Exploring the relationship of avoidant restrictive food intake disorder with cognitive flexibility and autism spectrum: a systematic review

INTRODUCTION: Lately, attention to eating disorders has increased significantly, leading to new questions for clinical research and the inclusion of new disorders in diagnostic manuals. Among these, the avoidant/restrictive food intake disorder (ARFID) has been included for the first time in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5). The new definition has improved the understanding of ARFID clinical manifestations, extending the research on the cognitive aspects of the disorder. The aim of this systematic review was to analyze the current research on ARFID and its cognitive and psychological features specifically related to cognitive flexibility, set shifting, autism and autistic traits. EVIDENCE ACQUISITION: Twelve studies were included from the database search and screening procedure. EVIDENCE SYNTHESIS: Most of the studies involved child or adolescent patients (11 out of 12). Evidence suggests that patients with ARFID exhibit cognitive rigidity and impaired set shifting, primarily, though not exclusively, in the context of food narrowness and resistance to trying new foods. Moreover, ARFID shares some cognitive features with autism spectrum disorder (ASD), such as sensory sensitivity and restricted food interests. However, the literature on ARFID cognitive profile is still limited, particularly in adult samples. CONCLUSIONS: Interesting data emerged regarding the association between ARFID and cognitive rigidity, set shifting and autistic traits, but further research is needed to clarify the mechanisms associated with the onset and maintenance of the disorder or its evolution in other nutrition disorders, which is crucial to inform evidenced-based and tailored clinical treatments.