Picky eating is a common childhood occurrence that may come and go over time. Many kids go through short phases where they only want to eat a few selected foods; this can be a normal part of childhood development and isn’t typically a cause for concern. Even in adulthood, disliking certain foods isn’t abnormal and rarely leads to nutrient deficiencies or health problems. Sometimes, however, picky eating evolves into severe restriction and an intense fear of consuming certain foods; this behavior may be a sign of a dangerous eating disorder known as avoidant/restrictive food intake disorder.
What is ARFID?
Avoidant/restrictive food intake disorder (ARFID) is a type of restrictive eating disorder. People with ARFID may eat at irregular intervals and only consume small amounts of food.
The characteristics of ARFID include:
- Extreme sensitivity to the smell, taste, or texture of a food
- Lack of interest in eating
- Fear that eating will cause something bad to happen (being poisoned, choking, vomiting, pain, dying, etc.)
While ARFID is a restrictive eating disorder like anorexia, ARFID isn’t caused by a fear of gaining weight or by a distorted body image.
Defining ARFID
According to the DSM-5, avoidant restrictive food intake disorder (ARFID) is a feeding or eating disturbance resulting in an inability to meet adequate nutritional needs as shown by meeting at least one of the following criteria [1]:
- Significant weight loss (or inability to achieve expected weight gain or growth in children)
- Nutrient deficiency
- Dependence on tube feedings or nutrition supplements to meet nutrition needs
- Marked impact on one’s mental health or social functioning
ARFID is most commonly seen in children, but it can also occur in adolescence and even adulthood. ARFID that develops later in life may be related to an earlier misdiagnosis or delays in seeking treatment, but the disorder can develop at any age.
Research about the prevalence of ARFID has yet to determine how many people suffer from the disorder.
One larger study conducted in the Netherlands found that 6.4% of children had symptoms resembling ARFID [2]. Another review found the prevalence of ARFID ranges anywhere from 0.3% to 15.5% of the population [3]. In previous years, a child with a severely restricted diet from selective eating would be diagnosed with “Feeding Disorder of Infancy or Early Childhood.”[1]. This diagnosis was limited to those who started experiencing symptoms before age 6.
When the DSM-5 (Diagnostic Manual for Mental Disorders) was released in 2013, Feeding Disorder of Infancy or Early Childhood was renamed ARFID and provided expanded criteria to allow diagnosis at any age [1].
What Causes ARFID?
There is no known cause of ARFID, but a variety of factors likely play a role in the development of the disorder. Those with autism spectrum disorder may be more sensitive to the sensory aspects of food (taste, smell, texture, etc.), which may explain why there is a higher prevalence of ARFID among autistic individuals[4].
Anxiety disorders and OCD may increase the likelihood that an individual will develop a fear of adverse food-related events. There may be a genetic component as well[4].
Signs and Symptoms of ARFID
Most physical symptoms of ARFID are related to malnutrition that results from a severely restricted diet.
Some of these physical signs include:
- Significant weight loss
- Digestive issues, including nausea, abdominal pain, bloating, and constipation
- Hair loss
- Delays in normal development
- Loss of menstrual periods (amenorrhea)
- Difficulty maintaining body temperature
- Decreased heart rate and blood pressure
- Development of fine body hair across the body (lanugo)
- Dizziness or fainting[5]
Long-term complications and health risks
ARFID can cause severe nutrient deficiencies and malnutrition. Those suffering from this eating disorder are at risk of dental erosion, weakening of the bones, difficulty digesting food, and organ failure. Thankfully, the health risks associated with ARFID can be greatly improved with treatment.
ARFID in Adults
While ARFID is most often diagnosed in childhood, adults can also be diagnosed. There is currently little research about ARFID in adulthood, so it’s unknown how many adults are living with the disorder.
Many adults with ARFID began developing symptoms of the condition in childhood which then persist into their adult years.
Co-occurring mental health issues, such as anxiety, depression, or trauma, can increase one’s risk of developing ARFID in adulthood, resulting in disinterest in eating, fear of certain foods, or fear of adverse effects from eating.
Food-related trauma, such as choking or witnessing someone choke, may increase one’s fear of eating and contribute to the development of ARFID in adulthood.
Treatments for Avoidant/Restrictive Food Intake Disorder
Effective ARFID treatment includes a multi-disciplinary team of eating disorder specialists. Individual therapy is essential in treating the root causes of the condition.
Cognitive behavioral therapy for ARFID (CBT-AR) is one form of treatment that helps people identify harmful and irrational thought patterns and develop coping skills for their anxiety-provoking food experiences [6].
Family-based therapy for ARFID (FBT-ARFID) equips families with the skills and resources to support their loved one through the recovery process, including resources for reducing eating disorder symptoms and promoting healthy eating patterns [6].
In addition to therapy, working with a registered dietitian can help reverse malnutrition and address nutrient deficiencies.
It is also important to consult with your primary care provider throughout treatment. Malnutrition can cause serious, life-threatening complications that need close medical monitoring. Those suffering from ARFID may also benefit from sessions with a mental health care provider, like a psychiatrist or licensed counselor. While no medication is designed specifically to treat ARFID, some medications can help manage symptoms of underlying anxiety, depression, or OCD. Symptoms of ARFID often improve with the treatment of these co-occurring conditions.
Families should not have to navigate the challenges of eating disorders alone. Toledo Center customizes treatment to meet each person’s unique needs and supports families through each step of the recovery process.
To learn more about which treatment option is right for you, call us at 419-885-8800 or complete our contact form today.
References
- https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t18/
- https://www.sciencedirect.com/science/article/pii/S2949732923000157
- https://pubmed.ncbi.nlm.nih.gov/36527163/
- https://www.webmd.com/mental-health/eating-disorders/what-is-arfid
- https://my.clevelandclinic.org/health/diseases/24869-arfid-avoidant-restrictive-food-intake-disorder#symptoms-and-causes
- https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/
