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Avoidant restrictive food intake disorder (ARFID) is an eating disorder that involves a severely limited caloric intake due to extreme aversions to certain foods, fear of vomiting or choking after eating, or a general disinterest in food.
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We’ll help you take the self-doubt and guilt out of eating, make peace with food, and become highly attuned to what your individual body needs.
To address the various underlying issues at play, ARFID treatment is often multidisciplinary, with a treatment team of healthcare professionals working to help with psychological, nutritional, psychiatric, and physical interventions. This offers a whole-person approach to recovery, as opposed to simply addressing disordered eating behaviors.
ARFID is still a relatively new medical designation, and research on the condition, including how to treat ARFID, is ongoing. How to treat ARFID in adults is especially underlooked, as the condition tends to impact children and adolescents.
Still, these forms of psychotherapy—or talk therapy—have been known to help treat other eating disorders, and may be helpful to treat ARFID in adults, adolescents, and children alike.
Cognitive behavioral therapy is the preferred method for treating many types of eating disorders, and it can also be used for treating ARFID.3
The idea behind CBT is helping patients first recognize, then proactively change, disordered thoughts, with the goal of eliminating these thoughts—and unhelpful behaviors that result from them—all together. This can be a particularly good way to help someone with ARFID, as disordered thoughts, such as the fear of choking or vomiting, can often be at the root of the problem.5
CBT also helps in the treatment of depression, anxiety, and obsessive-compulsive disorder, which commonly co-occur with ARFID.4
Due to the particular needs of many patients with ARFID, a new form of cognitive-behavioral therapy was developed specifically for avoidant/restrictive food intake disorder treatment.
The technique follows a "volume before variety" philosophy, encouraging weight gain first, through the consumption of preferred foods, in larger volumes, before introducing the concept of greater dietary variety.1
Once a patient is ready to begin expanding their diet, cognitive behavioral therapy for ARFID utilizes elements of exposure therapy to address the major factors maintaining the condition, such as having someone interact with food colors, textures, or scents they have strong aversions to.1
Exposure therapy, a specialized version of CBT, is used to help overcome the fear of certain objects or situations, and it can also be used to help ease the anxiety attached to certain foods common in people living with ARFID.4
This is usually done using mental visualization and relaxation techniques, writing and talking about feared foods, and learning positive coping skills. Individuals living with ARFID are also exposed to their feared foods in a safe environment.11,4
Changes are generally made slowly, and, at first, often within foods a patient already considers "safe." For example, if a patient will eat waffles, a therapist may try presenting them with waffles made from a different type of flour. As someone continues to feel more comfortable, changes become bigger and more variety, including foods a patient may fear, is introduced.11
While ARFID affects people of all ages, many of those struggling with the condition are children or adolescents.11 Family therapy is one of the most common forms of treatment for younger people with an eating disorder of any type, so it is also commonly used for treating ARFID.
Family-based therapy is designed to empower family members of an individual with an eating disorder to support their recovery. Parents or guardians are generally given full control of the child's diet at first, with autonomy returned in stages, as recovery progresses.3
The treatment philosophy also designates the eating disorder as an entity separate from the child, lifting blame and guilt from the family, as well as educating all members about refeeding strategies to help someone with ARFID restore healthy eating behaviors.6
Group therapy is a great way for people struggling with common experiences to gain perspective, feel a sense of support and community, and practice new coping mechanisms and skills in a safe environment.3 And the same can be said when it's used as ARFID eating disorder treatment.
Through these psychologist-led sessions, people with ARFID can share fears, concerns, and victories, as well as work on issues they may still need help with.
Interpersonal psychotherapy (IPT) works on resolving relationship stressors as they currently affect someone, rather than looking back at childhood development for the roots of issues.7
In this way, it may be an effective way to help someone with ARFID deal with the very real distress that frequently drives disordered eating behavior, including fears of choking or vomiting after eating.
Overall, IPT focuses on where relationships and eating disorders overlap, by exploring how issues within relationships can contribute to eating distress.7
Nutrition counseling is nearly always an important part of ARFID treatment. This type of support helps patients learn about their body’s nutritional needs and why certain foods are an important part of staying healthy.
Nutritional therapists can also play a big role in exposing people with ARFID to feared foods. With children, this could mean asking them to draw, color, or play with toys that look like certain foods, to help familiarize and destigmatize them.11
Nutritional counseling may also involve a meeting with a registered dietician to identify any nutritional deficiencies that have arisen due to a restricted diet. This can help them potentially create a meal plan or recommend other supplements.3
Online therapy is a relatively new development in the world of mental health, but its practice has been on the rise for several years.
This method allows patients to access care from wherever they are, as long as they have an internet connection. This can be especially helpful for those who live far from in-person treatment centers, have challenges around transportation or mobility, or who have difficult schedules, but it can be equally as convenient for someone who simply does not want to leave home to receive care.
Online programs are being found to be just as effective as in-person care in many cases, including when practicing CBT, which is one of the most common aspects of an ARFID treatment plan.8
Online care may not be right for all cases, particularly those involving severe symptom onset, but legitimate programs should complete a thorough evaluation at first to assess whether the therapy method is right for you.
Once a patient with ARFID is medically stable, they may be able to step down to residential care, which provides the supervision and support needed to continue with their treatment plan.2
Still, patients in residential treatment or inpatient care may still struggle with disordered thoughts and behaviors, including food restrictions or severe food aversions.
To combat those issues, this level of avoidant/restrictive food intake disorder treatment has patients live full-time at a treatment facility, where they can partake in rigorous daily schedules that include individual and group therapy, supervised meals, nutrition counseling, and medical evaluations, among other types of care.
Weight restoration is often a goal of this stage of ARFID recovery, though different assessment's may be used to measure a patient's progress.
The next level of care is partial hospitalization, a day program which can go on as long as 10 hours a day, up to 6 days a week.2
This stage of ARFID eating disorder treatment allows patients to continue receiving support and structure while having the chance to go home at night to their family, caretakers, or loved ones.
Still, most of a patient's meals will be eaten—and supervised—in a PHP. Partial hospitalization programs also frequently allow a patient to continue the type of ARFID counseling they were receiving at other levels of care, including individual or group therapy sessions, nutritional counseling, and medical evaluations.3
Daily medical monitoring is no longer needed by the time someone reaches this point of intensive outpatient programs in ARFID disorder treatment. Intensive outpatient treatment usually takes place just a few days a week, for a few hours a day, with patients attending therapy sessions or possibly joining an ARFID support group to remain accountable to their recovery journey.2
The more relaxed schedule can help someone with ARFID start incorporating social responsibilities like work and school back into their schedule. But IOPs offer more support than a standard outpatient program, for patients who still need or want it.
This least intensive level of care for treating ARFID typically involves maintaining a regular meeting with a therapist, psychiatrist, or dietician, in order to continue making progress, keep monitoring symptoms, identify potential triggers, and remain committed and accountable to ARFID recovery.
By the point of reaching outpatient treatment, patients have generally reached a healthy weight and made great progress at curbing any unhelpful eating habits. They're also generally considered self-sufficient in managing food restriction and avoidance, with meal monitoring mostly dropped by this point in treatment.
Treating ARFID at Within Health
Avoidant/restrictive food intake disorder is sometimes confused with anorexia nervosa or picky eating, but the condition is developed and maintained by its own unique factors and should be treated accordingly.
At Within Health, we create individual treatment plans for each of our clients, regardless of which eating disorder they're struggling with. We aim to support people with ARFID by helping them learn to embrace flexibility around food and eating, so they can overcome their food phobias and food restriction, and enjoy food and social eating once again.
Our ARFID treatment program is run entirely online or through our app, and consists of two levels of care:
Partial hospitalization program
Intensive outpatient program
The level of care required for an individual living with ARFID will be determined depending on the severity of the restriction, overall health and wellbeing, and a person’s specific needs.
Our multidisciplinary team of experienced psychotherapists, dietitians, nurses, and other mental health professionals not only provides cutting-edge treatment, but also unconditional compassion, support, and understanding.
We know how hard it is to seek help for ARFID, so we ensure you will not go through recovery alone. Supported group meals and group psychotherapy are there to make you feel like you’re part of a community, no matter what your gender identity, ethnicity, sexuality, or age, and reassure you that your struggle is not yours alone.
Through the Within Health app, help is available wherever you are, whenever you need it.
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.
Watching a loved one struggle with ARFID can be frustrating, heartbreaking, and difficult. Your first reaction may be to yell at them or argue about why they won't eat, or try to force feed them.
Instead, try to lead with compassion.
Validating that someone is struggling with a mental health disorder beyond their control can be freeing both for you and for them. Once you're more able to see their actions as part of a disorder, you can try to cultivate more patience. That's another key aspect of supporting someone with ARFID, both through treatment and recovery. And when it comes to trying new foods, it's important to give them room to make their own choices, even if they're choices you don't agree with.
But overall, one of the best ways to support someone with ARFID or any eating disorder is simply to be there for them. Listen to what they have to say, and make sure they know they're loved and cared for.
What is the best treatment for ARFID?
As ARFID is a relatively new diagnosis, treatment for the condition is still very much being studied. But for eating disorders in general, cognitive behavioral therapy is generally the first recommended line of therapy.
For ARFID in particular, there is CBT-AR, a version of cognitive behavioral therapy for ARFID, which aims at specific struggles people with that condition generally experience.
Nutritional counseling is also often recommended for treating ARFID, particularly in cases where someone has developed issues around malnutrition.
Are there ARFID support groups?
Yes. ARFID may be a new diagnosis, but it's becoming more widely recognized. As such, ARFID support groups have formed to help people with the condition find strength and support in a community of people who are going through similar challenges.
There may also be support groups for people with loved ones who have ARFID, to help them find a sense of understanding and share concerns, victories, and other common stories.
Support groups for eating disorders of all types are usually run on a local basis. An online search should be able to turn up some options, but you can also ask your doctor or call an eating disorder hotline for more information.
Get access to a streamlined experience with our industry-first treatment app. You can attend individual and group sessions, connect with your care team, submit weights and vitals via a numberless scale provided to you, receive meal support, access check-ins, and recovery-focused tools for use between sessions.