Written by Meredith Krayenhoff, Registered Dietitian. Published February 28, 2024.
In the vast landscape of mental health disorders, there are some conditions that may not receive as much attention as others but can significantly impact an individual's life. One such disorder is ARFID, which stands for Avoidant/Restrictive Food Intake Disorder.
This blog post, explores ARFID - its nature, its relationship to other psychiatric disorders, potential causes, and its treatment.
What is ARFID
Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new diagnosis in the realm of eating disorders. Unlike other eating disorders that are primarily focused on body image, weight, or shape, ARFID revolves around an avoidance or restriction of certain foods, leading to significant nutritional deficiencies, impaired growth (especially in children and adolescents), and considerable distress.
Despite being relatively lesser-known compared to disorders like anorexia or bulimia, ARFID poses its own set of challenges and complexities. The prevalence of ARFID is ~0.3%, which is quite similar to anorexia’s prevalence.
ARFID Explained: Beyond Picky Eating
ARFID It is unique in that it shares characteristics with 3 categories of other health concerns, but is distinct enough from each of them to warrant its own diagnostic.
1. Pediatric feeding disorders
Some children have difficulty with trying new foods, and are easily over-stimulated in regards to sensory properties of foods. Some strategies to manage picky eating can be beneficial to those with ARFID, but there are limitations in that they don’t address cognitive distortions, and ARFID can present in people of all ages, so many therapies aimed at children are not appropriate for adolescents and adults.
2. Eating disorders
Individuals with classical eating disorders benefit from a regular eating schedule with family support as needed, and experience an improvement in symptoms with increased intake, similarly to those with ARFID. However, those with ARFID typically are not concerned with their weight or body image; at least, this is not what is driving their restrictive or avoidant behaviour.
3. Anxiety Disorders
Panic disorder, post-traumatic stress disorder, and specific phobias all share commonalities with ARFID. In all of these conditions, it is typical to have a fear of aversive consequences, and to avoid the anxiety-producing stimulus. We can therefore use principles of exposure to reduce anxiety to these stimuli. However, sometimes clients may not experience anxiety around foods, but identify it more so as disgust or lack of appetite, that is driving the avoidance behaviour.
Symptoms of ARFID
The symptoms of ARFID can vary widely from person to person, but they typically involve a severe aversion to certain types of foods, textures, smells, or volumes of food.
Individuals with ARFID may have an extremely limited diet, often consisting of only a few "safe" foods that they are comfortable eating. They may also experience anxiety or panic attacks when faced with unfamiliar or challenging foods, leading to avoidance of social situations involving food.
Other symptoms may include low weight (although not everyone with ARFID is underweight), nutritional deficiencies, and gastrointestinal problems.
ARFID's Three Main Types: Sensory, Fear, and Disinterest
There are 3 main presentations of ARFID, and an individual may have one, two, or all three presentations.
1. Sensory Sensitivity
In this subtype, the client avoids certain foods due to their taste, texture, smell, temperature, or appearance. The foods are perceived as disgusting. Severity may be mild, moderate, or severe, depending on the degree of restriction, where a severe case will have the client eating 5 or fewer total food items.
2. Fear of Aversive Consequences
These clients are avoiding foods due to a fear of something bad happening if they eat them, such as choking, vomiting, or an allergic reaction. They may be overly cautious in terms of textures, amount of chewing, size of bites they take, and overall fear of eating.
3. Apparent Lack of Interest in Eating or Food
The final aspect relates mostly to portions, where an individual may feel full very quickly, not feel a sense of pleasure from eating, and have a very low appetite. In its most severe form, a client with this subtype may need to be fed through a tube.
Potential Causes of ARFID
The exact cause of ARFID is not fully understood, but it is believed to be influenced by genetic factors - a predisposition - followed by an environmental trigger. It is not caused by parents or parenting techniques. Some individuals may biologically have a heightened sensitivity to certain sensory experiences related to food, such as taste, smell, or texture.
They may then have a traumatic experience around food, such as choking or vomiting while eating, and will therefore develop a fear of eating. While most people feel fear following an experience like this, but then can rationalize and replace that fear with positive experiences, those with certain genetic factors don’t seem to desensitize naturally. This may lead to a self-perpetuating cycle in which avoided foods become more feared, and then more avoided as a result.
ARFID Treatment
Treatment for ARFID typically involves nutritional and psychological interventions. The primary goal is to expand the individual's range of acceptable foods and improve their overall nutritional intake while addressing any underlying psychological issues.
Contact us at In Good Nutrition to work with a registered dietitian who can support you in developing a structured plan to increase comfort with different foods. We’ll slowly practice exposure to increase tolerance of discomfort, and gradually introduce new foods in a way that leaves you feeling in control and supported. Know that family involvement is critical when the client is a child or adolescent.
Together we can help manage the social isolation and nutritional deficiencies that are fraught in individuals living with ARFID.