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When we think of eating disorders, we often imagine someone who has anorexia nervosa (AN) or bulimia nervosa (BN), but another type of eating disorder present in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is avoidant/restrictive food intake disorder (ARFID).1
Someone with food aversion, or ARFID, will avoid foods because they find them to be unappealing or because they are worried about the consequences of eating. What is different between this condition and other eating disorders like AN is that a person with ARFID does not have a concern or fixation with their weight or body shape. In fact, a person with ARFID may desire to eat properly and gain weight, but their food aversions prevent them from doing so.1
Some people may have food aversion because of their OCD, while others may have OCD symptoms as a result of their food aversion. Some people may also have ARFID and OCD as co-occurring disorders.
A person with food aversion and OCD may obsessively avoid certain foods or obsessively overeat only a few specific types of foods because they are attempting to avoid unpleasant symptoms like upset stomach, allergic reactions, or difficulty swallowing.
While someone with ARFID may be obsessive about avoiding eating food, sometimes a person experiences both ARFID and OCD. In some cases, the two disorders can appear similar, but when someone has both conditions, they will meet the distinct diagnostic criteria for each disorder.
A person with OCD experiences obsessive thoughts and mental images and engages in compulsions, which are behaviors or rituals meant to cope with the obsessive thoughts.3 Someone who has both ARFID and OCD may have intrusive thoughts about contamination, and they may avoid certain foods, or perhaps all foods, out of fear of eating something that is contaminated. In response to these fears, a person with ARFID and OCD may develop rituals around eating and disordered eating behaviors, such as only eating certain foods or only eating in certain locations.
There is evidence that ARFID and OCD can occur together. In a study involving 90 individuals with ARFID, 6.1% also had an OCD diagnosis.2 Given the fact that there is an overlap between ARFID and OCD, people may wonder, “How does OCD affect appetite?” The answer is that if a person has a fear of becoming ill from eating certain foods, their appetite may be diminished. Perhaps they also develop obsessive or intrusive thoughts in response to a worry that they will throw up or develop a stomach ache in response to eating. In this case, OCD could also reduce appetite.
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When a person lives with food aversion, OCD, and eating disorders, treatment is often necessary to restore health and well-being. OCD symptoms create significant distress and can interfere with a person’s functioning at school, work, or in relationships. ARFID often results in health problems, as it is linked to weight loss and nutritional deficiencies.1
When a person has co-occurring conditions like an eating disorder and OCD, it is important to receive comprehensive, integrated treatment to address both conditions. If the OCD is left untreated, for example, the eating disorder may persist.
Treatment for ARFID or food aversion with OCD often involves mental health care to address the underlying anxiety surrounding food or negative reactions to food consumption. Many patients must also work with a dietitian to develop an appropriate meal plan that provides adequate nutrition.2
Psychotherapy is also used to treat obsessive compulsive disorder and any existing anxiety disorders. A specific type of treatment called cognitive behavioral therapy (CBT) can be especially helpful, as it can teach individuals with OCD to overcome obsessive thoughts and change their behavior in response to these thoughts. CBT can also be utilized to help individuals with ARFID overcome obsessions and fears related to food.3
Those with ARFID, specifically children, may also benefit from responsive feeding therapy (RFT). This involves the individual’s parent or caregiver ensuring mealtime routines are present and coupled with pleasant interactions. Additionally, by limiting distractions during mealtime, the individual can focus on their meal.4
Ultimately, the best course of treatment for a patient with ARFID and OCD will depend upon their unique needs. If you’re living with obsessions surrounding food, it is important to reach out to mental health professionals or a treatment center. A team of qualified professionals can help you to identify the root causes of your fears around food and develop a treatment plan that addresses your disordered eating.
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.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
