Pancytopenia Associated with Avoidant Restrictive Food Intake Disorder: A Case Report
DOI:
https://doi.org/10.51338/rppsm.2020.v6.i3.151Keywords:
Avoidant Restrictive Food Intake Disorder, PancytopeniaAbstract
Avoidant restrictive food intake disorder (ARFID) is one of the least clearly understood feeding and eating disorders, and there are no guidelines for its treatment. Patients with ARFID often present comorbid psychiatric disorders. The feeding and eating disorders can present with pancytopenia associated with poor nutritional status. Our aim is to present a clinical case of pancytopenia in a patient with ARFID. The case concerns a 20‑year‑old man hospitalized with pancytopenia. It was diagnosed ARFID and comorbid generalized anxiety disorder. Cognitive behavior therapy was implemented, and after six months there was an improvement in the feeding behavior, with greater diversity of ingested food and remission of pancytopenia. This is the first documented case of ARFID with pancytopenia. A multidisciplinary approach is crucial not only for the correct diagnosis, but also for the effective treatment with relapse prevention.
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References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596
Spettigue W, Norris ML, Santos A, Obeid N. Treatment of children and adolescents with avoidant/restrictive food intake disorder: A case series examining the feasibility of family therapy and adjunctive treatments. J Eat Disord. 2018;6(1). doi:10.1186/s40337-018-0205-3
Feillet F, Bocquet A, Briend A, et al. Nutritional risks of ARFID (avoidant restrictive food intake disorders) and related behavior. Arch Pediatr. 2019;26(7):437-441. doi:10.1016/j.arcped.2019.08.005
Naviaux A-F. Management of ARFID (Avoidant Restrictive Food Intake Disorder) in a 12-year-old on a Paediatric Ward in a General Hospital: Use of Mirtazapine, Partial Hospitalisation Model and Family Based Therapy. Psychiatr Danub. 2019;31(Suppl 3):421-426. http://www.ncbi.nlm.nih.gov/pubmed/31488765. Accessed January 14, 2020.
Dumont E, Jansen A, Kroes D, de Haan E, Mulkens S. A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series. Int J Eat Disord. 2019;52(4):447-458. doi:10.1002/eat.23053
Sharp WG, Stubbs KH. Avoidant/restrictive food intake disorder: A diagnosis at the intersection of feeding and eating disorders necessitating subtype differentiation. Int J Eat Disord. 2019;52(4):398-401. doi:10.1002/eat.22987
Pitt PD, Middleman AB. A Focus on Behavior Management of Avoidant/Restrictive Food Intake Disorder (ARFID): A Case Series. Clin Pediatr (Phila). 2018;57(4):478-480. doi:10.1177/0009922817721158
Bryant-Waugh R. Avoidant restrictive food intake disorder: An illustrative case example. Int J Eat Disord. 2013;46(5):420-423. doi:10.1002/eat.22093
Kambanis PE, Kuhnle MC, Wons OB, et al. Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. Int J Eat Disord. 2019. doi:10.1002/eat.23191
Takeshima M, Ishikawa H, Kitadate A, et al. Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report. BMC Psychiatry. 2018;18(1):150. doi:10.1186/s12888-018-1743-6
Eckhardt S, Martell C, Duncombe Lowe K, Le Grange D, Ehrenreich-May J. An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children. J Eat Disord. 2019;7(1). doi:10.1186/s40337-019-0267-x
Chandran JJ, Anderson G, Kennedy A, Kohn M, Clarke S. Subacute combined degeneration of the spinal cord in an adolescent male with avoidant/restrictive food intake disorder: A clinical case report. Int J Eat Disord. 2015;48(8):1176-1179. doi:10.1002/eat.22450
Zickgraf HF, Murray HB, Kratz HE, Franklin ME. Characteristics of outpatients diagnosed with the selective/neophobic presentation of avoidant/restrictive food intake disorder. Int J Eat Disord. 2019;52(4):367-377. doi:10.1002/eat.23013
Keel PK, Kennedy GA, Wick MR. Eating disorders in children: Is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment? F1000Research. 2018;7. doi:10.12688/f1000research.13110.1
Zimmerman J, Fisher M. Avoidant/Restrictive Food Intake Disorder (ARFID). Curr Probl Pediatr Adolesc Health Care. 2017;47(4):95-103. doi:10.1016/j.cppeds.2017.02.005
