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Becker, Kendra

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Becker

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Kendra

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Becker, Kendra

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2021 - 20222

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Author's Publications: search.filters.isAuthorOfPublication.69135453-ff9f-4f60-ad1a-9496909071ed

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    A Moving Target: How We Define Avoidant/Restrictive Food Intake Disorder Doubles Its Prevalence
    (Physicians Postgraduate Press, 2021) Harshman, Stephanie; Jo, Jenny; Kuhnle, Megan; Hauser, Kristine; Burton Murray, Helen; Becker, Kendra; Misra, Madhusmita; Eddy, Kamryn; Micali, Nadia; Lawson, Elizabeth; Thomas, Jennifer
    Objective The DSM-5 criteria for avoidant/restrictive food intake disorder (ARFID) include ambiguities. Diagnostic criteria that allow for clinical judgment are essential for clinical practice. However, ambiguities can have major implications for treatment access and comparability and generalizability of research studies. The purpose of this study was to determine the degree to which distinct operationalizations of the diagnostic criteria for ARFID contribute to differences in the frequency of individuals who are eligible for the ARFID diagnosis. Methods Because criteria B, C, and D are rule-outs, we focused on criterion A, identified 19 potential operational definitions, and determined the extent to which these different methods impacted the proportion of individuals who met criteria for ARFID in a sample of children, adolescents, and young adults (n = 80) enrolled in an avoidant/restrictive eating study. Results Within each criterion, the proportion of individuals meeting diagnostic criteria differed significantly across the methodologies (all p values < 0.008). Using the strictest definition of each criterion, 49.4% (n = 40) of participants met criteria for ARFID. In contrast, under the most lenient definition of each criterion, the number nearly doubled, resulting in 96.3% (n = 78) meeting ARFID criteria. Conclusions Comparison of diagnostic definitions for ARFID among children, adolescents, and young adults confirmed a broad range of statistically distinct proportions within a single sample. Our findings support the need for additional contextual support and consensus among disciplines on operationalization in both research and clinical settings.
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    Elevated Fasting Satiety-Promoting Cholecystokinin (CCK) in Avoidant/Restrictive Food Intake Disorder Compared to Healthy Controls
    (Physicians Postgraduate Press, Inc, 2022-07-11) Burton Murray, Helen; Becker, Kendra; Harshman, Stephanie; Breithaupt Langston, Lauren; Kuhnle, Megan; Dreier, Melissa; Hauser, Kristine; Freizinger, Melissa; Eddy, Kamryn; Misra, Madhusmita; Kuo, Braden; Micali, Nadia; Thomas, Jennifer; Lawson, Elizabeth
    Objective: Avoidant/restrictive food intake disorder (ARFID) is characterized by food avoidance or dietary restriction not primarily motivated by body weight/shape concerns. Individuals with ARFID can report early satiation, post-prandial fullness, and high inter-meal satiety, but whether these symptoms are related to differences in the biology underlying appetite regulation is unknown. In male and female children and adolescents, we hypothesized that fasting levels of cholecystokinin (CCK), a satiety hormone, would be elevated in participants with ARFID (full or subthreshold) versus healthy controls (HC). Within the ARFID group, we also explored the relations of CCK with weight status, subjective appetite ratings, and ARFID severity and phenotypes. Methods: 125 participants (83 full/subthreshold ARFID and 42 HC, ages 10-23 years; 59% female) underwent fasting blood draws for CCK, completed self-report measures assessing subjective state and trait appetite ratings, and completed a semi-structured interview assessing ARFID severity. Results: Fasting CCK was higher in full/subthreshold ARFID versus HC with a large effect (F(1)=25.0, p<.001, ηp2=.17), controlling for age, sex, and BMI percentile. Within the ARFID group, CCK was not significantly related to BMI percentile, subjective appetite ratings, or ARFID characteristic measures. Conclusion: CCK may contribute to etiology and/or maintenance of ARFID, as children/adolescents with heterogeneous presentations of avoidant/restrictive eating appear to show elevated fasting levels compared to healthy youth. Further research is needed to understand relations between CCK and appetite, weight, and eating behavior in ARFID.