ARFID: Avoidant Restrictive Food Intake Disorder

You may recall your early years as your taste palate was developing. Perhaps you subsisted on typical “kid-friendly foods” like pizza, mac and cheese, hot dogs. Or maybe you were even more selective than most – earning the description of “finicky” or “picky.”   Selective or “picky” eating is not at all uncommon in young children but more often than not, as children develop, their preferences broaden, and they become more flexible and open with food. For some, however, this expansion is stymied, and their nutritional range remains rigid and narrow. Food-related anxiety can be high, social eating avoided and, in some cases, health may be negatively impacted. For those who suffer from high food anxiety and restricted range that is not driven by a concern with weight and shape, it may be validating to learn that there is a name for it… and treatment.

What Is Avoidant Restrictive Food Intake Disorder?

Avoidant Restrictive Food Intake Disorder (ARFID) is a condition recognized by the latest American Psychological Association diagnostic manual, the DSM-V. It is similar to anorexia nervosa in that involves the restriction of specific food types and/or quantity of food, but in ARFID, unlike anorexia, there is no fear of fat or concern with controlling weight or shape. Those with this mental health condition find it difficult to eat certain foods because of the taste, texture, or fear of aversive consequences, like choking or vomiting.  There is also a subset of sufferers who have chronic reduced food intake due to low appetite or low interest in food/eating.

ARFID goes beyond what we may refer to as “picky eating” because most individuals with ARFID feel an overwhelming sense of anxiety when presented with non-preferred (or “unsafe”) foods. Further, in many cases, this narrowed nutritional range can lead to weight loss (or a lack of weight gain for developing children) and/or nutritional inadequacies. In almost all cases, there is a significant social impact, as eating with others or outside of one’s “safe” setting can lead to a range of negative emotions like shame, embarrassment, or panic.

What Causes ARFID?

It is common for toddlers and young children to prefer certain foods over others . Broccoli, for example, is a nutritious food that children often have to learn to like in order to eat. Because of this, children usually grow out of rejecting certain foods. Children and adults with ARFID continue to have a difficult time with eating or even just the thought of eating.

As with many conditions, we understand ARFID to be caused by the interplay between genetic, psychological, and sociological factors that make some people more vulnerable to this extreme and pervasive form of selective eating. ARFID may develop after a particularly intense accident or medical condition that leaves a person with traumatic associations around swallowing food, such as choking or having pain when swallowing. The anxiety that arises at mealtime then might lead to difficulties making a routine out of eating, eating in social situations, or getting enough nutrition.

Some people develop ARFID without having had any particular event trigger. We believe that some people have heightened sensitivity to certain flavors, smells, or textures that can impact one’s experience of certain foods, making these foods feel overwhelming or overpowering and thus unpleasant. The possibility that some folks with ARFID may be “super sensors” is a valid theory and rationale for why some people find particular foods to be so aversive. For those with low appetite or lack of interest-type ARFID, there may be certain biological mechanisms at play such as delayed gastric emptying… or anxiety can be a strong influencer (or discourager!) of appetite. In many cases of this type of ARFID, the low appetite has no clear biological origin.

The Impact of ARFID

Forbes magazine recently featured an article on ARFID in which a dietician describes the impact of ARFID on the lives of children. Her insights pertain to ARFID sufferers of all ages, however.

Physically: Vitamin and mineral deficiencies may lead to a range of physical and mental health concerns. In growing bodies, ARFID may lead to stunting of growth or development due to poor nutrition or inadequate caloric intake. Individuals with ARFID might exhibit physical symptoms like gagging or vomiting during mealtimes in anticipation of eating or when presented with non-safe foods.

Psychologically: People with ARFID describe feeling shame or embarrassment when it comes to social eating. The stress of mealtime - which naturally occur multiple times per day - can contribute to depressed mood, anger, irritability. Poor nutrition and suppressed weight can bring on or exacerbate conditions like depression, anxiety, and OCD.

Socially: Food and eating are central to many social experiences so significant fear, anxiety, and rigidity at mealtime may lead to isolation. Loved ones of those with ARFID may struggle to navigate the condition, leading to increased stress within the relationships.

How Do You Treat ARFID?

Since ARFID is a relatively new diagnosis, there is no consensus in the medical field about specific treatment or intervention guidelines. Evidence-based treatments rely on years of extensive research. That said, there are several ARFID treatments that show great promise and that we at Columbus Park, have used with positive results. These treatments were developed based on learning and behavioral principles that have been studied extensively for decades, so rest assured, these treatments are well-considered and very encouraging.

For more about ARFID interventions at Columbus Park, please join us for our next two blogs:

• Cognitive Behavioral Therapy for ARFID (CBT-AR) (for individuals age 10 and up)
• Feelings and Body Investigators (FBI) for children (ages 4-10) with ARFID

 If you or a loved one is struggling with an eating disorder, please reach out to our team at info@columbuspark.com to discuss treatment options.