Avoidant/Restrictive Food Intake Disorder (ARFID)
(iStock)
We work with individuals with a variety of eating disorder diagnoses. Today, we want to share details about an eating disorder not often discussed, Avoidant/Restrictive Food Intake Disorder, or, ARFID.
What is Avoidant/Restrictive Food Intake Disorder ARFID?
ARFID is a fairly new eating disorder diagnosis that was added to the DSM 5 in 2013. Individuals with ARFID can sometimes be characterized as “extremely picky eaters” or “stubborn”. ARFID is often diagnosed in children, including those that identify as neurodivergent but adolescents and adults can receive this diagnosis as well.
Like all eating disorders, ARFID can affect all genders and ethnicities. However, unlike other eating disorders, ARFID is often not correlated with body image issues or the desire to lose weight. Instead, it is characterized by eating or feeding disturbance resulting in persistent failure to meet appropriate nutritional needs.
Types of ARFID
There are three common types of ARFID [1]:
AVERSIVE: Characterized by fear of adverse consequences like illness, nausea, choking, or allergies.
RESTRICTIVE: Characterized by a lack of interest in food or eating and getting full quickly.
AVOIDANT: Characterized by sensory avoidance due to issues with food texture, taste, smell, and temperature.
Individuals with ARFID likely have preferred or safe foods and can have difficulty incorporating new foods into their diet.
Diagnostic Criteria
ARFID vs. Anorexia Nervosa
Often, ARFID is compared to anorexia nervosa due to food restriction, significant weight loss, and/or significant nutritional deficiencies. It is crucial to note that, for folks with ARFID, restriction is NOT due to a desire to lose weight or manipulate their body.
Studies show that ARFID can look different in children and adults. In children and adolescents, the 3 most common symptoms include 1) a lack of interest in food, 2) fear-based food restriction, possibility due to a traumatic experience or neurodivergence, and 3) limiting food intake [1].
One study found that adults with ARFID symptoms can be differentiated from those with anorexia and bulimia symptoms, and even adult picky eaters, by three criteria: 1) food neophobia or the fear of novel foods, 2) inflexible eating behaviors, and 3) eating a very narrow range of foods [2]. The same study notes that adults with ARFID experienced a greater rate of internalizing distress, OCD symptoms, and eating-related quality of life impairment [2].
What causes ARFID and why is it so serious?
Like many mental illnesses, ARFID can develop for a variety of reasons, based on the individual. Studies show genetic, environmental, and socioeconomic factors, as well as beliefs about food all, play a role [1]. ARFID can lead to significant weight loss or being severely underweight, growth failure in adolescents, malnutrition, and/or nutritional deficiencies. Other mental health disorders like Obsessive Compulsive Disorder (OCD), anxiety, and other mood disorders can accompany an ARFID diagnosis.
Treatment
Though ARFID is a newer diagnosis, there are multiple evidence-based treatment options including Exposure Therapy, Dialectical Behavioral Therapy (DBT), and Cognitive Behavioral Therapy (CBT). These therapy modalities focus on mindfulness, reframing negative thought patterns, changing behaviors, and reducing anxiety around food by exposing individuals to new and feared foods. Specifically, CBT-AR, CBT focused on addressing ARFID, utilizes a 4 stage framework, focused on helping the individual achieve or maintain a healthy weight, correct nutritional deficiencies, eat a variety of foods, and feel more comfortable eating in social situations [4].
The good news is that recovery is possible!
If you or a loved one is struggling with ARFID, please reach out to our team today! We would love to help!
Resources Used:
[1] ARFID - Avoidant/Restrictive Food Intake Disorder. (n.d.). Eating Recovery Center. Retrieved September 22, 2022, from https://www.eatingrecoverycenter.com/conditions/arfid
[2] Zickgraf, H. F., Franklin, M. E., & Rozin, P. (2016, October 29). Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms. Journal of Eating Disorders, 4(1). https://doi.org/10.1186/s40337-016-0110-6
[3] Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017, July 17). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports, 19(8). https://doi.org/10.1007/s11920-017-0795-5
[4] Thomas, J.J. and Eddy, K.T. (2019). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, & Adults. Cambridge: Cambridge University Press.
Collaborative Counseling & Nutrition is an outpatient nutrition and body image counseling center, with locations in Indianapolis and Carmel, that provides compassionate, holistic eating disorder treatment. Through practicing mindfulness, intuition, and Health At Every Size, we are on a mission to help you find a true state of well-being! We take an anti-diet, weight-inclusive approach with all our clients and work to help guide you towards a way of healthy living designed by you, just for you! This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you are looking for a registered dietitian or therapist to assist you on your recovery journey, please reach out today!
