ARFID.  Firstly, sensory sensitivity to food qualities may   lead to avoidant and restrictive eating. This cau  – could involve sensory aversion to the taste,   look, smell, or texture of foods. Sensory  sensitivities and rigid eating habits,   which are features of ARFID, are often associated  with autism. However, it’s important to recognise   ARFID as a separate diagnosis from autism.  Not all autistic individuals experience   eating difficulties, and vice versa, not  all individuals with ARFID are autistic.   It has been hypothesised that sensory differences  could be due to differences in taste perception,   but the research needs to be done  to back the – up this hypothesis. The second driver for ARFID is a lack of  appetite or lack of interest in food. Often   individuals with ARFID can feel full very  quickly during a meal, or may not feel as   hungry as others. It has been hypothesised that  this could be driven by physiological differences   in appetite regulation, and differences  in the functioning of reward pathways   in the brain that influence how  rewarding an individual finds food. The third driver of ARFID that’s been  identified is the fear of potentially   distressing consequences of food intake, such as  choking or vomiting. This is often triggered by a   traumatic event. However, it’s not clear why some  individuals are more susceptible to long-lasting   food avoidance following a traumatic event,  such as food poisoning, as many of us experience   unpleasant food related events. It could be  that high baseline anxiety is a risk factor,   indeed, many individuals of ARFID often have  a co-occurring diagnosis of anxiety [pause]. Recent population studies have combined  questionnaire and medical record data,   have suggested a prevalence of one to 2%. This  would suggest ARFID is as prevalent as autism,   yet research and clinical awareness is  comparatively lacking for ARFID. However,   in clinical practice, ARFID is currently  underdiagnosed. A surveillance study within   the NHS found the prevalence of diagnosed  ARFID to be three in 100,000 individuals.   So there’s clearly a gap between  the rate of diagnosis of ARFID and   the populat – the rate – the prevalence  of ARFID traits within the population. ARFID is more commonly diagnosed in  childhood, but this is partly because   we don’t understand much about how ARFID presents  in adulthood yet. In terms of gender differences,   the findings are mixed. Some studies indicate  an increased prevalence in males, whereas,   other studies find no difference between  male and female genders, and there has been   a lack of research looking at prevalence  of ARFID across other gender identities. What is clear from research studies,  is that the incre – is the increased   prevalence of ARFID within autistic individuals,   with some studies finding one in two  autistic individuals have ARFID. But   it should be emphasised that the exact prevalence  does vary a lot across research studies [pause]. Pica is a feeding and eating disorder, defined as  “the recurrent intake of non-nutritive and – or   non-food substances, for instance, paper,  soap, coal or wood.” To receive a diagnosis,   pica behaviours have to be present for at least  one month, they also have to be inappropriate to   the development stage of the individual. For  instance, often babies will put whatever they   have in reach in their mouth, this wouldn’t  be classed as pica. To receive a diagnosis,   and the pica behaviours have to occur  outside cultural norms or traditions. It is important to study pica, as  those who experience pica frequently   have adverse health and psychosocial outcomes.  Individuals with pica are at increased risk of   significant medical consequences,  such as dental enamel erosion,   increased risk of infection, anaemia,  gastro-intestinal obstruction, and, also,   risk of poisoning. In addition to medical risks,  pica is also linked to psychosocial functioning,   it impacts family relationships and can lead  to less social contact with peers [pause]. Pica can occur at any point across the life  course, but onset is most commonly during   childhood. But it should be recognised that  pica is also common during other periods of   the life course, for instance, it’s common  during pregnancy, when there can be strong   cravings for non-food substances. Common  co-occurring conditions with pica include   autism and developmental delay, and children from  lower socioeconomic backgrounds are more likely   to develop pica. And in research that I’ve done,  looking at the Bristol Avon Longitudinal Study of   Parents and Children population cohort, I haven’t  found any evidence for gender differences for   pica, but confirmed the previous link between  pica, autism and developmental delay [pause].  Pica can occur within the context  of anorexia nervosa, where the   individual uses the eating of non-food  substances to avoid putting on weight,   but still gets the sensation of feeling  full. However, longitudinal research is   needed to investigate if pica itself leads to the  development of other eating disorders [pause]. In the UK, there are currently no National  Institute for Healthcare Excellence   guidelines for ARFID, because of an absence of  sufficient research. That’s not to say there   hasn’t been initial intervention research.  Early evidence highlights that food exposure,   psychoeducation, anxiety management  and family therapy are beneficial   for the treatment of ARFID. However, studies  reporting on psychological interventions have   be – often been characterised by small samples and  differences in how outcomes have been measured. For pica treatment, behaviour modification  programmes have often been used to redirect   an individual’s attention away from the  non-food object and towa – reward the   choice of appropriate food items. Also,  medication for managing behavioural   problems can help reduce the urges and  impulses to eat non-food items [pause]. Initial evidence has indicated genetics plays  a major role for the development of ARFID. The   first twin study of ARFID, involving Swedish  twins, has found that approximately 79% of   the risk of developing ARFID may be explained  by genetics. They did this by comparing the   prevalence of ARFID between monozygotic twins,  who share all their DNA, and dizygotic twins,   who on average are 50% related. The heritability  of ARFID is on par, or in many cases higher,   than that for other psychiatric  and neurodevelopmental conditions,   highlighting the importance of genetics. However,  it should be recognised there needs to be more   research in this area. There has only been two  studies so far, looking at the genetics of ARFID. For pica, there has been very little genetic  research, but there is evidence that for some   rare genetic conditions, such as Prader-Willi  syndrome, there’s increased rates of pica.