ARFID is a relatively new diagnostic term that many people may not be familiar with. ARFID stands for Avoidant-Restrictive Food Intake Disorder. The disorder is characterized by extremely selective eating habits as well as disturbed eating patterns and goes beyond phases that many children or even adults go through that involve “picky eating.” ARFID usually results in an individual experiencing energy and nutritional deficiencies. Many people with this condition will see a reduction in body size and may become dependent on nutritional supplements to maintain their health. ARFID in children or adolescents may compromise growth.
According to the American Psychiatric Association, ARFID became an officially recognized diagnosis in 2015. Their official definition states that ARFID is a feeding or eating disturbance that involves an inability to meet appropriate nutritional and/or energy needs. ARFID is considered a sensory disorder as well as a specific type of eating disorder. While many of the ARFID symptoms and health effects are similar to those found in individuals experiencing anorexia nervosa there are many distinct differences between these conditions. The root causes of both, as well as the symptoms of these disorders, will often be different. The following information explains the similarities and the differences regarding symptoms, corresponding medical complications, and the best treatment options.
Symptoms – How Is ARFID Different from Anorexia nervosa?
The following are several types of symptoms that are similar or the same for both ARFID and anorexia nervosa.
- Emotional and Behavioral Symptoms – Dramatic changes in body size, wearing layers of clothing to hide body size, and refusal to eat certain foods or types of foods are symptoms for those experiencing both ARFID and anorexia nervosa.
- Physical Symptoms – Individuals with both of these conditions may often experience dizziness, fainting, and difficulty concentrating. They may also have wounds that don’t heal effectively, weak immune systems, muscle weakness, and thinning hair.
According to the National Eating Disorders Association (NEDA), one of the significant differences between ARFID and anorexia nervosa is that an individual experiencing ARFID does not have a distorted body image and is not obsessed with body size. This, however, is almost always seen in individuals diagnosed with anorexia nervosa. Several distinct symptoms distinguish ARFID from anorexia nervosa. The following are several specific ARFID symptoms:
- Fear of Choking – People with ARFID often have an intense fear of choking or vomiting. While ARFID could be caused by genetic or psychological factors it is sometimes caused by a traumatic childhood event such as choking. Even an event at birth, such as near strangulation by the umbilical cord, may cause this disorder in some individuals.
- Slow Chewing – Individuals with ARFID will often chew their food unusually slow. This may be because a person is fearful of choking.
- Sensory Avoidance – Individuals with ARFID might avoid certain foods because of the texture, smell, or even the color of specific foods. Someone who is experiencing ARFID will sometimes have difficulty eating in a restaurant, in a school cafeteria, or even at a family gathering. Since so many social interactions center around food and eating functions, this can have an enormous impact on an individual’s social development. This can be particularly critical when the person is a child. The ongoing isolation could have an extreme impact on the child’s social relationships and even daily functioning.
- Often Seen with Other Disorders – Another primary difference between these two disorders is that individuals with ADHD, Autism, and intellectual disabilities have a greater chance of developing ARFID.
- Primarily Affects Children – Even though ARFID can affect individuals of all ages, this disorder usually affects children and adolescents. It should also be noted that boys are more often affected by ARFID than girls. This sets ARFID apart from nearly every other type of eating disorder since most disorders affect females at a higher rate than males.
To further distinguish the differences between ARFID and anorexia nervosa, it’s important to recognize symptoms that usually only occur in those experiencing anorexia nervosa.
- Emotional and Behavioral Symptoms – Those with anorexia nervosa will usually have an intense fear of changes in body shape or size. They may also maintain a rigorous exercise schedule.
- Physical Symptoms – Many symptoms that are unique to anorexia nervosa often involve those associated with purging methods. These include possible vomiting, extreme laxative use, and dental problems such as excessive cavities.
Health Complications – How Is ARFID Different from Anorexia Nervosa?
Even though the causes and symptoms may be different many of the obvious health and medical complications related to both ARFID and anorexia nervosa are similar. Nutritional deficiencies and malnutrition is one that both disorders have in common. Stomach and intestinal complications may also be present in individuals with either of these disorders.
ARFID in women can lead to health complications regarding menstruation and a normal monthly cycle. According to the Center for Young Women’s Health, adolescent girls with ARFID may experience delayed menstruation. Women that have already started a regular monthly cycle might stop menstruating. Low hormone levels and a delay in the onset of puberty are both health consequences of ARFID and anorexia nervosa.
A low pulse, low blood pressure, and even an irregular heartbeat are complications that sometimes occur with both of these eating disorders. Since wounds don’t heal as easily for individuals with ARFID, different types of infection may become a problem. Those with a weak immune system will be more susceptible to colds, flu, and possibly more serious diseases. Since ARFID is often seen in children, developmental delays are many times a major complication physically, emotionally, and mentally. While anorexia nervosa can occur in very young children this does not occur as frequently in pre-adolescence as ARFID does.
Treatment Options – How Is ARFID Different from anorexia nervosa?
Since many of the symptoms of ARFID and anorexia nervosa are similar it’s necessary to receive a diagnosis from a trained professional before treatment can be started and the process of ARFID recovery can begin. The next step is deciding what level of treatment is needed. This would depend on how severe the disorder is for each individual. Choices for levels of care could include residential treatment, partial hospitalization, or a variety of outpatient services. If physical symptoms, such as malnutrition are severe, hospitalization may be required at least initially. It’s also important to accurately diagnose any co-occurring disorders that the person may be experiencing. ARFID often occurs in conjunction with ADHD, anxiety, or other types of disorders. Evaluating how severe the condition is and if there are co-occurring disorders would be necessary when deciding the best course of treatment.
ARFID recovery will depend on implementing a treatment plan the meets each individual’s unique needs. Several of the same treatment methods are often used for both ARFID as well as anorexia nervosa. Even though the same type of therapy may be used, particular protocols will be different depending on the specific diagnosis and the unique treatment plan for each person. Some of the therapies that may be used for ARFID or Anorexia nervosa or both include the following:
- Cognitive Behavioral Therapy (CBT) – CBT is a type of psychotherapy that is often used for a variety of eating disorders. The focus is on changing the way an individual thinks and ultimately changes behavior. CBT can help people recognize their negative thought patterns and beliefs. They are taught new skills to cope with and overcome their anxiety associated with certain types of foods.
- Dialectal Behavioral Therapy – This type of therapy is often added to what has already been used in CBT. Dialectal Behavioral Therapy not only enables the person to build new skills to deal with negative situations but helps the individual to recognize situations that may bring about negative behavior. This therapy also helps a person to manage stress and positively deal with their emotions.
- Interpersonal Therapy – Interpersonal therapy promotes improving relationships and methods of communication. It examines how relationships and ways of interacting are causing or influencing an eating disorder.
- Acceptance and Commitment Therapy – This type of therapy doesn’t try to change a person’s thoughts or feelings, but instead empowers the individual with the tools and coping mechanisms to accept these thoughts and feelings while changing their actions and behavior.
- Family Based Therapy – A variety of family therapies are often used in the treatment of both anorexia nervosa and ARFID. Family therapy can be especially helpful if the individual is still a child. The Maudsley Method is a specific type of therapy that puts the parents or other responsible family members initially in charge of making sure a child receives all the necessary nutrition. The child is gradually given more control as the therapy progresses.
- Medication – There are a variety of medications that can be used for both anorexia nervosa and ARFID. Medication may be used specifically to help with weight gain while other types can be used to treat underlying or co-occurring disorders such as anxiety or depression.
Some therapies and treatments can be especially effective for ARFID.
- Exposure Therapy – While Exposure Therapy can be used for a variety of disorders, it can be particularly helpful for ARFID. The American Psychological Association states that this type of therapy involves individuals confronting their fears in a safe and controlled manner. This can help a person gradually reduce the fear of certain foods. The person is exposed first to the idea of a particular food, then the smell, later the texture, and finally the taste.
- Food Chaining – According to Boston Children’s Hospital, food chaining is a method that links foods an individual already likes and will eat to foods that are similar in taste or texture that are healthy for the person. For example, if an individual eats macaroni and cheese, veggies such as broccoli or cauliflower could be added to the pasta mix. Gradually the dish includes more vegetables and less pasta until the person is eating just vegetables with a light amount of cheese sauce.
- Group Therapy – Different types of psychotherapy can be incorporated into a group therapy session. Group therapy can be especially effective for those with ARFID. Group settings can help individuals ease back into social settings in a safe environment. Group meals may be shared as part of the therapy.
- Psychodynamic Therapy – This is a type of psychotherapy that attempts to get to the root causes of an eating disorder. The person’s underlying needs are discovered and discussed. This type of therapy is often used when a person is experiencing depression as well as an eating disorder. Psychodynamic psychotherapy focuses on analyzing and resolving issues that often begin on an unconscious level.
Selecting a high-quality treatment facility with a proven track record of treating eating disorders will increase the likelihood that ARFID recovery will occur as quickly as possible. Oliver-Pyatt Centers provide the highest level of treatment outside of a hospital setting. They provide access to highly trained psychiatrists, daily nursing assessments, and individual psychotherapy sessions. The professionals at Oliver-Pyatt Centers can assess specific ARFID symptoms and make sure each person receives individualized care that is structured and effective, yet psychologically gentle. They offer residential, outpatient, as well as supervised living options.
Since ARFID often affects young children and adolescents, it’s important to find a treatment facility that puts a strong focus on family. From the admissions process and throughout treatment, family involvement is encouraged and supported at Oliver-Pyatt Centers. The professionals at Oliver-Pyatt can also treat the co-occurring disorders that often accompany eating disorders, such as anxiety and depression. They provide complete psychiatric and medical care in a comfortable, home-like setting. Contact Oliver-Pyatt Centers for more information regarding treatment options.