It’s not unusual to experience some selectiveness around food. Many people have allergies that limit their food choices, others are naturally drawn to certain flavors or textures, and most of us likely demonstrated a degree of pickiness in childhood.
But what happens when these food preferences begin to erode your quality of life? When eating becomes increasingly narrowed in food variety and/or restrictiveness of overall intake that it leads to weight loss or unmet growth expectations, nutritional deficiencies, dependence on caloric supplements or tube feeding, and/or marked interference with psychosocial functioning, it could indicate the presence of Avoidant/Restrictive Food Intake Disorder (ARFID).
Misconceptions and insufficient research on ARFID can make it difficult for those struggling to find appropriate, supportive care. ARFID is a serious mental illness—it’s not just “picky eating,” a passing “phase,” or a choice, and it needs timely, specialized, evidence-based treatment that effectively addresses its unique considerations.
Avoidant/Restrictive Food Intake Disorder: A Brief Overview
Avoidant/Restrictive Food Intake Disorder (ARFID) is defined by a limited eating pattern (in either volume or variety of food) and is associated with significant medical and psychological consequences. Unlike other restrictive-type eating disorders such as anorexia and bulimia, whose disordered behaviors are motivated, in part, by a desire to manipulate weight and shape, ARFID’s eating disturbances are not associated with distorted body image or body dissatisfaction. Additionally, food scarcity, culturally sanctioned practices, or different medical or psychological concerns cannot explain ARFID eating patterns.
ARFID was officially categorized as an eating disorder diagnosis in the DSM-5 in 2013, though ARFID itself is far from new. Even though research on this underrecognized eating disorder is limited, the existing ARFID studies are telling.
What to Know About ARFID’s Epidemiology:
- Accounts for up to 15% of new eating disorder cases presenting for treatment
- 20-30% of patients are male (greater than in other eating disorders)
- Mean age of diagnosis is 11 years old
- Longer duration of symptoms before diagnosis than other eating disorders
- More likely to have co-occurring medical conditions
- 20% of patients display somatic concerns (i.e., choking, vomiting, or illness)
The symptoms of ARFID often begin in childhood. While there is no age of onset criteria, the average age of diagnosis is younger than other eating disorders. That said, ARFID can occur at any age, from young children to older adults. One study suggests that approximately 9.2% of adults with eating disorders meet the criteria for ARFID.
As with all eating disorders, ARFID is a biological, brain-based illness caused by a complex blend of psychological and social factors. The challenges faced by those living with ARFID are varied and depend on age and symptomology. It’s worth noting that ARFID may occur without any weight changes —weight loss is just one way that the failure to meet energy or nutritional needs may manifest. Patients with ARFID can present at any weight and still experience medical instability or malnourishment. Even so, ARFID in children and adolescents is generally diagnosed based on significant weight loss, a failure to achieve expected weight gain, or faltering growth. Early intervention for ARFID is essential for mitigating the potentially extremely harmful impacts of malnutrition.
Health Effects of ARFID:
- Cognitive impairment
- Inability to engage in socialized eating experiences
- Difficulty managing emotions
- Delayed puberty or dysregulation of reproductive hormones
- Impaired brain functioning and signaling
- Weakened food-related reward pathways
- Chronic abdominal pain, fatigue, and headaches
Conditions Associated with ARFID
ARFID is highly comorbid with other mental health disorders. According to research, ARFID is more likely than anorexia or bulimia to present with at least one additional mental health diagnosis. While a co-occurring condition can complicate treatment, it does not make recovery any less possible—provided treatment effectively addresses each co-morbidity.
ARFID is most often associated with the following mental health conditions:
- Generalized anxiety disorder (GAD)
- Obsessive-compulsive disorder (OCD)
- Autism spectrum disorder (ASD)
- Attention-deficit/hyperactivity disorder (ADHD)
- Pseudodysphagia (extreme fear of choking)
Considerations in the Treatment of ARFID
Even though ARFID is at the 10-year mark of being included in eating disorder care, there is still not a well-established standardized treatment for this condition. What is widely agreed upon is the need for multidisciplinary involvement, especially for more severe and medically complex cases of ARFID.
The foundational tenets of ARFID care are:
- Psychoeducation about ARFID
- Caregiver or family involvement and support
- Exposure therapy
- Treatment for co-occurring conditions
- Structured mealtimes
- Tools for ongoing progress following treatment
- Relapse prevention
The goals of ARFID treatment are:
- Achieve and/or maintain a healthy nutritional state
- Correct nutritional deficiencies
- Expand the variety and nutritional adequacy of accepted foods eaten
- Develop coping skills to identify and manage emotions
- Increase comfort in social situations
How Does Veritas Collaborative Treat ARFID?
Following a comprehensive medical screening, diagnostic questionnaire, and admission into Veritas at the recommended level of care, you or your loved one can expect an individualized treatment plan reflecting your personal and diagnostic needs. While much research still needs to be done, our years of clinical experience have led us to discover some essential aspects of ARFID treatment.
There are different expectations for ARFID patients compared to those with other eating disorders. Our staff recognizes that body movement/physical activity often serves a different purpose than its compensatory functioning for those with anorexia or bulimia, for instance. What’s more, there may be more flexibility and outside-the-box thinking with the meal plan, knowing that “flexibility” is relative for a patient with ARFID. We consider “flexibility” by taking into account the patient’s pre-treatment state.
Our first priority is to achieve or maintain a healthy nutritional state. To effectively engage in eating disorder treatment, a patient—first and foremost—needs a functioning brain. Our immediate aim is to help patients achieve or maintain a nutritional state that restores their brain health. We assess all patients, regardless of weight, for micronutrient deficiencies and medical complications from nutritional deficiencies. For patients who are underweight and/or show medical complications, we work on increasing the total volume of food before variety. Young patients with ARFID risk stunted growth. As such, we assess their growth compared to genetic potential and set weight goals considering expectations for remaining growth potential. Our treatment model aims to expand our patients’ “accepted” foods repertoire.
At Veritas, ARFID treatment reflects the following elements, integrated with our standard evidence-based programming:
- Assessment by an Occupational or Speech Therapist prior to admission or soon after, to be sure the patient has been assessed for their capacity to engage in care. If there are issues with chewing and swallowing, for instance, those should be addressed before ARFID care can commence.
- Orientation of patient and parents (or community of support) about what to expect in the ARFID treatment experience.
- Education on patient’s sensory issues, in order to alleviate anxiety about how treatment will unfold.
- Specialized group content:
- Food Discovery Group. Led by a registered dietitian and therapist pair. Patients meet five times a week at the same time and in the same space. Foods are introduced based on a food hierarchy, and patients use a ranking of experiences to evaluate their food exposures. Patients are encouraged to try new foods in a fun, social environment. With the support of providers and family, patients work to build food curiosity and tolerance.
- Enriched Exposure Therapy. Involving culinary experiences to increase comfort within kitchen and dining spaces. Within these age-appropriate social groups, there is no pressure to eat or taste food. These groups are playful and fun–most of the participation is being in the room and tolerating the smell of food within the environment.
- Body Awareness Group (instead of Body Image Group). Learn the purpose of emotion, how emotion is experienced in the body, and how to appropriately respond to emotions. Patients practice how to manage anxiety and identify where emotions are experienced in the body. Additionally, patients grow in understanding of the digestive process and utilize mindfulness.
Additional components of ARFID care offer opportunities for socialization, such as social skills groups, group meals, and restaurant and therapeutic outings. These programs are meant to mitigate social isolation, which can be intensified in those with ARFID due to stigmas and the lack of general awareness about this condition.
Recovery from ARFID is Possible
Managing treatment expectations in the context of ARFID is crucial. Patients and their parents or communities of support must be aware that progress can be slow, especially in the beginning as we work to redefine “normal” eating. At Veritas, our compassionate, knowledgeable team is here to soothe any of your treatment concerns, address your specific diagnostic needs, and guide you to lasting recovery. Regaining a balanced, varied, and peaceful relationship with food is possible. Get started with us today.
To learn more about treatment for ARFID and how it differs from other eating disorders, watch “ARFID 101” and “Beyond Picky Eating: Transdisciplinary Treatment Strategies for Treating Avoidant/Restrictive Food Intake Disorder” on our Recorded Presentations page.
While ARFID may be lesser known than other eating disorders, it is equally as serious and worthy of treatment. If you or a loved one is struggling, please reach out to Veritas Collaborative to begin recovery today. You can complete our online form or call us to discuss treatment options at 1-855-875-5812.
Veritas Collaborative is a specialty healthcare system for the treatment of eating disorders. Providing a range of services for individuals of all ages, Veritas offers Inpatient, Residential, Partial Hospitalization, Intensive Outpatient, and Outpatient levels of care. Multidisciplinary treatment teams – made up of physicians, psychiatrists, dietitians, culinary professionals, therapists, nurses, and skilled therapeutic assistants – aim to equip individuals, families, and communities with the skills necessary to continue recovery in the home environment.