When people think of eating disorders, conditions like anorexia nervosa or bulimia nervosa often come to mind. These disorders are typically characterized by body image concerns, intense fear of body shape & size, and behaviors aimed at minimizing weight or food consumption. However, there is another eating disorder that significantly impacts individuals but is often misunderstood or overlooked: Avoidant/Restrictive Food Intake Disorder, or ARFID.
What is ARFID?
ARFIDS often presents in early childhood and is often seen as “picky” eating. At first, this may not raise too much alarm since most children have strong food preferences and/or need multiple exposures before they actively choose a wide variety of foods. This is why it is often not identified as a problem until the child's food amount is lacking or parents start to get worried about the lack of nutrients the child has given the narrow group of foods they typically feel drawn towards. An individual with ARFIDS will select food or avoid foods based on taste, textures, and sensory sensitivities, fear of aversive consequences (such as choking or vomiting).
The criteria for ARFID include:
Persistent failure to meet nutritional or energy needs, leading to one or more of the following:
Significant weight loss or failure to achieve expected weight gain
Nutritional deficiencies
Dependence on supplements or tube feeding
Significant interference with daily life and social functioning
The avoidance or restriction is not due to a lack of available food or cultural practices.
It is not better explained by another medical condition or a mental health disorder, and it occurs without fears related to body image.
How is ARFID Different from Anorexia and Bulimia?
ARFID is distinct from anorexia and bulimia in several key ways:
1. Body Image Concerns
Anorexia and Bulimia: Both disorders are deeply rooted in concerns about body image and weight. People with these conditions typically engage in behaviors to lose weight or prevent weight gain, such as restrictive eating, excessive exercise, or purging.
ARFID: Individuals with ARFID are not driven by body image issues. Instead, their food avoidance stems from sensory sensitivities, fear of choking or vomiting, or a lack of interest in food.
2. Behavioral Triggers
Anorexia and Bulimia: Triggers often include societal pressures, personal experiences of body shaming, or internalized perfectionism.
ARFID: Triggers are more likely to involve specific sensory experiences (e.g., texture or smell of food), traumatic experiences with eating (e.g., choking or severe vomiting), or innate low appetite.
3. Physical and Emotional Manifestations
Anorexia and Bulimia: These disorders often lead to extreme weight or nutritional changes and medical complications related to malnutrition, as well as emotional distress from body dissatisfaction.
ARFID: While ARFID also causes significant physical and nutritional concerns, emotional distress is more likely to stem from social or functional impacts (e.g., difficulty eating in public or with family).
Who is Affected by ARFID?
ARFID can affect individuals of all ages, but it is particularly common in children and adolescents. Some adults may also experience ARFID, especially if their symptoms were not recognized or treated earlier in life. People with ARFID often have co-occurring conditions, such as:
Autism spectrum disorder
Attention deficit hyperactivity disorder (ADHD)
Gastrointestinal disorders
Recognizing the Signs
Early recognition of ARFID is crucial for effective intervention. Signs may include:
A highly limited range of accepted foods, often described as "picky eating" persists into adolescence or adulthood.
Avoidance of foods based on texture, smell, or appearance.
Fear of choking, gagging, or vomiting when eating.
Significant weight loss, failure to grow as expected, or reliance on nutritional supplements.
Difficulty participating in social or family meals.
Treatment Options for ARFID
Effective treatment for ARFID requires a multidisciplinary approach tailored to the individual’s needs. Here’s an overview of common treatment options:
1. Nutritional Counseling
A registered dietitian with experience in eating disorders can help create a balanced meal plan that gradually introduces a wider variety of foods. Nutritional counseling also addresses deficiencies and ensures that the individual’s energy needs are met.
2. Cognitive Behavioral Therapy (CBT)
CBT is a widely used therapeutic approach for ARFID. It helps individuals identify and challenge distorted thoughts about food and eating, and gradually reduces food-related anxieties. Exposure therapy, a component of CBT, can be particularly effective in helping individuals face and overcome food-related fears.
3. Occupational Therapy
For individuals with sensory sensitivities, occupational therapy can help desensitize them to challenging textures, smells, or other sensory triggers. Therapists use structured exposure and sensory integration techniques to make eating less stressful and more enjoyable.
4. Medical Management
In severe cases, individuals may require medical interventions to address malnutrition or weight loss. This might include temporary reliance on feeding tubes or specialized supplements to stabilize their physical health while they engage in therapy. The MD may also recommend a speech pathology assessment to make sure that there is not a swallowing problem the child is responding to when faced with food fears.
5. Family-Based Therapy (FBT)
For children and adolescents, involving the family in treatment is essential. Parents and caregivers learn strategies to support their child’s eating and create a positive, pressure-free mealtime environment.
6. Psychiatric Support
For those with co-occurring anxiety, depression, or other mental health concerns, psychiatric support, including medication, maybe a part of the treatment plan.
Overcoming Stigma and Misconceptions
ARFID is often misunderstood as "extreme picky eating," but it is a serious and diagnosable eating disorder. The stigma surrounding ARFID can prevent individuals and families from seeking help, especially when others dismiss their struggles as mere preferences or habits. Educating the public about ARFID can reduce this stigma and ensure that those affected receive the compassion and support they need.
A Message of Hope
Living with ARFID can be challenging, but recovery is possible with the right support and treatment. Whether it’s a child learning to enjoy a wider variety of foods or an adult overcoming long-standing fears, small, consistent steps can lead to significant progress. Remember, seeking help is a sign of strength, and no one has to navigate this journey alone.
Start Eating Disorder Treatment in Provo, UT, and Across Utah
If you or someone you love is struggling with ARFID, reaching out to a therapist or medical professional experienced in eating disorders is a critical first step. With patience, understanding, and comprehensive care, a healthier relationship with food is within reach. You can start your therapy journey with Inside Wellness by following these simple steps:
Contact us or give us a call at 801-699-6161
Meet with a caring therapist
Start improving your relationship with different foods!
Other Services Offered with Inside Wellness
Eating disorder treatment is not the only service offered by Inside Wellness Our team is happy to offer support with other forms of mental health support including anxiety treatment and body image therapy. Learn more about the support in person or online therapy can offer today by visiting our blog or FAQ today.