ARFID, short for avoidant restrictive food intake disorder, refers to limiting food, causing significant nutritional deficiencies, weight loss (or failure to gain expected weight), and problems with behavioral functioning. Any of these symptoms may warrant the need for help. While similar to anorexia, people with ARFID do not experience distress over body weight, size, and shape.1
What Is ARFID?
ARFID is a type of eating disorder where people do not consume enough food to meet their daily nutritional needs. Some people with ARFID experience anxiety or phobias over certain foods or types of eating. Others lack interest in eating or report having low appetites.2
ARFID tends to be more common in childhood or adolescence, but the onset can occur at any age. Many people with ARFID eat only certain types of food and in minimal amounts. This pattern may result in health problems and may require treatments ranging from needing nutritional supplements to feeding via tubes.
“ARFID impacts people all across the age spectrum, from young children to adults. In children, doctors may notice a stalling in their growth or weight loss,” says Staci Belcher, Research Professional in Nutritional Sciences at the University of Georgia. “Parents and caregivers may observe a lack of interest in foods, food restriction or fear, preference for specific flavors or textures (such as crunchy, sweet), or fear of vomiting/choking. In adults, ARFID clients may experience the above as well as having a relatively small list of foods they regularly eat. Because of that, they may have inflexible eating behaviors, food restriction, weight loss, or complaints of frequent fullness or upset stomach.”
ARFID vs. Anorexia
ARFID and anorexia nervosa both include the symptom of food restriction; however, the underlying motives are different. Someone with anorexia limits food because they want to lose weight or achieve a certain body type. They fear weight gain and often punish themselves with extreme dieting techniques to consume as few calories as possible.
Someone with ARFID is not motivated by weight loss. Instead, they often restrict calories unintentionally, and it’s because they fear or lack interest in eating.
ARFID vs. Picky Eating
Research shows that 8%-50% of children between 2 and 11 years old are picky eaters.3 However, being particular about food is a relatively normal part of childhood development. Although picky eaters may be frustrating for family members, the individual isn’t necessarily disturbed by their habits.
Picky eaters usually have specific food preferences and can maintain appropriate weight goals. People with ARFID may demonstrate substantial weight loss, and they may show no interest in eating whatsoever. They may also be disturbed by certain food textures or fear certain food-related consequences like vomiting, choking, or getting sick.
Picky eaters may turn down most foods and only choose to eat their favorites, but someone with ARFID may report they don’t feel hungry, never think about food, and often forget to eat because food just isn’t a priority.
Signs of ARFID In Children & Adults
Many parents mistake ARFID for picky eating. After all, the two conditions can look similar. A child with ARFID, however, may seemingly avoid every type of food. Unlike a picky eater, a child with ARFID can fail to achieve specific weight and growth milestones without treatment for the condition.
Adults with ARFID may show similar characteristics as children with ARFID. For example, they may avoid social settings where food is involved (due to fear of eating or fear of feeling embarrassed for how they eat). In long-term cases, adults with ARFID may struggle with serious health consequences due to inadequate nutrition.
The main symptom of ARFID is failing to eat enough food to meet nutritional needs. Understanding why someone does not eat enough food will help determine if ARFID is the appropriate diagnosis, or if it’s another condition. ARFID consists of both psychological and physical symptoms that cause significant distress to an individual’s well-being.
Common psychological symptoms of ARFID include:1
- Sudden refusal to eat certain foods
- Reported fears of choking or vomiting
- Having no appetite (or a very low appetite)
- Eating very slowly and barely consuming whatever is served
- Problems with eating in social situations
- Limiting food intake to avoid feared or disliked textures
- Difficult chewing and digesting
Common physical symptoms of ARFID include:1
- Rapid weight loss (or failing to gain expected weight in childhood)
- Gastrointestinal distress
- Difficulty concentrating
- Dizziness or fainting
- Insomnia or other sleep-related problems
- Loss of menstruation (or menstrual irregularities)
- Feeling cold all the time
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Causes & Risk Factors of ARFID
Like any eating disorder, there isn’t a specific cause that causes ARFID. Instead, ARFID likely results from a combination of genetic, psychological, environmental factors, and triggering events (i.e., choking). Certain risk factors may exacerbate one’s predisposition to develop this condition.
In addition, people with ARFID may also meet the criteria for other mental health issues like obsessive compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), or anxiety disorders.
Causes and risk factors for ARFID include:
- Autism (people with autism are much more likely to have ARFID)
- Having a history of severe picky eating in childhood
- Traumatic experiences (e.g., choking)
- Co-morbid mental health issues (e.g., depression, OCD, ADHD, anxiety)
- Family history of ARFID
- Gastroesophageal reflux disease (GERD)
Diagnosing Avoidant Restrictive Food Intake Disorder
To diagnose ARFID, a medical professional will usually engage in a complete assessment of the individual’s medical and mental health history. If diagnosing a child, the medical professional will often speak to both the parents and the child to understand the presenting issue.
To diagnose ARFID properly, a qualified healthcare professional will assess the individual’s eating habits and other lifestyle factors, such as if they have an underlying medical condition (like diabetes), mental health conditions, or specific cultural practices surrounding food intake.4 It’s essential to fully separate ARFID from picky eating or other eating disorders.
Treating ARFID often requires a comprehensive, multidisciplinary approach. The specific treatment will vary based on the severity of the individual’s condition and past history of professional intervention. If the individual has co-occurring mental health issues, treatment should provide adequate interventions for all symptoms.
Belcher encourages, “ARFID, like all eating disorders, is best treated through a team approach. Eating disorder specialists, including registered dietitians, licensed therapists, and medical providers including psychiatrists, should work together to identify strategies to renourish clients and begin to expand foods the client eats. Many clients’ symptoms improve with a specific type of Cognitive Behavioral Therapy for ARFID: CBT-AR. A dietitian and therapist work closely to plan for, execute, and process food exposures. Consistent and continued exposure to new foods and processing the emotional experience is the path to an improved quality of life, and health.”
Therapy can be highly effective for treating ARFID, providing a safe and supportive environment for recovery. Your therapist will work with you to develop reasonable goals and identify realistic steps towards achieving those goals.
Types of therapy for ARFID include:
- CBT: Cognitive behavioral therapy (CBT) helps people identify negative or unhelpful thoughts and transition them into more realistic ones.
- ERP: Exposure and response prevention (ERP), a part of CBT, encourages people to identify and gradually expose themselves to specific fears.5
- Family therapy: Family therapy may be recommended for children with ARFID. Family sessions may focus on education about the condition and practical coping skills for managing symptoms.
There are currently no FDA-approved psychiatric medications for ARFID; however, research shows that mirtazapine and lorazepam can reduce food-related anxiety. Furthermore, olanzapine may help reduce rigid thoughts about food.6
Similarly, physicians may recommend specific supplements or vitamins to ensure nutritional balance. If the individual has co-occurring mental health issues, it is important to evaluate the need for medication.
How to Get Help For ARFID
If you suspect you have ARFID, it is important to visit your primary care physician first. They will conduct a full physical and determine the severity of your condition via bloodwork, urine testing, or X-rays. They may also refer you to specialists such as registered dietitians and ARFID specialists.
You should follow similar guidelines for children. Talk to your child’s pediatrician about your concerns. It may be helpful to write down the symptoms you observe and note when they started and how frequently they present. Your pediatrician may also provide referrals for child ARFID specialists.
In severe cases, hospitalization is necessary. Hospitalization allows for continuous monitoring and evaluation of the physical effects associated with ARFID. Discharge occurs after achieving medical stabilization.
How to Find a Therapist
If you’re interested in finding a therapist to help you deal with symptoms of ARFID, start your search in a free online therapist directory. You can narrow down your search by things like cost, expertise, and location.
Supporting Someone With ARFID
It can be difficult to know how to help someone with an eating disorder. Remember ARFID isn’t just someone being picky about their eating habits. Let the person know you understand that this eating disorder isn’t their fault. Ask them how you can best support them through their struggle.
Belcher notes, “Clients often have to navigate comments about their eating, especially those related to ‘picky eating.’ Understanding that ARFID is not ‘picky eating,’ and that it is a complex eating disorder, shifts the focus from judgment to support. Avoid all comments about what they choose to eat or not eat. Restaurants or events with unknown food sources can cause stress, thus, serve or request foods your loved one enjoys and offer emotional support throughout the event. For younger children, ensure foods they enjoy are available and seek the guidance from their care team to increase accepted foods.”
Final Thoughts on ARFID
ARFID can be a confusing and even frightening condition for individuals and their loved ones. Fortunately, intervention and treatment can help people live meaningful, healthy lives. Early recognition can be paramount in improving how you feel. If you suspect you or a loved one is struggling with ARFID, reach out for support as soon as possible.