December 4th, 2023
We all have certain foods that don’t quite do it for us. Whether it’s the texture, taste or a dietary choice, these food aversions are usually minor inconveniences that don’t significantly impact our lives. However, for individuals with ARFID, this aversion to certain foods goes beyond mere pickiness; it becomes an eating disorder that can have profound effects on physical and emotional well-being. “ARFID” may not be as familiar as anorexia nervosa or bulimia, but it can be just as difficult to manage and treat.
In this exploration of ARFID, we will look at how ARFID manifests, its symptoms and causes and what treatment options are available.
What is ARFID?
At first glance, it may be tempting to label someone with ARFID as a “picky eater” or being unadventurous when it comes to food. However, ARFID goes far beyond typical food preferences.
People with ARFID restrict their food intake by avoiding specific foods or food groups. These restrictions can be due to the food’s sensory characteristics, such as texture, taste, smell or colour. Texture is a particularly common trigger for those with ARFID, and foods that are perceived as slimy, mushy, gritty or overly crunchy can evoke an aversive response. Imagine the sensation of biting into a crisp apple or the feeling of pasta between your teeth – for someone with ARFID, these seemingly ordinary experiences can be distressing.
ARFID can affect a person’s physical, psychological and social functioning. It can lead to weight fluctuations and nutritional deficiencies and cause significant anxiety and emotional distress. This can be due to the symptoms and day-to-day difficulties of ARFID and also because the condition is so misunderstood that people feel self-conscious about seeking help or discussing it with friends and family.
What causes ARFID?
Understanding the causes of ARFID can be complex as it often involves a combination of factors. While research in this area is ongoing, several potential contributors have been identified which include:
Some people with ARFID may have naturally heightened sensitivity to certain textures, tastes, smells or even the temperature of foods. These sensory sensitivities can make many foods unappealing or even intolerable to them.
Early childhood experiences
ARFID often traces its roots back to early childhood. Traumatic experiences related to food, such as choking incidents or severe illnesses, can create aversions to specific foods or food groups. These aversions can then persist into adulthood, and the original incident may even be forgotten.
Limited food exposure
Some individuals with ARFID may have had limited exposure to a variety of foods during their developmental years. This can occur for various reasons, such as overly cautious parenting or environmental constraints. When children don’t experience a wide range of flavours and textures, it can contribute to their selective eating habits.
Anxiety and mental health
Mental health conditions, particularly anxiety disorders, are commonly associated with ARFID. Anxiety can heighten sensory sensitivities and lead to avoidance behaviours. For example, a person with anxiety may avoid eating certain messy foods in social situations to prevent embarrassment.
Autistic spectrum disorder
There’s a significant overlap between ARFID and autistic spectrum disorders (ASD). Many individuals with ASD have sensory sensitivities and may exhibit selective eating patterns. It is important to understand, however, that not everyone with ARFID has ASD and vice versa.
Research suggests that genetics may play a role in the development of ARFID. For example, if a close family member has ARFID or another eating disorder, there may be a higher risk for someone to develop ARFID as well.
Signs and symptoms of ARFID
Identifying ARFID can be challenging as its signs and symptoms are often subtle and varied. However, understanding these indicators is crucial for early intervention and effective treatment. As well as a limited diet and sensory aversions, other signs include:
Some individuals with ARFID have specific rituals or routines associated with eating. These rituals can involve eating the same foods in the same way at every meal.
Anxiety or fear around food
Experiencing anxiety, fear, or even panic attacks related to food is common in ARFID, and mealtime can become a source of considerable distress.
Limited food experiences
People with ARFID often have limited exposure to new foods or culinary experiences and may avoid trying unfamiliar dishes or cuisines.
ARFID can lead to social isolation, particularly in situations that involve communal eating. As a result, social gatherings, dinner parties and dining out at restaurants can all be incredibly stressful ordeals.
Gastrointestinal symptoms can arise due to a limited diet and can include constipation, stomachaches and nausea.
Coexisting mental health conditions
ARFID is often accompanied by other mental health conditions such as anxiety disorders or obsessive-compulsive disorder (OCD).
Diagnosing ARFID is a complex process that requires the collaborative expertise of health professionals. The diagnostic criteria for ARFID have evolved over time, and it’s essential to consult with a specialist who is well-versed in eating disorders. Here are the key steps in the diagnosis of ARFID:
1. Clinical assessment
This is carried out by a mental health professional who conducts a thorough evaluation of the individual’s eating patterns, behaviours and physical health. This assessment aims to identify specific symptoms of ARFID and their severity.
2. Differential diagnosis
One of the challenges in diagnosing ARFID is distinguishing it from other eating disorders and conditions with similar symptoms. A skilled clinician will conduct a differential diagnosis to rule out anorexia nervosa, bulimia nervosa and other mental health and behavioural disorders.
3. Psychological evaluation
A psychological evaluation may include interviews and standardised questionnaires to assess the individual’s mental health and emotional well-being. This evaluation helps identify any coexisting mental health conditions that may require simultaneous treatment or management.
4. Medical assessment
Because ARFID can lead to nutritional deficiencies and physical health concerns, a medical assessment is crucial. This assessment includes a physical examination, blood tests and nutritional assessments to determine the individual’s overall health and the impact of ARFID on their body.
5. Collaborative approach
Diagnosing ARFID often involves a collaborative approach among healthcare professionals. Specialists from various fields, including psychology, psychiatry and nutrition, may work together to gain a comprehensive understanding of the individual’s condition.
ARFID treatment and support
Once diagnosed, a tailored treatment plan like those provided by UKAT is the most effective route to recovery and management. This plan may include:
- Nutritional counselling to address dietary deficiencies and establish a more balanced diet.
- Exposure therapy to gradually introduce new foods and reduce anxiety around eating.
- Cognitive-behavioural therapy (CBT) to address anxiety and fears related to food.
- Medication management for coexisting mental health conditions.
- Family-based therapy, particularly for children and adolescents with ARFID.
- Ongoing support and monitoring to track progress and prevent relapse.
Seeking professional help is a critical step on the path to recovery for individuals with ARFID. Early intervention and tailored treatment plans can significantly improve outcomes and help individuals develop a healthier relationship with food.
Begin the journey to recovery today
With the right treatment and support, it is possible to make major progress in the management of ARFID. Imagine a life where every meal isn’t a battle, where joy and nourishment replace anxiety, and the world of food opens up like a vast, inviting banquet. At UKAT, our expert teams are here to guide you on this transformative journey. We provide tailored ARFID treatment programmes that can help you develop a healthier relationship with food. With evidence-based therapy, effective nutritional guidance and ongoing support, we can help you overcome ARFID and create a brighter future. Contact us today to find out more.
(Click here to see works cited)
- National Eating Disorders Association. “Avoidant Restrictive Food Intake Disorder (ARFID).” National Eating Disorders Association, 2022, https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid. Accessed 30 October 2023.
- Substance Abuse and Mental Health Services Administration. “Table 22, DSM-IV to DSM-5 Avoidant/Restrictive Food Intake Disorder Comparison – DSM-5 Changes.” NCBI, 2016, https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t18/. Accessed 30 October 2023.