Introduction to Avoidant/Restrictive Food Intake Disorder (ARFID)
Understanding the Symptoms and Diagnosis of ARFID
Causes and Risk Factors Associated with ARFID
Treatment Options and Strategies for Managing ARFID
The Impact of ARFID on Individuals and Families
References
Further reading
The term “avoidant/restrictive food intake disorder”, or ARFID, is relatively new, having emerged in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (the manual used by healthcare professionals as an authoritative guide to diagnosing mental health disorders) back in 2013.1
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Introduction to Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoiding certain foods and restricted eating are the hallmarks of the condition, which, although is sometimes confused with other types of eating disorders, such as anorexia nervosa, is unique in its nuances and impact on the person. People with ARFID might exhibit restrictive or avoidant eating behaviors, which can often lead to weight loss, which can be significant, as well as nutritional deficiency (such as anemia). These eating behaviors can, in some cases, also be detrimental to psychosocial functioning. While people with ARFID frequency experience weight loss, it is not motivated by a sense of dissatisfaction with body shape, or a distorted perception of body image, as it can be in other eating disorders.2
The condition can impact anyone, regardless of age, gender, or background. The prevalence of ARFID is estimated to be 5-14% among pediatric patients with eating disorders treated via inpatient programs.2 The rate is estimated to be higher in pediatric patients receiving day treatment for eating disorders, at around 22.5%.2 Rates among adult populations are less studied, although it was recently estimated that just under 10% of adults with eating disorders might suffer from ARFID.3
For many years, the condition has been often misunderstood. Adults and children with ARFID have sometimes been described as “fussy eaters” and have not always had their condition recognized as a serious disorder requiring appropriate support. As awareness of ARFID grows, we can better diagnose, support, and treat people with the condition.
Understanding the Symptoms and Diagnosis of ARFID
ARFID is characterized by an eating disturbance where a person will restrict and/or avoid food intake. They may show little interest in food, avoid certain foods based on particular characteristics, or even have a fear or aversion of potential consequences (e.g. choking). A person with ARFID may experience complications due to behaviors around eating, such as weight loss, nutritional deficiency, and significant interference with psychosocial functioning such that their day-to-day life is impacted.4
It is important to recognize that ARFID is not the same as anorexia nervosa, although on the outside, some of its symptoms may be similar, such as restricting food intake. The key difference is that people with ARFID do not restrict food intake due to their feelings regarding their body size or shape.4
Causes and Risk Factors Associated with ARFID
People can develop ARFID for a number of reasons, often, these reasons fall under one of the following categories. Some people with ARFID may be highly sensitive to the taste, texture, and smell of food, which can lead to sensory-based restriction or avoidance. Other people may have had a negative experience with food that has led to fear around food, such as experiences of choking or vomiting. This can lead to avoidance of food based on the perceived potential frightening consequences. For some people, they may not recognize hunger in the same way that others do, this can lead to restricted eating due to a lack of interest in food due to a low appetite.5
ARFID can look different in each individual, and for each person, there can be a multitude of factors contributing to the development of their condition. In some cases, the cause of ARFID is not obvious.
Because ARFID is relatively new, in terms of how long physicians have had the term to diagnose it, we do not have an abundance of studies and data on the condition. However, it has been seen that sometimes, ARFID co-occurs with other conditions, such as anxiety disorders, autism, and ADHD.5
Interestingly, recent evidence has suggested that there may be a genetic component to ARFID, meaning that it may be heritable.
Treatment Options and Strategies for Managing ARFID
Because the term ARFID is fairly new, and clinicians have only been able to diagnose the condition for the last decade, academics and healthcare professionals are still striving to understand what the optimal treatment for the condition is. So far, not enough studies have been conducted to conclude which psychological treatment may work best for ARFID. However, both adults and children with ARFID have experienced great improvements from cognitive and behavioral interventions such that are used to treat another eating disorder - anorexia nervosa. Currently, an ARFID-specific form of cognitive behavioral therapy (CBT) is being developed for the treatment of the condition.6,7
Because ARFID is experienced differently for each individual, there is likely no one-size-fits-all treatment. In the coming years, we can hope for more tailored interventions to emerge for the treatment of the condition.
Speaking with a healthcare professional or an eating disorder charity is often a good place to start when looking for a diagnosis and appropriate treatment options.
The Impact of ARFID on Individuals and Families
ARFID is a serious eating disorder that can have a significant impact on an individual’s enjoyment of life as well as their mental and physical health. Additionally, those close to a person with ARFID, such as family members, may also feel the impact of the condition as they endeavor to support a loved one.
Fortunately, research into ARFID continues, and we hope to gain a deeper understanding of the causes of the condition as well as evidence on the best way to treat it.
Further information on the condition can be accessed from charities such as Beat Eating Disorders.
References
- Cooney, M. et al. (2018) ‘Clinical and psychological features of children and adolescents diagnosed with avoidant/restrictive food intake disorder in a pediatric tertiary care eating disorder program: A descriptive study’, Journal of Eating Disorders, 6(1). doi:10.1186/s40337-018-0193-3.
- Norris, M., Spettigue, W. and Katzman, D. (2016) ‘Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and Youth’, Neuropsychiatric Disease and Treatment, p. 213. doi:10.2147/ndt.s82538.
- Avoidant Restrictive Food Intake Disorder Facts & Statistics [online]. Available at: https://www.therecoveryvillage.com/mental-health/avoidant-restrictive-food-intake-disorder/arfid-statistics/
- Avoidant/restrictive food intake disorder (ARFID) [online]. National Eating Disorders Collaboration. Available at: https://nedc.com.au/eating-disorders/types/arfid
- What is avoidant/restrictive food intake disorder? [online]. Beat Eating Disorders. Available at: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/arfid/
- Treating ARFID [online]. ARFID Awareness UK. Available at: https://www.arfidawarenessuk.org/treatment
- Howard, M. et al. (2023) ‘Cognitive behaviour therapy (CBT) as a psychological intervention in the treatment of Arfid for children and young people’, The Cognitive Behaviour Therapist, 16. doi:10.1017/s1754470x22000629.
Further Reading