What Is Avoidant/Restrictive Food Intake Disorder?

Many eating disorders, such as Anorexia Nervosa and Bulimia Nervosa, are well-known even among non-medical professionals and oftentimes easy to point out. This is largely thanks to ongoing media attention and education efforts, but one eating disorder remains relatively unknown: ARFID. Avoidant/Restrictive Food Intake Disorder (ARFID), which in the past was referred to as Selective Eating Disorder (SED), was finally listed in the DSM-V in 2013 and is now commonly treated in eating disorder treatment centers.

In many ways, ARFID differs from other eating disorders. Its causes and ages of onset, as well as the demographic breakdown, are usually different from those of other eating disorders. Since ARFID normally begins in early childhood rather than adolescence, it’s also frequently confused with “picky eating,” which many children display; the difference is between not liking, for example, pickles and refusing to eat foods to the point that health is affected.

Since so little is known in the general public about ARFID, it is easy for parents and loved ones to miss the signs of the disorder. A lot of parents with concerns may have questions about this condition. Take a look at some of the common questions associated with ARFID, eating disorder treatment, and more.

What Are the Symptoms of ARFID?

Per the DSM-V, AFRID is defined as: 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.

This avoidance of certain foods brings on significant weight loss, nutritional deficiency, and a negative effect on the individual’s social life. It’s more than a dislike of certain foods; it’s a fear so strong that the person’s health is negatively impacted by it. If you notice your loved one is unwilling to eat a type of food, that their “fear foods” are growing in number, and that their weight is dropping significantly because they refuse to eat, it’s important to reach out for help and support.

Click here for a full list of the most common ARFID symptoms.

How Common Is ARFID?

ARFID is less studied than Bulimia Nervosa or Anorexia Nervosa, so there are relatively few numbers to go by when trying to understand the prevalence of the disorder. It is suspected that ARFID is under-diagnosed because many people simply assume that their child is a picky eater. However, those children who do truly need eating disorder support have issues that go far deeper than just being picky about what they eat. Most will avoid certain types of food to a point that it causes them problems with being malnourished or have other health issues.

Who Does ARFID Affect the Most?

ARFID does affect both males and females, but it tends to be an issue that is present in males the most. In addition, younger children seem to be more at risk than older children, as the condition will oftentimes improve with age and maturity, although this is certainly not a foregone conclusion.

People with certain mental health conditions are at higher risk for developing ARFID. About 20% of children with ARFID also have an Autism Spectrum Disorder. Additionally, about 20% of children with ARFID avoid certain foods because of sensory issues, which exacerbates the fear of certain foods based on their texture, flavor, or fear of choking or vomiting.

Is ARFID a Mental Illness?

Absolutely. The DSM-V does include ARFID as an eating disorder, and eating disorders are considered to be a mental illness.

ARFID is also frequently accompanied by other mood disorders. For example, 75% also have an anxiety disorder in addition to ARFID, particularly PTSD, which is the most common co-occurring disorder related to ARFID. Unlike other mental health illnesses such as chronic depression or acute anxiety, ARFID doesn’t usually respond to medications.

What Causes ARFID?

For people with a disorder like Anorexia Nervosa or Bulimia Nervosa, the underlying drive is often a fear of eating foods because they fear gaining weight or looking a certain way. However, ARFID is unique from other eating disorders because it is not triggered by body image disturbances, insecurities about appearance, or fear of gaining weight. Instead, a phobia or pathological fear of the food in question causes the restriction, although functionally the result can be similar to that of Anorexia Nervosa.

It is suspected that anxiety may be a major contributing factor for the disorder, and certain phobias also come into play. For instance, half of the children who need treatment for ARFID avoid eating certain foods because they are afraid of choking or vomiting.

It should also be noted that food restrictions due to cultural or religious doctrines are not considered to be signs of ARFID – for example, a Muslim individual who does not eat pork for religious reasons likely doesn’t have ARFID. When determining whether a person has ARFID, it is important to also ask about symptoms relating to Anorexia Nervosa and Bulimia Nervosa. As per the diagnostic manual, an ARFID diagnosis is not usually made if the symptoms only appear when the individual is experiencing acute symptoms of either disorder. Despite that, it is possible to suffer from more than one eating disorder simultaneously, and one may continue when the symptoms of another have abated.

What Does ARFID Treatment Involve?

Eating disorder support for ARFID typically involves Cognitive Behavioral Therapy (CBT), group therapy, food and nutrition counseling, and family therapy. The recovery process is individually catered to the client, so every eating disorder recovery journey can be different. Medication is not usually prescribed, although it can be prescribed for co-occurring disorders, like depression or anxiety. Instead, talk therapy techniques that focus on mindfulness, self-awareness, and facing fears are used.

Prime among these are CBT and exposure therapy. CBT is a retraining technique used in a variety of mental health treatments. It uses a Socratic technique between therapist and client, helping them identify which thoughts and ideas are disordered. When the client can begin to recognize them objectively, they can begin to replace those thoughts and ideas with healthier ones.

Exposure therapy is also a great example of replacing disordered behavior with healthier ones. It’s named after the gradual exposure to what a client is afraid to eat. Often beginning later in treatment when the client has begun to address their phobias and disordered thoughts. It’s a slow process; a person with ARFID who won’t eat meat won’t be forced to eat a steak the first time out, for example. This process can be frightening and difficult, but when it’s conducted thoroughly and carefully, presents a high chance for long-term, positive outcomes.

Reach Out for ARFID Help

Although it may not be as well-known as some other eating disorders, ARFID can cause serious health consequences and interfere with a person’s psychosocial functioning. If you, your child, or any loved one is struggling with ARFID, please reach out to the Alliance for Eating Disorders Awareness for resources and support.

If you are ready to take the next step in your recovery journey, please visit https://findedhelp.com/. This national, interactive database allows you to explore treatment options at all levels of care.

Oliver-Pyatt Centers, a Monte Nido Affiliate, provides residential and day treatment programs for individuals struggling with Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Exercise Addiction. We integrate highly personalized and sophisticated medical, psychiatric, clinical, and nutritional care with comprehensive family support. Our treatment is therapeutically grounded, incorporating state-of-the-art approaches, research, outcome data, and up-to-date medical knowledge.