Many eating disorders such as anorexia nervosa and bulimia nervosa are well-known even among non-medical professionals and oftentimes easy to point out.This is largely thanks to ongoing media attention and education efforts, but there is one eating disorder that remains relatively unknown: ARFID. Avoidant Restrictive Food Intake Disorder (ARFID), which in the past was referred to as Selective Eating Disorder (SED), was finally listed in the DSM-V (the official psychiatric diagnostic manual) in 2013, and now is commonly treated in eating disorder treatment centers.
In many ways, ARFID is different than other, more well-known eating disorders. Its causes and ages of onset, as well as the demographic breakdown, are usually different than those of anorexia nervosa, binge eating disorder, and bulimia nervosa. Since ARFID normally begins in early childhood rather than adolescence, it’s also frequently confused with “picky eating,” which many children display; the difference between not liking, for example, pickles and refusing to eat foods to the point that health is affected.
Since so little is known in the general public about ARFID, it is easy for parents and loved ones to miss the signs of the disorder. A lot of parents with concerns have questions about this condition. Take a look at some of the common questions associated with ARFID, eating disorder treatment, and more.
What Are the Symptoms of ARFID?
Per the DSM-V, AFRID is defined as: An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs.
This avoidance of certain foods brings on significant weight loss, nutritional deficiency, and a negative effect on the individual’s social life. In more prosaic terms, a person with AFRID won’t eat particular foods or food groups. It’s more than a dislike of certain foods; it’s a fear so strong that the person’s health is negatively impacted by it. If you notice your loved one is unwilling to eat a type of food, that their “fear foods” are growing in number, and that their weight is dropping significantly because they refuse to eat, a psychiatrist or eating disorder treatment center should be contacted as soon as possible.
How Common Is ARFID?
ARFID is less studied than bulimia nervosa or anorexia nervosa, so there are relatively few numbers to go by when trying to understand the prevalence of the disorder. In one study of adolescents undergoing eating disorder recovery in a specialist clinic, about 14 percent of the clients met the diagnosing criteria for ARFID, according to the National Eating Disorder Association.
It is suspected that ARFID is underdiagnosed because many people simply assume that their child is a picky eater. However, those children who do truly need eating disorder support have issues that go far deeper than just being picky about what they eat. Most will avoid certain types of food to a point that it causes them problems with being malnourished or have other health issues.
Who Does ARFID Affect the Most?
ARFID does affect both males and females, but it tends to be an issue that is present in males the most. In addition, younger children seem to be more at risk than older children, as the condition will oftentimes improve with age and maturity, although this is certainly not a foregone conclusion.
People with certain mental health conditions are at higher risk for developing ARDIF. About 20 percent of children with ARFID also have an autism spectrum disorder. Additionally, about 20 percent of children with ARFID avoid certain foods because of sensory issues, which exacerbates the fear of certain foods based on their texture, flavor, or fear of choking or vomiting.
Is ARFID a Mental Illness?
Absolutely. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) does include ARFID as an eating disorder, and eating disorders are considered to be a mental disorder. While a professional who specializes in eating disorders should be in charge of designing a treatment program for a person with ARFID, virtually every psychologist and psychiatrist should be able to recommend a specialist based on the preliminary signs of the disorder.
ARFID is also frequently accompanied by about a third of children who need eating disorder support in an eating disorder treatment center also have other mood disorders. For example, three out of four also have an anxiety disorder in addition to ARFID, particularly PTSD, which is the most common co-occurring disorder related to ARFID. Unlike other mental health illnesses such as chronic depression or acute anxiety, ARFID doesn’t usually respond to medications.
What Causes ARFID?
For people with a disorder like anorexia nervosa or bulimia nervosa, the underlying drive is often a fear of eating foods because they fear gaining weight or looking a certain way. However, ARFID is unique from other eating disorders because it is not triggered by body image disturbances, insecurities about appearance, or fear of gaining weight. Instead, a phobia or pathological fear of the food in question causes the restriction, although functionally the result can be similar to that of anorexia nervosa.
It is suspected that anxiety may be a major contributing factor for the disorder, and certain phobias also come into play. For instance, half of the children who need selective eating disorder treatment avoid eating certain foods because they are afraid of choking or vomiting. Noticing the symptoms of depression or anxiety can be more difficult in small children, so a consultation with a child psychology expert will likely be necessary.
It should also be noted that food restrictions due to cultural or religious doctrines are not considered to be signs of ARFID – for example, a Muslim who does not eat pork for religious reasons likely doesn’t have ARFID. When determining whether a person has ARFID, the attending doctor or psychiatrist will also ask about symptoms relating to anorexia nervosa and bulimia nervosa. As per the diagnostic manual, an ARFID diagnosis is not usually made if the symptoms only appear when the individual is experiencing acute symptoms of either disorder. Despite that, it is possible to suffer from more than one eating disorder simultaneously, and one may continue when the symptoms of another have abated.
What Does ARFID Treatment Involve?
If your loved one starts at an eating disorder treatment center after they are diagnosed with ARFID, their treatment can involve multiple levels of therapeutic care. Eating disorder treatment comes in both residential and day treatment forms, and the doctors, client, and staff at the treatment center will work together after diagnosis to decide which format is most appropriate. In cases where medical care is needed due to malnutrition, diabetes, anemia, or another consequence of severe ARFID, residential treatment followed by a step-down program is usually recommended. Day treatment programs usually contain many of the same treatment methods as residential, but in a less intensive setting and done on the client’s schedule. Both are effective.
Eating disorder support for ARFID typically involves cognitive behavioral therapy, group therapy, food and nutrition counseling, and family therapy. The recovery process is individually catered to the client at most eating disorder treatment centers, so every eating disorder recovery journey can be different. Medication is not usually prescribed, although it can be described for co-occurring disorders like depression or anxiety. Instead, talk therapy techniques that focus on mindfulness, self-awareness, and facing fears are used.
Prime among these are CBT (Cognitive Behavioral Therapy) and exposure therapy. CBT is a retraining technique used in a variety of mental health treatment situations. It uses a Socratic technique between therapist and client, helping them identify which thoughts and ideas are disordered. When the client can begin to recognize them objectively, they can begin to replace those thoughts and ideas with healthier ones.
Exposure therapy is also a great example of replacing disordered behavior with healthier ones. It’s named after the gradual exposure to what a client is afraid to eat. Often beginning later in treatment when the client has begun to address their phobias and disordered thoughts. It’s a slow process; a person with ARFID who won’t eat meat won’t be forced to eat a steak the first time out, for example. This process can be frightening and difficult, but when it’s conducted thoroughly and carefully, presents a high chance for long-term, positive outcomes.
Reach Out for ARFID Help
Although it’s not as well-known as some other eating disorders, ARFID can cause serious health consequences and interfere with a person’s psychosocial functioning. However, professional help is more readily available and successful than ever. If you, your child, or any loved one is struggling with ARFID, please reach out to your doctor, therapist, or an eating disorder treatment center as soon as possible and get started on the journey to recovery.