ARFID: An Introduction for Parents with Frequently Asked Questions

Most eating disorders are easily characterized and oftentimes easy to point out thanks to ongoing media attention and education efforts, but one eating disorder remains relatively unknown: ARFID. Avoidant Restrictive Food Intake Disorder (ARFID), which was often formerly referred to as Selective Eating Disorder (SED), is one of the most recently listed eating disorder subtypes in the DSM-5. Despite being less well-known as anorexia nervosa or binge eating disorder, ARFID is commonly treated in eating disorder treatment centers. A lot of parents with concerns have questions about this condition. Take a look at some of the common questions associated with ARFID, selective eating disorder treatment, and more.

What Are the Symptoms of ARFID?

ARFID is a mental illness in which the individual compulsively avoids a certain food or food group to the point that it affects their health. According to the diagnostic criteria provided by the mental illness handbook, the DSM-5, an ARFID diagnosis requires:

• The individual demonstrates a disturbed eating experience that is associated with one or more of the following:
  • Nutritional deficiency as a result of inadequate intake of food
  • Weight loss (adults) or failure to gain weight (children)
  • Decline in psychosocial function
  • Dependence on supplements to maintain nutritional health
• The disturbed eating is not due to an explainable external factor, such as food being unavailable or in short supply.
• The person does not have a distorted body image.
• The feeding disturbance or food restriction is not a result of some other physical or mental illness. For example, a person who loses weight because of the flu or food poisoning does not have an eating disorder, so a diagnosis of ARFID would not be relevant.

People with ARFID restrict their food intake. Unlike anorexia nervosa, this is not triggered by a desire to lose weight or avoid gaining weight. The effect can be the same, however, resulting in low body weight and several health effects. These can include anemia, loss of bone density, a variety of gastrointestinal problems, heart problems, seizures, and more. In small children and adolescents, it can curtail growth and development.

How Common Is ARFID?

ARFID isless 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 in 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. Some studies indicate that about 3.2 percent of all people in the United States experience ARFID at some point in their lives. That sounds like a small number, but it can range into the hundreds of thousands, if not millions.

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 psychiatric and psychological disorders 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 having other health issues.

Also, please note that various cultures and religions require certain food restrictions as part of their culture. They may restrict certain food groups, meats, or kinds of food, but these restrictions do not negatively affect a practitioner’s health. Restricting, for example, shellfish or beef, as part of a culture does not count as a symptom f ARFID.

Who Does ARFID Affect the Most?

ARFID does affect both males and females, but it is slightly more common in males. In addition, younger children seem to be more at risk than older children, as the condition will oftentimes improve with age and maturity. 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.

ARFID is slightly unusual among eating disorders in that is not caused by body image distortions or a desire to lose weight. This means in part that it’s less likely, to begin with adolescence like most eating disorders. That being said, a traumatic experience can act as a trigger or ARFID at any age. Also bucking the usual trend regarding other eating disorders, ARFID is not more or less prevalent in the LGBTQ community. Most eating disorders have a higher incidence in those communities.

Is ARFID a Mental Illness?

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. About a third of children who needeating 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.

Because of its listing in the DSM-5, most psychiatrists, even those who don’t specialize in eating disorders, are at least familiar with the symptoms and can make an initial diagnosis. Unlike some mental illnesses, however, medicine is generally ineffective when it comes to treating ARFID. Despite being listed as a psychiatric illness, psychotherapy rather than prescriptions is considered to be the keystone of ARFID treatment. However, several therapeutic methods (discussed below) have been proved through clinical trials and real-life experience to help clients overcome ARFID.

What Causes ARFID?

For children with something like anorexia or bulimia, the underlying drive is often a fear of eating foods because they fear gaining weight or looking a certain way. Body dysmorphia, or a distorted self-image, is a major contributing factor for eating disorders such as bulimia nervosa and binge eating disorder. However, ARFID is unique from other eating disorders because it is usually related to something else entirely.

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 ARFID treatmentavoid eating certain foods because they are afraid of choking or vomiting. These triggering events are frequently experienced in early childhood, and might also include eating spoiled food or eating something that triggers an allergic reaction.

There is also some indication that eating disorders of all kinds have a genetic component. The science is still being conducted, but some studies show that certain genetic structures give people a genetic predisposition towards developing eating disorders. Anecdotally, people whose parents have an eating disorder are much more likely to develop one themselves, although it is unclear how much of this likelihood is due to “nature” and how much is “nurture.”

What Does ARFID Treatment Involve?

If your child enters an eating disorder treatment center after they are diagnosed with ARFID, their treatment can involve multiple levels of therapeutic care. Eating disorder support for ARFID typically involves cognitive behavioral therapy, group therapy, food and nutrition counseling, and family therapy. The recovery process is usually individually catered to the individual, so every eating disorder recovery journey can be different.

Of special note are two specific kinds of therapy that apply to most cases of ARFID. The first is a type of therapy specifically tailored to help with PTSD and overcoming trauma. It’s known as CPT, short for Cognitive Processing Therapy. This offshoot of Cognitive Behavioral follows a strict 12-session plan for the individual in treatment to acknowledge, understand, and accept the traumatic events that have led to disordered eating. Because ARFID is so often triggered by a traumatic eating experience, CPT is a mainstay in its treatment. It’s also a mainstay in other forms of eating disorder treatment.

The other type of therapy most frequently used in ARFID treatment is exposure therapy. This type of therapy is often used in cases of specific phobias and other disorders involving irrational fears. Exposure therapy works by gradually exposing the client to the situation or object they fear under controlled circumstances. As an example, a person with arachnophobia might be asked to watch a video of spiders, then view one in a cage, then view one outside the cage over weeks or months. For a person with ARFID, they will gradually be exposed to the food they won’t eat, incorporating it into meals and demonstrating that it will have no ill effect. Exposure therapy can be very difficult for the client, so it is always performed under controlled circumstances and with appropriate emotional support.

How Can I Arrange Treatment?

Most eating disorder treatment facilities are well-prepared to address ARFID as well as other eating disorders. For most parents, the best course is to speak to a psychologist or psychiatrist specializing in children, who can make a diagnosis. After that, a specific treatment plan can be designed and implemented, whether on a residential or day treatment basis. Eating disorder facilities specializing in adolescent care exist, and for adult patients, the options are even more ample. It’s best to take action sooner rather than later; recovery is most successful when addressed early.