"If I could survive without eating, it would be a huge relief": Development and initial validation of the Fear of Food Questionnaire

Hana F Zickgraf; Patrick Loftus; Benjamin Gibbons; Lauren C Cohen; Melissa G Hunt

doi:10.1016/j.appet.2021.105808

"If I could survive without eating, it would be a huge relief": Development and initial validation of the Fear of Food Questionnaire

Appetite. 2022 Feb 1:169:105808. doi: 10.1016/j.appet.2021.105808. Epub 2021 Nov 16.

Authors

Hana F Zickgraf¹, Patrick Loftus², Benjamin Gibbons², Lauren C Cohen², Melissa G Hunt²

Affiliations

¹ University of South Alabama, Department of Psychology, USA; University of Pennsylvania, Department of Psychology, USA; Penn State Hershey Medical Center, Department of Psychiatry & Department of Surgery, USA. Electronic address: mhunt@sas.upenn.edu.
² University of Pennsylvania, Department of Psychology, USA.

PMID: 34798226
DOI: 10.1016/j.appet.2021.105808

Abstract

Background: Fear of food and behavioral avoidance of specific foods, food groups, and food related social situations can substantially reduce health related quality of life in individuals with a wide range of conditions that affect appetite, eating behavior, and digestion, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), vomit and choking phobias, and food allergies/sensitivities. When this avoidance leads to weight/nutritional and/or psychosocial impairment, the diagnostic criteria for Avoidant/restrictive food intake disorder (ARFID) are met. Fear of food is an important target for interventions designed to improve psychosocial functioning and quality of life in such individuals. The purpose of this research was to develop and validate a novel measure of fear of food.

Methods: Participants (n = 1138) were recruited from ongoing clinical trials for both IBD and IBS, from Amazon's Mechanical Turk, from Reddit support forums for IBS, IBD, and vomit phobia, and from an undergraduate subject pool. Exploratory and confirmatory factor analysis, Pearson's correlations, one-way ANOVA, and intraclass correlation coefficients were used to assess the validity and reliability of the Fear of Food Questionnaire.

Results: The final 18 item questionnaire showed excellent internal consistency, test-retest reliability, convergent validity, discriminative (known groups) validity, as well as good factor structure. Fear of food was highly correlated with visceral hypersensitivity, catastrophizing, GI symptom severity and health related quality of life, as well as with self-reported Fear-ARFID symptoms. Individuals meeting study criteria for Fear-ARFID reported the highest scores relative to control and other analogue clinical groups.

Conclusion: The Fear of Food Questionnaire appears to be reliable and valid across populations and may be a valuable tool in the assessment and treatment of Fear-ARFID.

Keywords: ARFID; Avoidant/restrictive food intake disorder; Choking phobia; Eating disorder; Fear of eating; Fear of food; Inflammatory bowel disease; Irritable bowel syndrome; Quality of life; Vomit phobia.

MeSH terms

Fear
Feeding and Eating Disorders*
Humans
Quality of Life*
Reproducibility of Results
Surveys and Questionnaires