All About

Avoidant Restrictive Food Intake Disorder (ARFID)

The Diagnostic and Statistical Manual of Mental Disorders (DSM) added a new diagnosis called avoidant restrictive food intake disorder (ARFID) when they published the fifth edition (DSM-5). ARFID no longer has an age limitation and differs from eating disorders associated with body image disturbance. (1)

For those who struggle with ARFID, eating seems like a chore and not something to be enjoyed or satisfy hunger. Sometimes they grapple with eating specific food due to texture or consistency. Others don't want to eat anything due to their feelings about all food.

Avoidant Restrictive Food Intake Disorder (ARFID)

What is

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant restrictive food intake disorder, or ARFID, is an eating disorder that involves consuming less food than what is needed for proper body health, maintenance, and development. 

ARFID presents similarly to anorexia in avoiding food intake; however, it does not include anxieties about body weight or size in most cases. Those with ARFID limit their food intake because of negative psychological associations with eating and particular kinds of food. 

ARFID can present in children, resulting in improper growth, and in adults, presenting in a breakdown of the body’s organs due to lack of proper nutrition. (13) These strong feelings about food can cause nutritional deficiencies and physical problems like anxiety and depression.

For example, when a person grows up disliking foods like fruit or vegetables because they don’t like them raw because they crunch while they eat them. The person with ARFID also won’t eat them cooked because it changes the taste or consistency. As these patients get older, these feelings don’t change. 

Furthermore, ARFID affects adult populations as well. This disordered eating pattern usually occurs when patients don’t establish healthy dietary practices during early development. These patients will then carry this disorder throughout their lifetime if left untreated.

Diagnosing

Avoidant Restrictive Food Intake Disorder (ARFID)

Individuals with ARFID eat very little or avoid eating certain foods. However, they do not have a distorted body image like anorexia nervosa and are not preoccupied with their weight like bulimia. That can make diagnosing this eating disorder difficult for clinicians. (2)

A person with avoidant restrictive food intake disorder has a feeding problem that results in them not receiving adequate nutrition. Children, adolescents, and adults who have symptoms of ARFID need to meet specific guidelines outlined in the DSM-5. (1) The criteria include:

  • Significant weight loss
  • Insufficient growth in children
  • Notable nutritional deficiency
  • Dependence on vitamin supplements 
  • Reliance on enteral (tube) feeding
  • A significant interruption in psychosocial capacity
  • Unassociated with cultural practices
  • Does not result from anorexia or bulimia nervosa
  • Not attributed to any other medical or psychological disorders

Medical professionals use different tools to determine if the symptoms a person experiences match distinct conditions. 

Medical providers might need to conduct screenings and assessments using lab tests with other medical techniques for them to come up with consistent diagnoses that rule out possible alternatives.

Signs & Symptoms of

Avoidant Restrictive Food Intake Disorder (ARFID)

Knowing how to spot the signs and risk factors of ARFID can help a person determine whether they or a loved one needs medical attention.

Here are some of the signs and symptoms of ARFID: (6)

  • Severe weight loss
  • Abdominal pain
  • GERD or acid reflux symptoms
  • Dressing in layers of clothes to stay warm 
  • Attempting to hide weight loss with baggy clothes
  • Digestive issues
  • Heavily restricting food types or amounts
  • Consuming only foods of certain textures
  • Claiming to feel sick or full during mealtimes
  • Constantly feeling cold
  • Experiencing weakness 
  • May have excessive energy
  • Has a fear of choking or vomiting
  • Limiting food options that increase over time

Effects of Avoidant Restrictive Food Intake Disorder

Many people have food preferences, but if a person avoids a wide variety of foods throughout their lifetime, they may require medical intervention or treatment. 7 The significant effects of ARFID can be acute or chronic and may include both short and long-term effects: 

Short-Term Effects

  • Constipation
  • Difficulty concentrating
  • Dizziness or fainting
  • Dry and brittle hair, skin, and nails
  • Hair thinning
  • Irregular heart rate
  • Issues with sleep
  • Muscle weakness
  • Nutritional insufficiencies
  • Poor wound healing 
  • Stomach cramps. (8)

Long-Term Effects

  • Abnormal menstrual cycles
  • Brain damage
  • Constantly feeling cold
  • Decreased immune function
  • Dental problems
  • Developmental delays
  • Heartburn
  • Low blood cell counts
  • Low iron and potassium
  • Low thyroid hormone levels
  • Malnutrition
  • Permanent use of tube feeding due 
  • Social isolation
  • Stunted puberty due to malnutrition. (8)

Related Disorders

ARFID is common in clinical settings and is associated with high levels of physical and psychological comorbidity. It has a significant impact on physical health and psychosocial behaviors. (9)

ARFID is closely associated with anxiety, stress, and depression. Also, it is common for a person with ARFID to have experienced some form of trauma associated with eating, such as choking. (10)

For that reason, proper support and treatment for co-occurring disorders are effective treatment methods for those struggling with ARFID.

Treatment of

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is a complex disorder that affects both physical and mental health. When a person seeks treatment for ARFID, their care team must create an individualized treatment plan to support the person's unique medical, nutritional, and psychological well-being.

Therapies for Avoidant Restrictive Food Intake Disorder

The treatment for avoidant restrictive food intake disorder concentrates on boosting nutrition and feelings management about food. Treatment specialists will help the person with ARFID create healthier relationships with food so they may live a healthier life. 

Several therapies can help reduce how often a person engages in the disordered eating behaviors associated with ARFID. These include:

  • Cognitive behavioral therapy (CBT): CBT treatment gives ARFID patients a feeling of control and understanding regarding food consumption. It reduces unpleasant feelings about eating that trigger the disorder by making those connections between different variables clearer.
  • Dialectical behavior therapy (DBT): These mindfulness-based therapies help people cope with stress, regulate their emotions, and improve social relationships. In turn, these changes can reduce food avoidance or restrict intake.
  • Speech therapy: Speech therapy is necessary for improving the oral-motor muscles. Without these skills, it becomes challenging to eat or swallow properly, which may lead to ARFID.
  • Hospitalization: Many cases require a hospital stay to support the patient with weight gain or in more serious medical situations caused by malnutrition.

Often, patients with ARFID will meet with a dietician. During these sessions, a nutritionist will construct a personalized meal plan for the patient. The dietician will work with medical personnel and treatment specialists about the patient’s specific medical and treatment needs. (11)

Medications for Avoidant Restrictive Food Intake Disorder

The FDA has not approved any medications for the treatment of ARFID. However, doctors will prescribe supplements to improve the malnutrition associated with this disorder. 

Some doctors may prescribe medications to stimulate the patient's appetite. Some doctors will prescribe anxiety medication if needed. (11)

Understanding

Avoidant Restrictive Food Intake Disorder (ARFID)

When trying to understand eating disorders like avoidant restrictive food intake disorder, listening with an open, compassionate mind free of judgment will offer the most support. ARFID is so much more than picky eating, and should not be something scolded, or shamed when it presents in children or adults.

Often, the causes of eating disorders like ARFID are complex and closely linked to underlying mental health conditions that require specialized treatment for recovery. Someone presenting with ARFID may also be experiencing a variety of co-occurring disorders that expand far beyond someone simply not liking a particular food. 

The longer a patient experiences ARFID without treatment, the more at risk they are for significant, lasting health issues. Therefore, people are encouraged to seek treatment if they have any concerns that they or someone they love may have ARFID.

Living With Avoidant Restrictive Food Intake Disorder

Avoidant restrictive food intake disorder is a form of disordered eating that typically presents during childhood. 

An example of ARFID in children may be the refusal to eat certain foods or those with colors, consistencies, and odors they don't like, but this may be hard to distinguish from children who are simply picky eaters. Children with AFRID will have developmental delays due to a lack of proper nutrition. In contrast, picky eaters will generally have healthy development as they consume enough food for their age category. 

People with ARFID don't eat because they lose interest in food or think it is harmful. Color, odor, and/or consistency can also explain why people struggling with this disorder avoid eating. (3)

People with ARFID may struggle to be part of social activities and maintain relationships due to their eating problems. These are just a few of the issues surrounding this eating disorder. 

History of Avoidant Restrictive Food Intake Disorder

Before 2013, an ARFID diagnosis was known as either "selective eating disorder" or "feeding disorder of infancy or early childhood." Before the publication of DSM-5, this diagnosis was restricted to only those six years and under. (4)

However, later findings discovered that adults also struggle with avoidant restrictive food intake disorder. Further studies show that behavioral patterns of adult ARFID patients somewhat differ from those of pediatric patients. (5) These findings were the catalyst for reclassifying this disorder.

Avoidant Restrictive Food Intake Disorder in Pop Culture

Unlike well-known eating disorders like anorexia nervosa or bulimia nervosa, ARFID does not seem to have any significant representation in pop culture. People often associate this disorder with a person just being picky, and they feel that children will outgrow this "phase” leading to many children not receiving proper treatment for their condition. 

The lack of general awareness in society about this condition aids in the stigmatization and misinformation about ARFID. Without treatment, a person doesn't simply outgrow this condition, and it is much more complicated than a childhood phase.

How to Help Someone with

Avoidant Restrictive Food Intake Disorder (ARFID)

How can a person help someone with a restrictive eating disorder? Start by opening up an avenue for conversation where you genuinely listen to their feelings without judgment. 

Many ARFID sufferers struggle in their relationships and often feel isolated because of their illness. (11) Due to fear of judgment and shame, people and children with ARFID suffer in silence without support for any of the conditions associated with ARFID, like nutritional deficiencies, anxiety, depression, or the trauma that may have led to their negative feelings about food.

People with ARFID generally experience extreme anxiety and distress around mealtime. Remaining supportive throughout every step taken towards progress is critical to recovery, no matter how small those steps may be. 

Try to understand that everyone has a different body shape and size that is deserving of care and love regardless of what number presents on the scale or their specific challenges around food. 

The compassionate care team at Within Health is ready to help you or someone you love build a healthy relationship with food and your body. Call our admissions team today to start healing from ARFID.

Frequently asked questions

What kind of eating challenges do people with ARFID have?

The challenges those who suffer with ARFID face include avoiding foods based on color, texture or smell. (2) Those with ARFID often eat at a slow pace and their appetite appears to be small. For this reason, ARFID sufferers will avoid eating in social or public settings.

Do I have ARFID if I’m a picky eater?

Not necessarily. ARFID involves picky eating, but many people have food preferences that do not present because of an eating disorder. However, if you believe your picky eating is rooted in deeper impulses about food or is causing you to not receive enough nutrition daily, you may want to speak to a nutritionist or physician about ARFID.

Resources

1. Psychiatry online: DSM library. Psychiatry Online | DSM Library. (2013). https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596.

2. Davis, BA, H. A. (n.d.). ARFID: What you need to know about this eating disorder. ARFID: What You Need to Know about This Eating Disorder | Columbia University | Child Psychiatry. https://childadolescentpsych.cumc.columbia.edu/articles/arfid-what-you-need-know-about-eating-disorder  

3. Attia, E., Walsh, B. T., (2020, June) Avoidant/restrictive food intake disorder - mental health disorders. Merck Manuals Consumer Version. https://www.merckmanuals.com/home/mental-health-disorders/eating-disorders/avoidant-restrictive-food-intake-disorder

4. RM, M. K. A. O. (2017, August 29). Avoidant/Restrictive Food Intake disorder: A new eating disorder diagnosis in the Diagnostic and statistical manual 5. Current opinion in pediatrics. https://pubmed.ncbi.nlm.nih.gov/28537947/

5. Nakai Y.,Nin K.,Noma S., Teramukai S., Wonderlich SA. (2021, September). Characteristics of avoidant/restrictive food intake disorder in a cohort of adult patients. European eating disorders review: the journal of the Eating Disorders Association. https://pubmed.ncbi.nlm.nih.gov/27594387/.

6. Sherman, C. (Ed.). (2021, August). Avoidant/restrictive food intake disorder (ARFID) (for parents) - East Tennessee children's. KidsHealth. https://kidshealth.org/ETCH/en/parents/arfid.html.  

7. Bence, S. (2021, June 25). How avoidant restrictive food intake disorder is diagnosed. Verywell Health. https://www.verywellhealth.com/avoidant-restrictive-food-intake-disorder-diagnosis-screening-and-criteria-5185069#citation-1

8. Other eating disorders. Mount Sinai Health System. (n.d.). https://www.mountsinai.org/locations/eating-weight-disorders/disorders/other-eating-disorders

9. E, M. N. T. (2019, February). [ARFID - avoidant and restrictive food intake disorder: Clinical characteristics]. Revue medicale suisse. https://pubmed.ncbi.nlm.nih.gov/30763001/

10. Mittal, G. (n.d.). ARFID. ARFID | Duke Center for Eating Disorders. https://eatingdisorders.dukehealth.org/education/resources/arfid  

11. Avoidant/restrictive food intake disorder in children: What you need to know. Massachusetts General Hospital. (2019, January 9). https://www.massgeneral.org/children/avoidant-restrictive-food-intake-disorder/

12. M, Z. J. F. (2017, April). Avoidant/Restrictive Food Intake disorder (ARFID). Current problems in pediatric and adolescent health care. https://pubmed.ncbi.nlm.nih.gov/28532967/ 

13. Avoidant restrictive food intake disorder (ARFID). National Eating Disorders Association. (2018, February 22). https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid

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