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) Some people may experience this condition as food aversion with a co-occurring obsessive compulsive disorder (OCD). This is due to some people with ARFID being obsessive about avoiding certain types of food. In this article you can learn the details of these disorders, as well as how they are treated.
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)
A person with food aversion and OCD may obsessively avoid certain foods or become obsessive over eating 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 over food avoidance, 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 a fear of eating something that is contaminated. In response to these fears, a person with ARFID and OCD may develop rituals around eating, 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 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 the appetite.
When a person lives with ARFID and/or OCD, treatment is often necessary to restore health and wellbeing. 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 dietician to develop an appropriate g meal plan that provides adequate nutrition. (2)
Psychotherapy is also used to treat obsessive compulsive disorder. 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)
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 a mental health provider or 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 needs.