336 Feeding and Eating Disorders
potential. In older children, adolescents, an d adults, social functioning tends to be ad-
versely affected. Regardless of the age, fami ly function may be affected, with heightened
stress at mealtimes and in other feeding or ea ting contexts involving friends and relatives.
Avoidant/restrictive food intake disorder  manifests more commonly in children than
in adults, and there may be a long delay betw een onset and clinical presentation. Triggers
for presentation vary considerably and includ e physical, social, and emotional difficulties.
Risk and Prognostic Factors
Temperamental. Anxiety disorders, autism spectrum disorder, obsessive-compulsive
disorder, and attention-deficit/ hyperactivity disorder may in crease risk for avoidant or
restrictive feeding or eating behavi or characteristic of the disorder. 
Environmental. Environmental risk factors for avoida nt/restrictive f ood intake disor-
der include familial anxiety. Higher rates of  feeding disturbances may occur in children of
mothers with eating disorders. 
Genetic and physiological. History of gastrointestinal co nditions, gastroesophageal re-
flux disease, vomiting, and a range of othe r medical problems has been associated with
feeding and eating behaviors characteristic of  avoidant/restrictive food intake disorder.
Culture-Related Diagnostic Issues
Presentations similar to avoidant/restrictive fo od intake disorder occur in various popu-
lations, including in the United States, Cana da, Australia, and Euro pe. Avoidant/restrictive
food intake disorder should not be diagnosed when avoidance of food intake is solely re-
lated to specific religious or cultural practices.
Gender-Related Diagnostic Issues
Avoidant/restrictive food intake disorder is equally common in males and females in in-