FBI: A NOVEL APPROACH TO TREATING ARFID

FEELING AND BODY INVESTIGATORS: MAKING EATING AND EXPANDING FOOD REPERTORY FUN

Picky eating on steroids.  That’s what a lot of parents say when referring to a subset of picky eaters who meet the criteria for a clinical eating disorder called Avoidant/Restrictive Food Intake Disorder or “ARFID.”   Some kids have a range of 5 foods they’ll be willing to eat.  Others will stick to a particular color food like only white.   Some children have zero interest in eating all together.

Invariably there are tears, frustration… some parents just give up since it feels like a “losing battle” and pushing only makes things worse.  Families may be held hostage; on vacation, the child eats french fries for breakfast, lunch, and dinner.  At school they won’t eat at all.

Perhaps this sounds a bit familiar.  Maybe your child’s idiosyncrasies are a little different, but the theme is the same.  Feeding your child is impossible.

Rigid and restricted eating in children disrupts family life, personal functioning and can lead to serious nutritional inadequacies and inhibition of normal growth in both weight and stature.

What is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder, which is a relatively new diagnosis in the field of eating disorders (added to the DMS in 2013). While ARFID can involve selective or "picky" eating behaviors, it's important to note that ARFID goes beyond mere picky eating.

Picky eating usually refers to selective eating based on taste, texture, or other personal preferences, whereas ARFID involves severe limitations in the amount or variety of foods consumed, leading to significant nutritional deficiencies, weight loss, or other health problems. People with ARFID may avoid certain foods due to sensory issues, fear of adverse consequences (such as choking or vomiting), or a lack of interest in eating.

ARFID can affect individuals of any age and often requires professional intervention, including nutritional counseling, therapy, and sometimes medical intervention, to address both the physical and psychological aspects of the disorder.

ARFID in Kids

There are several approaches to treating ARFID in children.  In this piece, we’re going to talk about a newer intervention, designed specifically for children, that shows much promise.

Feeling and Body Investigators

Feeling and Body Investigators is a novel ARFID treatment designed specifically for children.  Originally designed for younger kids, roughly between the ages of 4-10, the treatment has expanded with an approach that is age appropriate for teens, too. 

FBI as it’s known, due to the “detective work” involved in exploring different tastes and textures, was developed by Nancy Zucker, PhD and her colleagues and Duke Center for Eating Disorders.  Feelings and Body Investigators is a potent but playful intervention that helps children with ARFID move from fear and avoidance to a curious and playful approach to feelings, body sensations, and flavors.  The treatment encourages experimentation and trying in a friendly, sometimes silly and all together fun therapy structure.

How FBI Works

 The idea behind FBI treatment is to help the child experience and explore with openness while developing willingness to try.  The goal is to encourage tolerance – and eventually satisfaction - in foods previously avoided as unfamiliar or unpleasant. 

FBI therapists create an inviting, safe, and playful atmosphere, meeting with the child and parents all together.  The goal is to change the language and ultimately, the energy, around food and eating by creating a joyful approach and engaging the child’s innate curiosity.   The treatment engages the child with characters like “Henry Heartbeat,” “Sabrina Stuffed” and “Julie Jitters.”  The therapist is the guide for the “private detectives” on a “mission” to explore body sensations and feelings.    

Reducing Fear While Increasing Curiosity

FBI teaches children that our bodies are quite good at communicating needs to us.  The task is to get more comfortable listening to the body’s messages and responding appropriately.  New foods are presented as “experiments” and introduced during weekly “missions.”  Children are guided in expanding language around internal experience (what things feel like) while getting support in strategies to cope and self-soothe.

Sessions have a consistent and predictable structure intended to increase the child’s sense of security in the work.  Every week, “detective work” teaches the child new things about their body and its messages.  A giant body map is a fun way to record different experiences with colored markers.  Homework between sessions helps the child practice – and ultimately, expand on their learning - at home.

ADDED BENEFITS of Parent Involvement

A strength of FBI is the integration of parent education and support. It’s very difficult for children to overcome ARFID without skilled parent involvement. FBI brings parents in as partners and builds up their capacity to support further food expansion work at home. Perhaps most importantly, FBI helps parents reduce their frustration and increase their skillfulness when it comes to helping their child through their fears and resistance.

Next steps

FBI is not the only treatment for children with ARFID. There are several well respected interventions based on similar foundational principles. The idea overall is that children with ARFID tend to prefer familiar and safe and resist expanding into new territory - especially when it comes to food. For this reason, any treatment for ARFID will invariably build the child’s sense of safety, confidence and willingness to try new things..

Learn More

If you’re intrigued about FBI, call us!  A senior clinician can talk to you about whether FBI is right for your child.