What is ARFID?
One of the less well-known eating/feeding disorders is Avoidant Restrictive Food Intake Disorder, or ARFID. While this diagnosis was previously called “Selective Eating Disorder,” the former name could be misleading, as an ARFID diagnosis goes beyond labeling someone as just a picky eater. ARFID describes a disturbance in eating or feeding in which there is a disinterest, avoidance, and/or concern about eating, in general, or particular foods. The individual may avoid certain foods because of their negative associations, including particular sensory aspects, difficulty with digestion, or fear of possible aversive consequences of eating, such as vomiting.
More importantly, an ARFID diagnosis signifies that the individual is failing to consume an adequate amount of calories for proper development, growth, and even bodily function.
For instance, the individual may experience significant weight loss; fail to maintain an expected weight or vertical growth (in children); exhibit significant nutritional deficits or bodily dysfunction; depend on enteral or oral feeding/nutritional supplements; and/or experience psychosocial impairment.
Who Develops ARFID and Why?
ARFID symptoms show up typically in infancy or childhood, but may also present or persist into adulthood; ARFID is most often diagnosed in children. While many kids may exhibit strange, particular, or restricted eating behaviors, such patterns usually resolve on their own. However, for those who continue to demonstrate worsening concerns about food intake, they may meet criteria for ARFID. They could be very sensitive to the taste, color, texture, consistency, or appearance of certain types of food, or may have experienced a distressing food-related incident in the past, such as choking or vomiting, which creates insecurity around eating.
Something to note is that the eating behaviors of someone with ARFID are not due to lack of food availability, practiced as part of a cultural ritual, or reasonably associated with a medical condition (such as loss of appetite after chemotherapy) or other mental health disorders (including another eating disorder). However, individuals with ARFID may later develop another eating disorder.
ARFID vs. Anorexia Nervosa
As you read the description of ARFID, you may compare this to the presentation of someone with anorexia. Although food restriction/avoidance, significant weight loss, and failure to meet expected weight and growth standards are also symptoms of anorexia, one main difference between these two disorders is the following: ARFID does not include a disturbance in one’s perception of their body weight and shape or distress about weight gain, both which are fundamental components of anorexia.
ARFID Warning Signs:
Psychological & Behavioral:
- Significant restriction in types/amount/textures of food consumed
- Lack of appetite/interest in food
- Fears of choking or vomiting
- Significant weight loss
- Dressing in layers to hide weight loss or stay warm
- Persistent, non-specific gastrointestinal issues with no known cause
- Menstrual irregularity or loss
- Abnormal laboratory findings
- Dizziness, fainting, or lethargy
- Cold intolerance
- Sleep disturbances
- Fine hair on body (lanugo)
- Dry skin; thin, dry and brittle hair or nails
- Muscle weakness
- Cold, mottled hands and feet or swelling of feet
- Lowered immune functioning/wound healing
Some ARFID Examples:
- A child consumes an excessive amount of children’s multivitamins and gets iron poisoning, leading her to vomit profusely and be hospitalized. After this incident, she is fearful to eat certain foods, anticipating that she will vomit again. Thus, she avoids eating in general, and as an adult, consistently maintains an unhealthy weight and faces nutritional deficiencies, thereby requiring a feeding tube.
- An adult appears to have a healthy relationship with food. However, his mother recalls that as an infant, he experienced gastroenteritis, and thereby rejected feeding as to avoid the flare up and pain of such gastrointestinal issues. As a result, he failed to meet expected weight gain and growth standards for infants.
Treatment Is Available
ARFID can be an extremely distressing and impairing condition for a child or adult; fortunately, treatment is available and can include cognitive behavioral therapy, exposure therapy, and addressing any other underlying psychiatric concerns (depression, anxiety). Moreover, having a team of professionals, including a psychotherapist, registered dietician, occupational therapist, and psychiatrist can be helpful in coordinating the client’s care.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth Edition). Washington, DC: American Psychiatric Association.
Avoidant Restrictive Food Intake Disorder (ARFID). (2017, February 26). Retrieved January 11, 2019, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid
Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual therapy and facilitates Virtual Body Image Groups for adults and adolescents with eating disorders, body dissatisfaction, and comorbid disorders. If you are experiencing body image distress or any other psychological turmoil related to a chronic illness, contact Bahar for a counseling appointment.