Dimensions of Impulsivity, Perceived Stress, and Presence of Pica and ARFID Among Pakistani Young Adults

Abstract

Pica and ARFID are two of the three new eating and feeding disorders introduced in the DSM5, this inclusion has drawn attention to the immediate need for research into their prevalence, diagnostic assessment, underlying risk factors and optimal treatment (Lindvall Dahlgren, Wisting & To, 2017). Since then, several studies have explored their frequency and pervasiveness (Hammerle et al, 2016; Ernst, Burger & Hammerle, 2017). Pica often goes undiagnosed and most of the research available is on non-institutionalized population in the form of case studies which makes it difficult to estimate the global prevalence rates, still it is estimated that the prevalence may range from 0.3% to 4% (Nasser, Muco & Al Saad, 2020). ARFID is also understudied since, until the DSM-5, it was thought to be a condition that exclusively affected children and its diagnostic criteria was not as well-defined as it is now (Nicely et al, 2014). Moreover, there are very few studies available that explored the predictors or causes of these eating disorders specifically in Pakistani context. The objectives of the current study include (a) to estimate the presence of pica and ARFID symptomology among young adults in Pakistan, (b) to examine the relationship between dimensions of impulsivity, stress and presence of pica and ARFID. The sample consisted of 660 young adults with age range 18 to 25 years, recruited through homogeneous convenient sampling. The respondents were provided with a questionnaire comprising of an informed consent, a demographic sheet and self-report measures to assess symptomology of pica and ARFID, dimensions of impulsivity and perceived stress. To assess the presence of pica and ARFID, PARDI-AR-Q (Bryant-Waugh et al, 2019) was used, it was modified to include the items to gauge presence and severity of pica. To measure the dimensions of impulsivity UPPS-P Impulsive Behavior Scale (Cyders et al, 2004) was used. Perceived stress was measure by Perceived Stress Scale (Cohen, Karmak & Mermelstein, 1983). Since the age group and the culture covered in this study are both understudied, it addressed the research gaps related to both of these factors and has furthered the understanding of pica and ARFID in local as well as global context. Each of the dimensions of impulsivity was found to be positively correlated to presence of pica and perceived stress was identified as a mediating factor between each of the dimensions of impulsivity and presence of pica. Similar positive associations and mediating role of perceived stress were established between presence of ARFID and each of the dimensions of impulsivity. The clinical utility of the present research resided in the identification of associated factors, an information which can be used to tailor psychological interventions, modify existing ones, and inform the future research on evidence-based treatment