Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder, or ARFID, is a relatively new diagnosis that was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. ARFID is an eating or feeding disturbance that is characterised by the persistent refusal to eat certain foods or food groups based on their sensory characteristics, such as texture, taste, smell, or colour. ARFID is different from most other feeding disorders (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Otherwise Specified Feeding & Eating Disorder) in that the person is not concerned about shape or weight. Instead, the restrictive eating is due to issues such as:

• Sensory aversions to particular tastes, textures, or smells (common with autism and Sensory Processing Disorder)
• Lack of interest in eating (can be due to anxiety, depression, physical illness, food allergies etc.)
• Low appetite

ARFID can lead to significant nutritional deficiencies, dependence on enteral feeding or oral nutritional supplements, and psychosocial impairment. It can occur at any age and affects both genders, but is more common in children and adolescents. The exact cause of ARFID is unknown, but it is believed to be a complex interplay of genetic, biological, psychological, and sociocultural factors. Early diagnosis and intervention are crucial to prevent long-term health consequences and to improve the quality of life of individuals with ARFID.

What are the Symptoms of ARFID?

Avoidant Restrictive Food Intake Disorder (ARFID) manifests itself through a variety of symptoms that can vary from person to person. One of the most common symptoms is a severe limitation in the types of food a person will eat. This isn't simply a case of being a picky eater; people with ARFID may restrict their diet to such an extent that they exclude entire food groups, often leading to significant nutritional deficiencies.

Individuals with ARFID may also display a heightened sensitivity to the taste, texture, smell, or appearance of certain foods. This can lead to an intense aversion and avoidance of these foods. They may also have an extreme fear of eating new or unfamiliar foods, a condition known as neophobia. Other symptoms include a lack of appetite or interest in food and distress at the prospect of eating. In severe cases, individuals may experience such significant weight loss or failure to gain weight that it interferes with their growth and development, particularly in children and adolescents. It's also not uncommon for patients with ARFID to experience gastrointestinal symptoms, such as abdominal pain or discomfort, in response to eating.

ARFID symptoms include:
‍- Avoidance or restriction of certain food groups or textures
- Persistent failure to meet nutritional and/or energy needs
- Lack of interest in food and picky eating
- Significant weight loss or failure to gain weight during growth
- Nutritional deficiencies, such as anemia or low bone density
- Dependence on nutritional supplements or tube feeding
- Interference with social functioning due to eating behaviours

What Causes ARFID?

The causes of Avoidant Restrictive Food Intake Disorder (ARFID) are not fully understood, but they are likely to be a combination of genetic, psychological, and environmental factors. Some research suggests that ARFID might be associated with a heightened sensitivity to tastes and textures, which could be genetically determined. This sensitivity can make certain foods seem unpalatable or even disgusting, leading to avoidance.

Psychological factors can also play a role in the development of ARFID. For example, a traumatic event related to food, such as choking or vomiting, can lead to fear and avoidance of eating. Anxiety disorders and obsessive-compulsive disorder have also been linked to ARFID. Moreover, some autistic children (medically known as Autistic Spectrum Disorder) or children with Attention Deficit Hyperactivity Disorder (ADHD) may also develop ARFID, due to their difficulties with sensory processing.

Environmental factors, including family eating habits and cultural food practices, can also contribute to the development of ARFID. While more research is needed to fully understand the causes of ARFID, it's clear that this disorder is complex and multifactorial, involving an interplay of genetic, psychological, and environmental influences.

How Is ARFID Diagnosed?

Avoidant Restrictive Food Intake Disorder (ARFID) is diagnosed through a comprehensive evaluation by a mental health professional or eating disorder specialist. Diagnosis is based on the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These criteria include an avoidance or restriction of food intake that leads to significant weight loss, nutritional deficiency, dependence on nutritional supplements, or interference with social functioning.

The professional will conduct a detailed interview with the individual to understand their eating behaviours, attitudes towards food, and any related fears or anxieties. It's important to differentiate ARFID from other eating disorders like anorexia nervosa and bulimia nervosa, which are related to concerns about body shape and weight. In ARFID, the avoidance of food is not driven by these concerns, but rather by a lack of interest in food, or avoidance due to the sensory characteristics of food or past negative experiences around food.

Medical tests may also be conducted to rule out any underlying medical conditions that could be causing the symptoms. These could include gastrointestinal disorders, food allergies, or metabolic diseases. Additionally, because ARFID is often associated autism (medically known as Autistic Spectrum Disorder or ASD), ADHD, or with mental health difficulties such as anxiety, a comprehensive psychological assessment may also be needed.

Tips for Managing Avoidant Restrictive Food Intake Disorder

Managing Avoidant Restrictive Food Intake Disorder (ARFID) involves a multi-disciplinary approach that combines nutritional rehabilitation, psychotherapy, and sometimes medication. The goal of treatment is to expand the variety and amount of food intake, meet nutritional needs, and reduce anxiety and fear around food.

Here are a few tips that may be helpful in managing ARFID:

Seek professional help: Reach out to eating disorder treatment centres or mental health professionals who specialize in eating disorders. They can provide a comprehensive treatment plan that addresses the physical, emotional, and psychological aspects of ARFID.

Gradual exposure: Slowly introduce new foods into the diet. Start with small amounts and gradually increase the quantity over time. This can help to reduce anxiety and fear about trying new foods.

Create a positive eating environment: Make meal times as stress-free and enjoyable as possible. Avoid forcing or pressuring the individual to eat, as this can increase anxiety and resistance.

Nutritional supplements: In some cases, nutritional supplements may be necessary to ensure that the individual is meeting their nutritional needs. This should be done under the supervision of a healthcare provider.

Family involvement: Family support and involvement is crucial in the treatment of ARFID, especially in children and adolescents. Family-based therapy can help to reinforce positive eating behaviours and address any family dynamics that may be contributing to the disorder.

Cognitive-behavioral therapy (CBT): This type of therapy can be effective as it helps them to identify and change negative thought patterns and behaviours related to food.

Remember, recovery from ARFID is possible with the right treatment and support. If you or a loved one is struggling with this disorder, seek help from a healthcare professional.

How to Find Treatment for ARFID

As ARFID is so new, there is currently no evidence-based treatment suitable for all forms of ARFID. Consequently, treatment is best tailored to the individual's needs and may include:

Nutritional rehabilitation
A registered dietitian can help create a personalized meal plan to address nutritional deficiencies and promote healthy weight gain.

Cognitive-behavioral therapy (CBT)
CBT can help individuals identify and challenge unhelpful thoughts and beliefs about food and eating.

Exposure therapy
Gradual exposure to feared or avoided foods can help reduce anxiety and increase the individual's willingness to try new foods.

Specialist Supportive Clinical Management (SSCM)
SSCM uses an individualised and flexible approach with the goal of not just improving eating disorder symptoms but also enjoyment and quality of life

Family-based treatment (FBT)
FBT involves working with the entire family to support the individual in making changes to their eating behaviors (please note that we do not offer family therapy at Exhale Psychology Centre but can recommend family therapists if you would like FBT in addition to individual therapy).

Unfortunately, treatment for ARFID is not available under the Eating Disorder Management Plan (EDMP), but ARFID can be treated under the Mental Health Care Plan (MHCP), the Team Care Arrangement (TCA), private health insurance, and when paired with level two autism, under National Disability Insurance Scheme (NDIS).

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