What is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder that involves extreme food restriction, aversion, and selectivity. Unlike other eating disorders, ARFID does not involve any distress about self-esteem, body issues, or a desire to look a certain way. Individuals with this disorder restrict foods out of fear that they will choke, be poisoned, have an allergic reaction, or even die from eating foods that are unfamiliar or anxiety-inducing. ARFID is a serious somatic disorder that can cause severe lifelong consequences if left untreated.
by: Enchi Dai
When it comes to the topic of eating disorders, it’s likely that the first thing that comes to mind is the condition often marked by an extremely low weight (anorexia nervosa), or binge eating and purging (bulimia nervosa). However, there exists an eating disorder that doesn’t belong to these categories. Let’s discuss Avoidant/Restrictive Food Intake Disorder (ARFID), focusing on its definition, common symptoms, and treatment options.
What Is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by highly selective eating habits and disturbed feeding patterns throughout the lifespan. It is a new diagnosis appeared in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This diagnosis replaces and extends the “picky eater” syndrome, a feeding disorder during infancy or early childhood in DSM-IV. ARFID is comprised of a range of conditions in which people become severely hindered in their ability to nourish themselves adequately.
Most people with ARFID have a short selection of safe foods that they will eat exclusively. These safe foods are mainly comprised of bread & cereal products, fast foods, and sweets. Individuals with AFRID may lose significant amounts of weight due to severe malnourishment resulting from their restrictive food choices. However, it is important to note that the behaviors associated with ARFID do not center around weight control or body image like Anorexia Nervosa and Bulimia Nervosa. Additionally, ARFID does not include avoidance or restriction of food intake relating to a lack of food availability, cultural practices, or developmentally normal behaviors such as picky eating in toddlers or reduced intake in older adults. Instead, individuals with ARFID may have an intense aversion to certain food tastes or textures, preoccupation with nutritional value of certain foods, or inordinate fears that eating will cause indigestion/vomiting.
What Are the Common Symptoms of ARFID?
According to DSM-5, several features may be associated with individuals with ARFID:
A lack of interest in eating or food, leading to weight loss or nutritional deficiencies
Restricting types or amounts of food
A restricted range of preferred foods that becomes more limited over time
Dependence on enteral feeding or oral nutritional supplements
Very young infants may present as being too sleepy, distressed, or agitated to feed.
Infants and young children may not engage with the primary caregiver during feeding or communicate hunger in favor of other activities.
In older children and adolescents, food avoidance or restriction may be associated with more generalized emotional difficulties that do not meet diagnostic criteria for an anxiety, depressive, or bipolar disorder, sometimes called “food avoidance emotional disorder.”
How to Treat ARFID?
Because ARFID is still a relatively new diagnosis, effective treatment methods are still being researched and understood. Many behavioral and psychological interventions have demonstrated significant effects, such as cognitive-behavioral therapy (CBT), dialectal behavioral therapy (DBT), interpersonal therapy, family therapy, and exposure therapy. One group of researchers has identified a novel form of cognitive-behavioral therapy for ARFID — CBT-AR (Thomas et al., 2017). CBT-AR is appropriate for people of all ages and teaches skills for approaching novel foods in a stepwise fashion (i.e., first look, then touch, then smell, then taste, then chew). CBT-AR relies on parent support to increase dietary volume for youth who are underweight. It includes both in vivo and interoceptive exposure for managing phobic responses to traumatic experiences such as vomiting or choking.
If you suspect that you or someone you love may be suffering from ARFID, please seek professional help. Disordered eating patterns can lead to a range of complications, but early treatment and intervention can significantly increase the recovery rate.
At BALANCE eating disorder treatment center, we offer a variety of virtual programs and services that will help you heal your relationship with food. In our Individual Nutrition Counseling sessions, you will work closely with our highly trained Registered Dietitians to customize a program specific to your needs. Whether you are challenged with an eating disorder or looking for nutrition counseling, we can help you. This program is designed to help clients move from structured eating to intuitive eating, reduce food and body image anxiety, increase hunger and satiety awareness, and develop a program that works with your lifestyle. Click the button below to browse our full selection of programs & services.
This post was written by BALANCE Blog Intern, Enchi Dai.
Enchi is a Bachelor's-Master's student at New York University, majoring in Psychology. After her recovery from disordered eating, Enchi became passionate about spreading ED awareness, advocating for intuitive eating, and promoting Health at Every Size. Enchi is also an ACE Certified Personal Trainer and Registered Yoga Teacher (RYT 200). Her goal is to help people become healthier both physically and mentally, instead of encouraging them to pursue a certain body image. Along with her internship at BALANCE, Enchi works as a Research Assistant and Crisis Counselor to prepare herself for the future career as a Clinical/Counseling Psychologist.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: A Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports, 19(8), 54. https://doi.org/10.1007/s11920-017-0795-5