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Examining ARFID vs. anorexia

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Avoidant restrictive food intake disorder (ARFID) and anorexia nervosa (AN) share a number of common signs and symptoms, leaving many people to confuse the two. 

But while the conditions may outwardly resemble one another, they’re rooted in two very different psychological standpoints, which ultimately manifest as two different disorders.

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In this article

What is ARFID?

ARFID is one of the newest additions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the record of all officially-recognized mental health conditions, only first appearing in the manual in 2013.

Previously referred to as “Selective Eating Disorder,” people experiencing this condition encounter what’s referred to as “eating or feeding disturbance” in their everyday lives, which describes a range of behavioral patterns, including:

  • A general lack of interest in food or eating.
  • Avoidance of certain foods based on sensory characteristics like texture or color.
  • A fear of consequences from eating certain foods, typically tied to a fear of pain or choking.

ARFID can also present as severe anxiety around mealtimes or in the presence of certain foods, eating very small portions, difficulty chewing, or frequently vomiting or gagging after being exposed to certain foods.

One of the main factors distinguishing ARFID from more routine picky eating is the severity of the behaviors—and their consequences. 

While more routine picky eaters often have certain foods they can enjoy and eat without distress, individuals with ARFID may struggle to tolerate an amount or variety of foods which provide them with adequate vitamins and nutrients. And people with ARFID also tend to experience greater levels of distress when confronted with food they find aversive.

What is anorexia nervosa?

Anorexia nervosa is another type of eating disorder commonly characterized by a severe restriction or limitation on food intake.

People struggling with this disorder tend to exhibit a fixation on the concepts of weight, body image, diet, and body shape and size. Most people with anorexia nervosa display an intense fear of gaining weight, and many will also have a distorted perception of their own weight or body shape and size, in some cases believing themselves to present as far bigger than they actually are.

While a low body weight has historically been considered a marker of this disorder, medical experts now understand that it is possible for people of all body weights, shapes, and sizes to experience anorexia nervosa.

Some people who struggle with this disorder also use methods other than severe food restriction to attempt to manipulate their weight, including excessive workout routines, which may persist even in times of exhaustion or sickness, and the use of laxatives or other substances that help dispel the contents of the stomach and bowels.

Comparing ARFID vs. anorexia 

When comparing ARFID vs anorexia nervosa, it’s imporant to examine both the similarities and the differences of the two eating disorders. Avoidant food restrictive intake disorder and anorexia nervosa may appear very similar from the outside, and do share some common signs, symptoms, and risk factors. But the two disorders are ultimately very different from one another, for a number of reasons.

The similarities between ARFID and anorexia nervosa 

The most obvious similarities between AN and ARFID are the common physical and medical manifestations of the disorders. 

Both AN and ARFID can cause food restriction and undernutrition, which may result in weight loss in adults and failure to experience expected gains in height and weight in children. However, due to genetic differences, some people with either of these disorders may experience physiological symptoms of undernutrition without significant weight loss. Regardless of weight, individuals with ARFID or AN who are not consuming enough overall energy or enough of certain nutrients may develop symptoms including hair loss, impaired immunity, low body temperature, sleep disturbances, digestive problems, low energy, and difficulty concentrating. 

But the two conditions also share a number of overlapping mental and emotional aspects.

Both conditions have strong links to autism spectrum disorder (ASD). In fact, many behavioral and cognitive features of ASD represent the same psychological underpinnings of AN and ARFID, including cognitive inflexibility and impaired set-shifting (or shifting attention between tasks). (1)

Co-occurring—rates of autism and anorexia nervosa are estimated to be anywhere from 4.7% to 23%, while ARFID and autism spectrum disorder have been found to have a comorbid rate as high as 21%. (2,3)

Avoidant food restrictive intake disorder and anorexia nervosa also both frequently overlap with various anxiety disorders and obsessive-compulsive disorder (OCD). These conditions are often thought to be risk factors for developing both anorexia nervosa and ARFID, and vice versa.

The differences between AFRID and anorexia nervosa 

While anorexia nervosa and ARFID both involve the severe restriction or limitation of food, the driver behind these eating and feeding behaviors is different.

People struggling with anorexia nervosa are often motivated by an extreme fear of weight gain, or a desire for thinness – fixations that have been linked in some scientific literature to stress-borne traits like “perfectionism,” and even aspects of OCD. 

People struggling with avoidant restrictive food intake disorder, on the other hand, don’t put the same emphasis on body image. The motivation to avoid food in the case of people with ARFID is typically tied to the extreme fear of choking or severe sensitivity to food texture, taste, color, or smell. In fact, ARFID is often considered a sensory disorder as well as an eating disorder, due to these connections.

ARFID can also present as a general disinterest in food, whereas many people with anorexia nervosa fixate on the subject of diet, despite greatly limiting their own intake. And clinically, avoidant food restrictive intake disorder tends to have an earlier onset, and affect more people assigned male at birth, than anorexia nervosa. However, it is possible for both AN and ARFID to occur in people of any age and gender. 

Treatment for ARFID vs. anorexia

The best course of treatment for either disorder may also look different. While AN and ARFID are distinct disorders, it is possible for an individual to have both, either at the same time or at different points during their life. In individuals who present with both AN and ARFID, effective treatment must address both and be attentive to which set of cognitions is motivating each food fear or eating disorder behavior. 

While there is currently no standard treatment for ARFID, people struggling with anorexia nervosa tend to respond well to cognitive behavioral therapy (CBT), a form of therapy that involves loosening up cognitive inflexibility and building up self-esteem. 

For people with either AN or ARFID who are malnourished, nutritional rehabilitation is an important part of the treatment process. In traditional treatment for anorexia nervosa, including a variety of foods in a recovery meal plan is often considered to be an important part of both providing adequate nutrition and disrupting disordered food choices. However, in people with ARFID, it is important that each individual’s meal plan incorporates adequate amounts of tolerated foods, and that any exposure to new or feared foods is done in a slow and safe way to avoid creating additional trauma around the experience of eating.

The good news is that both conditions can ultimately be addressed through treatment —and recovery is possible.

If you or a loved one are struggling with ARFID or anorexia nervosa, it’s never too late to seek the help you need that could lead you on the path to recovery.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Karjalainen, L., Råstam, M., Paulson-Karlsson, G., & Wentz, E. (2019). Do autism spectrum disorder and anorexia nervosa have some eating disturbances in common?. European child & adolescent psychiatry, 28(1), 69–78. https://doi.org/10.1007/s00787-018-1188-y
  2. Eating disorders. National Autistic Society. (n.d.). Retrieved December 21, 2022, from https://www.autism.org.uk/advice-and-guidance/topics/mental-health/eating-disorders 
  3. Koomar, T., Thomas, T. R., Pottschmidt, N. R., Lutter, M., & Michaelson, J. J. (2021, May 7). Estimating the prevalence and genetic risk mechanisms of ARFID in a large autism cohort. Frontiers. Retrieved December 21, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyt.2021.668297/full

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