child eating disorder Archives · Alison Pelz, LD, RDN, CDCES, LCSW

Avoidant/Restrictive Food Intake Disorder (ARFID) often remains underrecognized and misunderstood.

Adults who have struggled with Avoidant/Restrictive Food Intake Disorder for most of their life may feel it is impossible for things to be different. Parents who have a child struggling with ARFID have, more often than not, literally tried everything to help their kiddo eat, but nothing seems to be working. ARFID is often equated with picky eating, but it’s actually much more complex than that.

Although ARFID is a newer diagnosis, there is really nothing new about it.

Prior to being added to the DSM-5, it was included in a broader category called “Feeding Disorder.” It was added to the DSM-5 in order to develop better ways to treat it.

Parenting a Child with ARFID

If you are a parent, well meaning doctors may have minimized your child’s selective eating. This can be particularly true if your child is on track with growth. This can be frustrating for a number of reasons. You spend significant time to figure out how to feed your child – and it takes a lot of mental energy and often can feel very limiting to keep dealing with this challenge day after day.

If it’s left unaddressed, ARFID can lead to nutritional deficits, which can impact both physical health and emotional well-being. Early detection of ARFID is important so it doesn’t turn into a life-long struggle. Understanding ARFID is crucial for effective intervention, and a comprehensive treatment strategy tailored to the individual’s specific needs is necessary.

Understanding ARFID

Avoidant/Restrictive Food Intake Disorder is not just a simple case of picky eating; it is a complex psychological condition that can cause significant nutritional and reduced quality of life, particularly if it endures into adulthood.

Unlike other eating disorders that are often driven by concerns about weight and body image, ARFID is characterized by an avoidance of food based on sensory sensitivity, lack of interest in eating, depressed appetite, and/or fear of adverse consequences such as choking, throwing-up, or an allergic reaction.

Individuals grappling with ARFID may face a persistent difficulty when it comes to eating sufficient quantities or varieties of food. This can stem from deep-seated anxiety, gastrointestinal discomfort, or past negative associations with food.

Recognizing Avoidant/Restrictive Food Intake Disorder Symptoms

Persistent avoidance of specific foods or food groups or low food intake are characteristic of ARFID. Physical responses such as gagging may coincide with this avoidance of certain foods.

The eating patterns of individuals with ARFID reveal a restrictive intake that fails to meet their physiological needs. Without treatment, ARFID can lead to potential nutritional deficiencies, weight loss, or developmental delays, irrespective of age, gender, or body weight.

Behavioral signs and changes in eating that may indicate ARFID include:

Poor appetite
Getting full quickly
Avoiding eating due to fear of choking
Picky eating that often gets worse over time

Avoidant Restrictive Food Intake Disorder (ARFID) is often misinterpreted as a phase among children or as mere pickiness in adults; however, it represents a significant feeding or eating disorder that hinders one’s capacity to consume an adequate variety and volume of food.

Impact of ARFID on Everyday Life

ARFID’s restrictive eating patterns in children can lead to low energy, isolation, and anxiety around meal times. For caregivers, it can be a struggle to know how to feed your child, or it can take lots of effort to prepare foods that you know they will eat in order to support growth.

For older children and adolescents, ARFID can make socializing, which often happens around food (such as parties, sleep overs, family events or team dinners), anxiety provoking for both the child and parents. The disorder’s consequences radiate outward, often simmering into familial tensions and social rifts, as loved ones grapple with the complexities of ARFID.

Adults with ARFID tend to have a decrease in quality of life. Moreover, the fear of eating outside one’s comfort zone can hinder personal and professional growth, particularly when mealtime activities are involved.

Ultimately, the disorder’s grasp can dampen overall quality of life, exerting a significant emotional toll.

Approaches to Treating ARFID

The main goal of treatment for ARFID is supporting the sufferer with eating enough (and enough variety) to keep their body nourished. For children, treatment works to support growth. Treatment for children, adolescents, and adults can help to improve overall quality of life.

Improved quality of life looks different depending on the individual with ARFID. For some, that may mean eating most food. For others, it may mean expanding the variety of food in order to support quality of life and being nourished.

Avoidant/Restrictive Food Intake Disorder treatment usually focuses on making eating or feeding a priority.

That is, for most folks, increasing the number of times each day they eat meals and snacks. Due to the nature of ARFID, eating often gets put off because it is uncomfortable for the person to eat, or they simply aren’t hungry.

Structured meal planning can be an effective strategy for managing ARFID, as it introduces routine and predictability into the dining experience. By brainstorming menus in advance, individuals and families gain clarity and a sense of control over their food choices.

Having structure and making eating a priority can help make sure people are getting adequate nutrition and reduce meal time stress.

In addressing the dietary concerns that stem from Avoidant/Restrictive Food Intake Disorder, we take a gradual approach to food exposure. Food exposures are designed in collaboration with the client and/or the family in order to personalize care.

Incremental exposure to food means starting with foods that are less anxiety-provoking, building up to a more diverse diet over time. Food-related anxieties are meticulously deconstructed, facilitating the individual’s encounters with previously feared foods in a safe and controlled environment.

Efforts are channeled into ensuring balanced nutritional intake while concurrently addressing emotional and cognitive barriers. Over time, the individual learns to associate eating with safety rather than distress, thus gradually dismantling the cycle of avoidance that characterizes ARFID.

My Approach to ARFID Treatment

When I am working with children with ARFID I work closely with their caregivers. I have learned from my training in Cognitive-Behavioral Therapy for ARFID that I can bring the expertise in eating disorders, and the parents & kiddo bring the expertise on their family, food beliefs, culture, and abilities (to name a few).

With adults with ARFID I use a similar mindset. I bring skills to the table to treat the eating disorder and they bring their expert knowledge of themselves.

Are you concerned that you or your child are dealing with Avoidant/Restrictive Food Intake Disorder? Sign up for a free consultation to learn more about how I can help you and your family.

If you are a parent or caregiver, desperate to help your child who is struggling with an eating disorder, family-based treatment may be the solution you are searching for.

Often, families come into my office worried sick about their child.

Their child might have lost a lot of weight or been acting “sneaky” around food. Maybe their child has been over-exercising, using laxatives, or throwing up after eating.

Or, they might be worried because their child only eats a small number of foods, or eats a lot of food at once.

Or maybe your child has become an extremely “picky eater”.

On top of that, parents are often terrified because they have heard doctors mention hospitalization and many therapists have turned them away. When they do research online, things look bleak.

No matter their child’s symptoms, when families first come in they are often frantic, frustrated, and feeling powerless. They don’t know what to do.

If you find yourself in a similar boat today, you’re not alone. I have worked with countless families who walk into my office feeling this way. Sadly, there’s a lot of blame put on the parents. All they want for their child is to get better and live a happy life without the constant obsession with food.

Many parents have been seeking help for a while. Unfortunately, they have found no real results. They often receive criticism, but no real guidance on how to help their child get better, or well-meaning doctors say they will grow out of it and that it’s just a phase.

I’m here to give you hope.

After years as a therapist and registered dietitian, I’ve seen the positive results that come from family-based treatment where parents are properly equipped and supported to be part of the solution their child needs.

Why Choose Family-Based Treatment?

Family-based treatment (FBT) for eating disorders is an evidence-based treatment for disorders like anorexia, bulimia, binge eating disorder, and even ARFID (i.e. extreme selective eating).

Unlike many other treatments that put the responsibility on the identified patient or the person with the eating disorder, FBT includes the parents. Instead of seeing the parents as part of the cause of the eating disorder, they are seen as part of the solution.

We use your expert knowledge of your child to help your child get better.

This method of treatment makes sense to parents. If your child had cancer or some other serious medical condition, you, as the parents, would be highly involved in treatments including appointments, physical therapy, and all the steps to recovery.

It shouldn’t be any different for treating eating disorders.

Eating disorders are an epidemic in our country. According to the NIH, for teens between the ages of 13 and 18, the lifetime occurrence of anorexia, bulimia, and binge eating disorder is 2.7%. These disorders are twice as common among girls than boys. They also tend to be more common the older the teen gets.

When it comes to ARFID or avoidant/restrictive food intake disorder, the prevalence is between 5 and 22%, with about 2% reaching the need for help. ARFID also tends to happen with anxiety disorders and neurodivergence. Effective, evidence-based treatment for eating disorders is important and necessary.

How Effective is Family-Based Treatment?

Family-based treatment has been used in the United Kingdom for many years. It has proven to be more effective than other forms of eating disorder treatment.

With a 75% success rate, teens receiving FBT also recover faster than with other treatments. The research also shows that teens are doing better after engaging in FBT than in other treatments.

How Does Family-Based Treatment Work?

In family-based treatment, a clinician guides the parents in empathizing with the child while also holding boundaries around eating, food, and other eating disorder behaviors like binge eating and laxative use.

The therapist coaches the parent on how to teach their child to eat again. The goal is for the child to eventually have age-appropriate responsibility with food intake and eating habits, once the child has reduced their eating disorder symptoms and is stabilized. They also want to encourage an appropriate relationship with food and their body image.

Family-based treatment usually lasts around 20 sessions and happens in three stages.

During the first stage, the parents are responsible for preparing and serving food as well as insisting that it gets eaten. They are pretty much doing what a nurse during inpatient treatment would do. There is no room for negotiation around food or other eating disorder behaviors like purging, misusing exercise, or laxatives.

The second and third phases include slowly giving responsibility for food and exercise back to the child.

During the second phase, the child may return to more normal activities while being supervised by their parents for any signs of relapse.

During the third stage, the child begins to transition back on track with their developmental stage of eating.

What Makes FBT Different?

Family-based treatment is quite different from the standard eating disorder treatment.

First of all, at its core, FBT does not blame the child’s parents (or the child) for the eating disorder. One of the core beliefs of family-based treatment is that no one in the family is to blame. Really, the focus is on getting the child well instead of placing blame.

In other treatments, the person with the eating disorder is treated on their own outside of the family system, but with FBT, the parents, child, and sometimes even the siblings, are involved in treatment.

The parents’ care and motivation to help their child are used to make some major changes in the family’s life, especially around food. Their unique expertise on their child is used to help them get better, and parents are taught how to interact with their child around food, and other eating disorder behaviors.

This allows the family to overcome the eating disorder, together.

Another difference with FBT is the focus on food, nutrition, and eating disorder behavior rehabilitation. FBT believes that a lot of the symptoms of the eating disorder will disappear when the child is better nourished and no longer using other eating disorder behaviors. So they first focus on nutrition, feeding, and decreasing the other eating disorder behaviors.

Often, parents think that their child has to be “motivated” for treatment to be effective. One of the differences with FBT is that the child does not need to be motivated to change to get better. The motivation to make change happen starts with the parents.

What are the Benefits of Family-Based Treatment?

Family-based treatment has benefits for both the family as a whole and the child, including:

The child or teen usually gets better faster than any other treatment, making it one of the quickest ways to help your child and family heal.
Parents are involved in the child’s treatment, allowing them to be the child’s primary support instead of feeling powerless and at fault.
This is a good replacement for inpatient treatment or partial hospitalization, allowing your child to stay home.
FBT is an evidence-based approach, so you know you are doing the best you can for your child.

Now that you know how FBT can help, let’s look at who it can help.

Who is FBT for?

FBT has been shown to be effective for kids, teens, and young adults. showing signs of eating disorders.

It has been used to help kids and teens who are struggling with anorexia, bulimia, binge eating disorder, as well as avoidant restrictive food intake disorder (ARFID).

In the cases of binge eating disorder and bulimia, the family is taught to help feed their child adequately and supportively interrupt binge eating, purging, laxative use, and misuse of exercise.

FBT works both for teens who have been to inpatient multiple times and still struggle to let go of the symptoms, and for teens who have just started to engage in eating disorder behaviors, and any child in between.

FBT is not just for teens, however. It can also be used with children and young adults still living at home. FBT can be used in all different types of families or caregiving situations (like grandparent caregivers and single-parent households).

Who Should Not Do FBT?

FBT is often used instead of hospitalization. If the child is underweight and does not have any other reason to be medically supervised, FBT can be a great option rather than hospitalization.

However, if your child or teen needs to be medically supervised for another reason, then hospitalization is recommended.

In the same way, if the child needs to be supervised for other psychiatric illnesses, then this is also a situation where FBT is not going to help until the child is stable psychologically. Family-based treatment may also not be a good option if the child has experienced certain types of trauma.

What Happens During Family-Based Treatment?

Family-based treatment may last around 20 sessions. At each session, you can expect your child or teen to check in with the therapist for mental health support.

After this, the therapist will meet with the parents and child for coaching around nutrition and other eating disorder behaviors. The coaching isn’t just about what to eat but also about how to talk to your child about eating and other eating disorder behaviors, including how to express empathy without giving in.

Unlike other eating disorder treatments where the therapist just meets with the child, most of the time, the FBT therapist meets with the caregivers and child.

Family-Based Treatment is Worth the Hard Work

Family-based treatment can be very intense for the whole family. In the beginning, you will be very involved in your child’s day-to-day life, as well as your child’s nutritional rehab, but the hard work will be worth it when your child learns to eat and regains their health again.

Not only does family-based treatment help your child stay home, as hospitalizations can last weeks or months, but it also helps to heal your whole family from the disruption that the eating disorder has caused.

While it can be hard to find family-based treatment, don’t give up! Finding someone who is trained to do family-based treatment can make the difference for your child.

At the minimum, when you are seeking FBT you will need to at least start with a medical doctor and a therapist. If your team includes a dietitian, initially they will only meet with the parents and not the child.

As a therapist who is also a dietitian, I can help you understand what is going on from both angles. If you are in Texas and interested in working with me, click here to fill out a contact form. I would love to support you and your child on your journey to health.

Tag Archives: child eating disorder

Understanding ARFID: More Than Picky Eating