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.
