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Treatment for Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (“ARFID”) is a condition recognized by the latest American Psychological Association diagnostic manual, the DSM-V. ARFID 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 ARFID 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 ARFID 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.

Feeling and Body Investigators is a novel ARFID treatment designed specifically for children, ages 4-10. Developed by Nancy Zucker, Ph.D. and her colleagues and Duke Center for Eating Disorders, Feelings and Body Investigators 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.

The focus of FBI treatment is to experience and explore with openness, developing a willingness to try and ultimately, encouraging tolerance or eventually satisfaction in things previously deemed unfamiliar or unpleasant.

Within the structure of the 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 ultimately, to explore the world of food safely. 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, children learn that their bodies are very good at communicating needs to them so they work to get more comfortable listening to their bodies and responding appropriately. 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 take-aways. Homework is designed to help the child generalize what they’ve learned in session into their real lives.

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