ARFID (Avoidant restrictive food intake disorder)
ARFID, or Avoidant/Restrictive Food Intake Disorder, is a relatively new eating disorder characterised by a severe restriction of food intake or “extreme picky eating”. Various factors, including medical conditions, mental health issues and cultural influences, can cause ARFID. It can have severe physical and psychological consequences, making it essential to understand the disorder to identify and get the needed help.
What is ARFID?
ARFID is an eating disorder that can result in serious health consequences, including malnutrition and poor growth. People with ARFID have an intense fear of certain foods or new food, have difficulty eating certain textures or flavours, lack interest in eating and do not feel hungry. They are often underweight and picky eaters, but they are not usually trying to lose weight on purpose.
ARFID was first described in the 1960s by psychoanalysts who used the term “Selective Eating” to describe a range of eating disturbances, including anorexia and bulimia and “nonspecific” eating patterns. The term ARFID was not recognised as a separate diagnosis until 2013, when it was added to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). The diagnosis of ARFID is based on a detailed assessment by a mental health professional.
What causes ARFID?
It’s thought that ARFID is caused by a combination of biological and environmental factors, such as a person’s genetic makeup and early experiences with food. It is classed as a mental health disorder in which individuals experience a persistent lack of interest in food or avoidance of certain foods due to past experiences. This can lead to malnutrition, as individuals often do not consume enough calories and nutrients to maintain a healthy diet and lifestyle. Moreover, eating disorders’ mental and physical consequences can be highly detrimental to long-term mental health.
Additionally, certain medical or mental health conditions can increase a person’s risk of developing ARFID, such as anxiety disorder or hypersensitivity to certain foods’ smell, taste, or texture.
At what age can an individual develop ARFID?
ARFID can start at any age, but it is typically seen in young children and adolescents. It can manifest in toddlers who avoid certain textures or the taste of certain foods due to factors like sensory issues but often goes on undiagnosed until much later when the individual’s symptoms become more severe and require specialised treatment.
Are there differences between adult symptoms and child symptoms of ARFID?
Child symptoms of ARFID may be more severe and last longer than adult symptoms. This is because children may be more sensitive to their environment and have a smaller appetite due to size and age. Children may also lack knowledge about different foods and may not have the same independent eating habits as adults. Additionally, children may be more influenced by their peers when it comes to eating habits and this can lead to a more significant impact on their ARFID symptoms.
Adults, however, have a slight upper hand in terms of self-awareness. Even though adults may sometimes experience difficulty understanding and expressing their feelings, they often have the advantage of life experience and hindsight to help them better recognise and manage the disorder.
How do I spot the signs and symptoms of ARFID in my child/other children?
The signs and symptoms of ARFID can vary from child to child. Common signs and symptoms to look out for include:
- Difficulty transitioning to different types of food
- Avoidance of certain foods based on texture, appearance, or smell
- Eating significantly smaller amounts than other children their age
- An unhealthy preoccupation with body weight or shape
- Unusual behaviour s around food, such as gagging or refusing to try new foods
- Extreme picky eating or difficulty trying new foods
- Loss of appetite
- Weight loss or failure to gain weight appropriately
- Irritability or fatigue after eating certain foods
- Problems with nutrition, such as vitamin deficiencies
How can I spot the signs and symptoms of ARFID in adults/myself?
Spotting the signs and symptoms in yourself or other adults can be tricky. Here are the most common signs that have been a good indicator of ARFID in the past.
- An inability to eat certain types of food or food groups, such as meats, dairy, or fruits and vegetables.
- A fear of choking or vomiting in response to certain types of food or textures.
- Extreme worry about certain foods’ smell, taste, colour and texture.
- Avoidance of certain eating environments due to anxiety about trying new foods or feeling embarrassed about eating habits.
- Reduction in general health due to inadequate caloric intake or poor absorption of vitamins and minerals from food.
- Persistent feelings of fullness after eating only a small amount of food.
- Low body weight or BMI.
- Deterioration of physical health due to nutritional deficiencies.
How can ARFID be treated?
Treatment for ARFID involves identifying the disorder’s underlying cause, usually a combination of biological, psychological and environmental factors. To address all components of ARFID, a multidisciplinary team of professionals is often needed, such as psychiatrists, dieticians, psychologists and other experienced healthcare providers.
Treatment strategies can vary in different centres. At Banbury Lodge, it takes the form of cognitive-behavioural therapy (CBT), family therapy, increased support, or medication to help alleviate anxiety or depression, nutritional education, group work and one-on-one counselling.
Treatment typically involves addressing both the physical and psychological symptoms of ARFID, such as nutrition support to help restore healthy eating patterns and psychotherapy to help develop healthier ways of thinking and responding to food-related concerns.
Ultimately, treatment aims to help restore normal eating behaviours and improve any nutritional deficiencies as a supportive unit.
How can parents help their children who have been diagnosed with ARFID?
It can be heart-breaking to see your child go through the symptoms of ARFID, but you must be well prepared and ready to make changes in yours and your child’s daily life. Below, we have put together tips on how you can help your child overcome ARFID:
- Learn about ARFID. Educate yourself and your family about the condition to support your child best.
- Model healthy eating habits. Children with ARFID need to see adults practising healthy eating habits, such as eating balanced meals and snacks.
- Introduce new foods slowly. Start by offering small amounts of new foods and offering positive reinforcement when your child shows interest or tries them.
- Respect their mealtime limits. Don’t pressure or punish your child if they don’t try a new food or finish a meal. Making mealtimes relaxed and stress-free is important for helping your child feel more comfortable with food.
- Make sure they get enough nutrients. Speak to a dietitian or nutritionist to ensure that your child is getting all the nutrients they need, even if they are not eating enough variety of foods.
- Consider counselling or therapy for your child. A therapist can help your child work through the underlying psychological issues that may be causing their ARFID. Further, this type of professional can also provide you with coping strategies and techniques to better navigate the condition with your child at home.
How can you help an adult loved one diagnosed with ARFID?
It could be overwhelming to see your loved one suffering from ARFID. Here are some tips on how you can help:
- Educate yourself about ARFID to better understand what your loved one is going through.
- Offer support without being judgmental. Remember that ARFID is a disorder, not a choice.
- Help them build skills to manage their anxiety around food and the food environment.
- Talk to their doctor or mental health professional about medication management and other ARFID treatments.
- Help them find creative ways to meet nutritional needs, such as liquid nutrition drinks and snack bars.
- Encourage your loved one to engage in activities that distract from their worries about food and nutrition, such as outdoor activities or creative projects.
- Be patient and understanding of the progress they may make in overcoming their ARFID.
How does Banbury Lodge treat ARFID?
Banbury Lodge offers a rehabilitation treatment programme for clients with ARFID. This programme typically includes a combination of psychotherapy, nutrition education, medical monitoring, meal exposure/exposure therapy and parent education (if applicable). Our staff of experienced professionals have all experienced treatment first-hand, and understand this highly complex disorder. We are dedicated to supporting each client through their recovery journey and offering the tools that will help them reach their goals.