title: Disordered eating and food restrictions in children with PANDAS/PANS.
abstract: OBJECTIVE
  Sudden onset clinically significant eating restrictions are a defining feature of the clinical presentation of some of the cases of pediatric acute-onset neuropsychiatric syndrome (PANS). Restrictions in food intake are typically fueled by contamination fears; fears of choking, vomiting, or swallowing; and/or sensory issues, such as texture, taste, or olfactory concerns. However, body image distortions may also be present. We investigate the clinical presentation of PANS disordered eating and compare it with that of other eating disorders.
  
  
  METHODS
  We describe 29 patients who met diagnostic criteria for PANS. Most also exhibited evidence that the symptoms might be sequelae of infections with Group A streptococcal bacteria (the pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections [PANDAS] subgroup of PANS).
  
  
  RESULTS
  The clinical presentations are remarkable for a male predominance (2:1 M:F), young age of the affected children (mean=9 years; range 5-12 years), acuity of symptom onset, and comorbid neuropsychiatric symptoms.
  
  
  CONCLUSIONS
  The food refusal associated with PANS is compared with symptoms listed for the new Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) diagnosis of avoidant/restrictive food intake disorder (ARFID). Treatment implications are discussed, as well as directions for further research.
authors.affiliation: 1 Division of Pediatric Neuropsychiatry, Rothman Center, Department of Pediatrics, University of South Florida , St. Petersburg, Florida.
authors.forename: Megan D
authors.initials: MD
authors.lastname: Toufexis
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hommer
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gerardi
authors.forename: Paul
authors.initials: P
authors.lastname: Grant
authors.forename: Leah
authors.initials: L
authors.lastname: Rothschild
authors.forename: Precilla
authors.initials: P
authors.lastname: D'Souza
authors.forename: Kyle
authors.initials: K
authors.lastname: Williams
authors.forename: James
authors.initials: J
authors.lastname: Leckman
authors.forename: Susan E
authors.initials: SE
authors.lastname: Swedo
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
mesh_terms: D000208:Acute Disease; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000209:etiology; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000302:isolation & purification