Are you or someone you know struggling with significant food avoidance or limited eating patterns? Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that may explain these challenges.
Eating disorders affect approximately 9% of Americans, or about 28.8 million people, during their lifetime. ARFID, specifically, a lesser-known eating disorder impacting physical and mental well-being, might affect about 0.5-5% of the general population.
This article thoroughly explores ARFID, including its symptoms, causes, and treatment strategies, and provides expert-backed insights with actionable advice.
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What Is ARFID?
Why does awareness of ARFID matter? It can impact nutrition, physical health, mental well-being, and growth and development in children and teenagers.
ARFID 101
ARFID is a relatively new eating disorder diagnosis characterized by significant food avoidance or restriction, often related to sensory sensitivities, fear of adverse reactions (e.g., choking or vomiting), or lack of interest in eating. It is most common in children but can affect individuals of all ages.
This disorder can cause food avoidance and complications linked to inadequate nutrition. Unlike numerous other eating disorders, particularly anorexia nervosa, ARFID is not characterized by a distorted self-image or fear of gaining weight.
Treatment helps restore your or your child's nutritional habits, health, and quality of life.
ARFID vs. Picky Eating
Unlike typical picky eating, ARFID can lead to serious health complications, including nutrient deficiencies and growth concerns, due to limited food intake.
Picky eaters might not like certain foods' taste, texture, or smell, but this habit alone doesn't affect a child's growth and development.
Children often outgrow picky eating over time, while ARFID typically requires professional treatment and dramatically impacts health.
ARFID Prevalence
The prevalence of ARFID appears to be higher among children than adults, as adulthood often expands the diet. However, there is limited research on the prevalence of this specific eating disorder among the various population groups.
Recognizing the Symptoms of ARFID
It's critical to recognize the signs and symptoms of ARFID to determine if you or a loved one needs treatment for this form of eating disorder.
Physical Symptoms
Physical symptoms of ARFID include:
- Weight loss
- Fatigue
- Muscle weakness
- Abdominal pain
- Stomach cramping
- Upset stomach
- Constipation
- No appetite
- Feeling full before meals
- Cold intolerance
- Low body temperature
- Cold hands and feet
- Dizziness/fainting
- Slow pulse
- Irregular menstrual cycles in females
- Difficulty sleeping
- Dry skin
- Dry or brittle nails
- Brittle, dry, or thinning hair
- Lanugo (fine body hair)
- Poor wound healing
Individuals with ARFID may have co-occurring medical issues or complications, such as:
- Anemia
- Dehydration
- Malnutrition
- Electrolyte imbalances
- Low blood pressure
- Heart problems
- Delayed puberty in children
- Osteoporosis
- Stunted growth
- Amenorrhea (stopped periods)
- Weakened immune system
In severe cases, untreated ARFID can lead to serious complications, such as malnutrition or growth delays, even when initial diagnostic tests appear inconclusive.
Behavioral Symptoms
Behavioral symptoms in people with ARFID may exhibit include:
- Avoiding foods with certain textures, tastes, smells, or colors
- Not eating specific food groups
- Anxiety around meals
- Fear of choking or vomiting
- Extreme pickiness at mealtime
- Limiting food eaten
- Only eating certain foods
- Loss of interest in eating
- Difficulty paying attention
- Ritualistic eating patterns
- Picky eating that worsens over time
People with ARFID may have compulsive behavior patterns surrounding food, such as eating foods in a specific order. If they tend to engage in activities involving food, the condition may affect socialization and interpersonal relationships.
Exploring the Causes of ARFID
Numerous factors may contribute to ARFID. Examples include:
Biological and Genetic Factors
Studies show that ARFID has a strong genetic component, meaning some people are more likely than others to develop the condition because of a higher predisposition. Research indicates that genetic factors may account for up to 79% of ARFID risk.
People with biological family members with eating disorders, sensory sensitivities, or anxiety disorders have a higher risk of ARFID.
Gastrointestinal reflux disease (GERD), allergies, eosinophilic esophagitis, and other medical conditions are also associated with ARFID.
Psychological and Emotional Factors
Psychological and emotional factors linked to ARFID include:
- Fear
- Anxiety
- Trauma
- Social or cultural influences
- Depression
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism spectrum disorder
- Aversion to certain textures
- A fear of food harming you
ARFID is most common among children, though it affects individuals of all ages.
Environmental Triggers
Environmental factors, such as traumatic food experiences or past food insecurity, may also contribute to ARFID development. Examples of environmental ARFID risk factors include:
- Traumatic experiences
- Past food insecurity
- History of choking
- Force-feeding
Environmental triggers may be responsible for about 21% of ARFID.
Diagnosing ARFID
Identifying and diagnosing ARFID consists of:
Diagnostic Criteria
The DSM-5 criteria for diagnosing ARFID include:
- Eating disturbance with persistent failure to meet appropriate nutritional or energy needs and one or more of the following: significant weight loss, significant nutrient deficiency, interference with psychosocial functioning, or dependence on dietary supplements or enteral feeding (tube feeding).
- The eating disturbance is not attributed to a medical condition or another mental health disorder.
- The disturbance isn't explained by a lack of available food or culturally sanctioned practices.
- The eating disturbance doesn't occur with anorexia nervosa, bulimia nervosa, altered body shape or weight perceptions, or a desire to be thinner.
A healthcare professional discusses your or your child's medical history, symptoms, lifestyle, mental health, and eating habits to make a diagnosis and establish the most effective treatment.
They also complete a physical exam and may order urine testing, blood tests, an electrocardiogram (EKG), or other diagnostic tests.
When to Seek Professional Help
Seek professional evaluation if you or your child exhibit symptoms suggestive of ARFID, such as limited food intake, weight loss, or nutrient deficiencies. A healthcare provider can determine whether the symptoms meet DSM-5 criteria.
Treatment Options for ARFID
Treatment options for ARFID may include:
Medical Interventions
Medical interventions available for treating ARFID and addressing nutrient deficiencies include:
- Nutritional counseling and support
- Tube feeding
- Dietary supplements
- Growth and development monitoring in children and teenagers
- Medications to reduce anxiety or increase appetite
- Intensive hospital-based programs
A multidisciplinary team of healthcare providers, including primary care physicians, dietitians, mental health professionals, and specialists (e.g., gastroenterologists or speech-language pathologists), often collaborates to treat ARFID effectively.
Therapy-Based Approaches
Effective therapy-based approaches for ARFID include:
- Cognitive behavioral therapy (CBT)
- Family-based therapy
- Group therapy
- Supportive parenting for anxious childhood emotions for ARFID (SPACE-ARFID)
- Food exposure therapy
- Psychoeducation with motivational interviewing
- Therapy for underlying concerns (e.g., autism, ADHD, anxiety)
Therapy is highly individualized and can dramatically improve the overall health and quality of life of children, teenagers, and adults struggling with ARFID.
Strategies for Caregivers
Parents and other caregivers are essential in treating ARFID, improving nutritional status, and optimizing overall health. Adopting simple day-to-day management and meal planning tips helps individuals with ARFID thrive.
Examples of strategies for caregivers include:
- Serve and consume a variety of nutritious foods
- Be a role model in healthy eating behaviors
- Schedule regular snacks and meals
- Eat meals as a family
- Encourage children to try new foods — but don't force them to eat
- Reward positive eating behaviors with fun activities
- Encourage relaxation techniques (e.g., deep breathing, yoga, meditation) to manage stress or anxiety around food
- Avoid being critical of or placing blame surrounding eating challenges
- Prepare foods arranged in creative, colorful, and fun ways
- Consider serving finger foods to kids
- Alter textures (e.g., mash up fruits and vegetables) based on food preferences
- Introduce new foods with similar textures and colors of a food your child loves
- Involve children in meal planning and food preparation processes
- Continue offering nutritious and new foods, but don't pressure kids to eat them
It may take multiple exposures (10 or more) for children to accept a new food. Encourage without pressuring, as a positive mealtime environment is key.
Living with ARFID
Individuals struggling with ARFID can still lead healthy, productive, fulfilling lives by seeking treatment and using mindful approaches at mealtime.
Coping Strategies
To support a loved one's recovery, be supportive and encouraging, and have a positive attitude about nutrition and exercise at home.
ARFID treatment takes time, a personalized approach, and ongoing support from a healthcare team and family members. Don't give up!
Case Studies
Numerous case studies showcase ARFID recovery journeys.
One individual successfully managed ARFID after participating in an inpatient treatment program that included group therapy and nutritional counseling. She is now a peer mentor for others struggling with ARFID.
Another ARFID success story recovered from ARFID with the help of strong family support and the Eating Disorders Families of Australia (EDFA).
ARFID case studies reported in research demonstrate success using family-based treatments and psychoeducational and motivational treatment, which focus on exploring motivation for altering eating behaviors.
A review suggests the most common ARFID treatments used in literature are cognitive behavioral therapy (CBT), family-based therapy, and medications.
The case studies included in this article are for illustrative purposes only and are based on generalized or anecdotal examples. Individual experiences with ARFID may vary, and these cases do not represent specific individuals or guarantee similar outcomes. Always consult a qualified healthcare professional for personalized evaluation, diagnosis, and treatment of ARFID or related eating disorders.
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Key Takeaways
- ARFID is a complex eating disorder that goes beyond typical picky eating, potentially leading to nutrient deficiencies and health complications. With early intervention and professional treatment, individuals with ARFID can experience significant improvement in health and quality of life.
- A better understanding of and identifying ARFID is the first step toward making a meaningful difference in the life of a child, teenager, or adult struggling with this eating disorder.
- If you or a loved one suffers from ARFID, seek professional guidance today — early intervention matters.
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