Avoidant/Restrictive Food Intake Disorder (ARFID) is a common eating disorder diagnosis that describes children and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of adverse consequences and/or apparent lack of interest in eating or food.
Food avoidance or restriction leading to persistent failure to meet nutritional needs, causing >1 of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency
- Dependence on tube feeding or oral supplements
- Psychosocial impairment
It is different to other eating disorders because is not driven by fear of weight gain or body image disturbance or fear of fatness. Instead people with ARFID might have one, two or all three of these important concerns:
- Some find that novel foods have strange or intense tastes, textures or smells and they feel safer eating foods that they know well
- Others have had a scary experience with food, like throwing up, choking or allergic reaction, so they may avoid the foods that make them sick or stop eating all together
- Other don’t feel hungry very often, think eating is a chore, or get full very quickly.
Once established, a pattern of food avoidance can become longstanding and highly resistant to change. The good news is that there are helpful steps you can put in place to interrupt these patterns of behaviour.
Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.
As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms.
- People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
- Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
- Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.
Treatment for ARFID is Cognitive-Behavioural Therapy for Avoidant Restrictive Food intake Disorder (CBT-AR). It is a model that involves 4 stages over 20-30 sessions. The first stage is learning about ARFID and getting started with small changes, second stage builds on from the first where you start to make bigger changes and set goals (reverse nutritional deficiencies or weight restoration). The third stage is facing your fears with gaining exposure with new or feared foods, tasting a small amount at first, then incorporate larger amounts and the final stage is developing the skills to keep practising on you own into the future.
If you’re worried about yourself or somebody you know, it’s important to seek treatment as soon as possible, as ARFID can lead to malnutrition if left untreated. We provide both Psychological and Dietitian support during this treatment to ensure that the individual has the best chance at full recovery.