ARFID: Avoidant Restrictive Food Intake Disorder
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by significant avoidance or restriction of food intake that can lead to weight loss, nutritional deficiency, or dependence on supplements.
In almost all cases, the condition interferes with psychosocial functioning, at times in profound ways.
Unlike other eating disorders like anorexia nervosa or bulimia nervosa, ARFID isn't driven by a desire for weight loss or body image concerns. Instead, it typically involves an aversion to certain foods based on sensory characteristics like taste, texture, smell, or appearance, or it may stem from fear of adverse consequences such as choking or vomiting.
ARFID may also present as chronically low appetite or low interest in food altogether. ARFID can affect individuals of any age but is more common in children and adolescents. Treatment usually involves a multidisciplinary approach, including nutritional counseling, therapy to address underlying anxiety or sensory issues, and sometimes medication.
Often, concern is raised as the child’s eating difficulties have a significant social and emotional impact. Food restrictions interfere with normal participation in eating experiences at home and beyond and often cause stress and conflict among family members.
If you think your child may be struggling with ARFID, here is some information that can help you better understand what’s going on and how you can help them.
Signs of ARFID
ARFID can look different for everyone, ranging from chronic food resistance to fear of eating altogether. The first step in helping your child tackle their restrictive eating is to understand whether they’re suffering from a disorder or just going through a picky eating phase. Here are some signs that their problem may be more than just picky eating:
Limited Food Range: Children with ARFID often have a highly restrictive range of preferred foods and may avoid entire food groups. This limitation can lead to an insufficient variety of nutrients in their diet.
Fear of Adverse Consequences: There may be a fear of negative consequences associated with eating, such as choking, vomiting, or stomach pain.
Chronic Lack of Interest in Eating: Children with ARFID may present with a lack of interest in eating more generally (i.e. they easily forget to eat or find eating burdensome) or with low appetite (getting full quickly or not getting adequate cues that it’s time to eat).
Potential Dangers of Avoidant/Restrictive Food Intake Disorder
Children who struggle with Avoidant/Restrictive Food Intake Disorder are at risk of a wide range of potential health issues, from malnutrition to impaired growth and development. Here are some of the potential issues that could arise if left untreated.
Nutritional Deficiencies: One of the most immediate dangers is malnutrition. ARFID can lead to severe nutritional deficiencies due to a restricted diet lacking essential nutrients, such as vitamins, minerals, and proteins.
Impaired Growth and Development: In children and adolescents, ARFID can impair normal growth and development due to inadequate calorie intake and essential nutrients necessary for physical growth.
Weakened Immune System: Poor nutrition can compromise the immune system, making individuals with ARFID more susceptible to infections and illnesses.
Cognitive Impairment: Inadequate nutrition can affect cognitive function, including concentration, memory, and overall mental clarity. This can impact academic or professional performance and daily functioning.
Emotional Distress: ARFID can cause significant emotional distress, including anxiety, depression, and social isolation. The stress associated with meal times and social gatherings can exacerbate these emotional challenges.
Eating Disorders: ARFID may increase the risk of developing other eating disorders, such as anorexia nervosa or bulimia nervosa, especially if the restrictive eating patterns persist over time and become deeply ingrained.
Medical Complications: Chronic malnutrition can lead to various medical complications, including cardiac issues, gastrointestinal problems, hormonal imbalances, and bone density loss.
Dental Problems: Limited food intake may lack the necessary nutrients for dental health, potentially leading to dental decay, cavities, and other oral health issues.
Social Impairment: Avoidance of certain foods or eating situations can lead to social isolation, strained relationships, and difficulties participating in social activities involving food, such as parties or gatherings.
Quality of Life: Overall, ARFID can significantly impact an individual's quality of life, affecting physical health, emotional well-being, social interactions, and overall functioning in various life domains.
Treating ARFID: Feeling and Body Investigators
Feeling and Body Investigators (FBI) is a novel ARFID treatment designed specifically for children, ages 4–10. Developed by Nancy Zucker, Ph.D. and her colleagues at Duke Center for Eating Disorders, FBI is a playful but potent intervention that encourages children with ARFID to become curious about different sensations, feelings, and flavors so they may “lean in” and experiment, rather than avoiding things they initially may find unfamiliar or aversive.
Increase Curiosity and Playfulness
The focus of FBI treatment is to experience and explore with openness, developing a willingness to try and ultimately, encouraging tolerance or eventual satisfaction in things previously deemed unfamiliar or unpleasant.
Within the structure of FBI treatment, the therapist will create a safe, inviting, and playful atmosphere, meeting with the child and parents all together. The goal is to engage the child’s innate curiosity and enable them to safely explore the world of food. Using fun characters like “Henry Heartbeat,” “Julie Jitters,” and “Sabrina Stuffed,” the therapist guides the family as private detectives on a mission to explore body feelings and sensations.
In FBI treatment, children learn that their bodies are very good at communicating needs, and so they work to become more comfortable listening to their bodies and responding appropriately.
Try Eating Experiments
When new foods are introduced to the child, the experience is framed as a “mission” and the new food is an “experiment” or interesting new specimen to investigate. Children are supported in expanding language around their internal experience (what it feels like) and they are guided in integrating strategies to self-soothe and cope.
Each session follows a consistent and predictable format. Through their “detective work,” participants learn something new about the body each week. The therapist uses a giant body map to record each session’s takeaways. Homework is designed to help the child generalize what they’ve learned during a session as part of their real lives.
Treating ARFID: Home-Based Support
For younger patients with ARFID, we typically recommend home-based support and gentle exposure therapy to address food avoidance and rigidity. Sessions are most effective when conducted in the home environment, where your child feels safest and where much of their eating takes place. Sessions begin with rapport-building and a focus on playfulness, curiosity, trust, and safety.
Slowly and systematically, the feeding coach will work with your child to create a plan for gradual change—whether it is to expand their food repertory, increase the quantity of food they eat, or experiment with food to reassure them that they can remain safe.
Expanding Your Child’s Food Repertory
Caregivers are given guidance and strategies that they may use at home to support progress and keep the work going between eating sessions.
In expanding food quantity or repertory, it’s critically important for the child to feel safe and in control. The feeding coach will work with them in a playful and encouraging manner, helping the child collaborate around goal setting and treatment planning (although the child won’t realize that they’re setting goals or planning treatment!). Exposures happen slowly and within a reassuring and sensitive structure.
Increasing Flexibility
As an example, if your child is only willing to eat one type of chicken nugget, prepared and served in a very particular way, your feeding coach might work on systematically switching up that nugget. Perhaps starting with serving the favored nugget on an unfamiliar plate, cutting in a novel way, adding salt… then eventually trying out a different brand, and then moving on to a range of chicken preparations.
We find that preparing foods in creative, friendly presentations (i.e., tiny burgers or pancakes shaped like stars) can ease the child into trying and expanding foods.
More Approaches for Treating ARFID
As with any other eating disorder, ARFID is nuanced. This means a single approach may not be enough to support your child’s recovery. Luckily, there are many ways to approach healing this eating disorder depending on what your child needs. In addition to the aforementioned approaches, FBI and Home Eating Coaching, are alternative interventions designed for ARFID.
Nutritional Rehabilitation: Working with a registered dietitian or nutritionist specialized in eating disorders can help develop a structured meal plan that ensures adequate nutrition while gradually reintroducing avoided foods.
Cognitive-Behavioral Therapy (CBT): CBT, particularly cognitive-behavioral therapy for ARFID (CBT-AR), is often the primary psychological intervention for individuals aged 10 and up. CBT-AR helps individuals identify and challenge negative thoughts and beliefs about food and eating, gradually expanding their food repertoire and reducing anxiety around eating.
Exposure Therapy: Exposure therapy involves gradually exposing individuals to feared foods or eating situations in a controlled and supportive environment, helping them desensitize and build tolerance to previously avoided foods. Exposure itself is a broad technique that is a central part of most ARFID treatments.
Family-Based Treatment (FBT-AR): FBT involves the family in the treatment process, particularly for children and adolescents with ARFID. The treatment empowers parents to take an active role in reestablishing healthy eating habits and providing support and structure around mealtimes. In the FBT model, parents assist their child expanding their food repertory by engaging in exposure at home.
Medical Monitoring: Regular medical monitoring by a healthcare provider is essential to monitor growth, nutritional status, and any potential medical complications associated with ARFID.
Medication: In some cases, medication may be prescribed to manage comorbid conditions such as anxiety or depression, which commonly coexist with ARFID. There are also medications that can increase appetite and loosen negative associations with food.
Occupational Therapy: Occupational therapists can assist individuals with ARFID in developing skills and strategies to manage sensory sensitivities or aversions related to food textures, tastes, or smells.
Mindfulness and Relaxation Techniques: Teaching relaxation techniques such as deep breathing, progressive muscle relaxation, or mindfulness can help individuals manage anxiety and distress around eating.
Support Groups: Participating in support groups or peer support networks can provide individuals with ARFID and their families with a sense of validation, understanding, and encouragement, reducing feelings of isolation and stigma.
Long-Term Follow-Up: ARFID treatment may require long-term follow-up to maintain progress, address any relapses, and provide ongoing support as individuals continue to expand their food variety and normalize their eating patterns.
Create an Individualized Treatment Plan
It will likely take a blend of these options to help your child find relief. That’s why the treatment plan and approach with Columbus Park is customized for each family and child. The first step is a parent meeting where we can gain an understanding of your child along with your valuable observations and concerns.
From this information, we can provide a recommended direction and begin to structure a plan, bringing your child into the mix once we have some clarity about how to best move forward.
Get ARFID Treatment Now
We work with children at Columbus Park and focus on ways to make treatment align with the needs of both the child and the parents. If you’re ready to learn more about the best approach for your family, reach out to us by booking a free consultation call.
