More than just picky eating: Avoidant / Restrictive Food Intake Disorder (ARFID)
Contributed by: Alexandra Caron, LPC | Reviewed by: Chelsea Fielder-Jenks, LPC-S, CEDS-S, PMH-C
What is ARFID?
Avoidant / Restrictive Food Intake Disorder (ARFID) sometimes referred to as “selective eating or picky eating” is an eating disorder which affects a person's physical and/or mental health by significant impairment to eating or feeding behaviors. ARFID behaviors are not motivated by concerns with body weight or shape, which is primarily distinguished from Anorexia Nervosa. Those who struggle with ARFID are unable to meet their nutritional needs due to food avoidance and/or lack of interest in food. This disorder can result in significant weight loss, nutritional deficiency and psychosocial impairments. ARFID is distinguished from “picky eating” by the level of distress/anxiety individuals experience at mealtimes that leads to pervasive food avoidance or aversion. ARFID has a high comorbidity with Autism Spectrum Disorder (ASD), Obsessive Compulsive Disorder (OCD), Attention-Deficit/Hyperactivity Disorder (ADHD) and trauma-related disorders.
Three Sub-Types of ARFID:
Restrictive: individuals experience lack of interest in food, low to no appetite and extreme pickiness
Avoidance: individuals avoid food based on sensory features associated with taste (sweet or sour), textures (often soft foods), smell of foods and appearance or color
Aversive: individuals will avoid food due to fear of adverse reaction including; fear of choking, nausea, vomiting, difficulty swallowing, uncomfortable physical sensations or allergic reaction
Signs & Symptoms
Common Signs of ARFID include:
avoiding entire food groups and certain textures
list of “acceptable or safe” foods that often get shorter with time
significant food preferences often specific to brand, shape or color
preoccupation with preparation methods
distress when introduced to new or unfamiliar foods
dependence on nutritional supplements or feeding tube
vomiting or gagging after exposure to certain foods
Common Symptoms of ARFID include:
cardiac complications
bone density loss (osteopenia / osteoporosis)
severe nutritional deficiency
gastrointestinal complications
significant weight loss & stunted growth in children
menstrual irregularities
dizziness and/or fainting
ARFID Diagnosis
The following is criteria to be diagnosed with Avoidant / Restrictive Food Intake Disorder based off the Diagnostic and Statistical Manual of Mental Disorders most recent 5th edition (DSM-5):
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
Significant nutritional deficiency.
Dependence on enteral feeding or oral nutritional supplements.
Marked interference with psychosocial functioning.
The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Treatment with Healgood
Receiving a diagnosis of ARFID can be scary and difficult, but you don’t have to go through this alone. ARFID is treatable with evidence-based treatment approaches including Family Based Treatment (FBT), Cognitive Behavioral Therapy (CBT) and Exposure Response Prevention (ERP).
If you or a loved one is struggling with an eating disorder, the clinicians at Healgood are here to help. Recovery is possible with early detection and a multi-disciplinary approach providing the best prognosis. Healgood clinicians specialize in treating the full spectrum of eating disorders and co-occurring conditions. Schedule a free consultation at hello@healgoodcounseling.com.
Resources
Cognitive Behavioral Therapy for Avoidant / Restrictive Food Intake Disorder by Jennifer J Thomas and Kamryn T. Eddy
The Picky Eater’s Recovery Book: Overcoming Avoidant / Restrictive Food Intake Disorder By Jennifer J. Thomas, Kendra R. Becker and Kamryn T. Eddy
Childhood Avoidant/Restrictive Food Intake Disorder: Review of Treatments and Parent-Based Approach By Yaara Shimshoni, PhD and Eli R. Lebowitz, PhD