What is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder. It’s an eating disorder characterised by a limited or restricted intake of food, often due to sensory sensitivity, fear of adverse consequences, or a lack of interest in eating. ARFID is different from other eating disorders, such as anorexia nervosa or bulimia nervosa, as it doesn’t involve a preoccupation with body shape or weight.

Some common features of ARFID include:

  • Avoidance of whole food groups or textures (e.g. fruit, meat, vegetables, slimy and mixed textures)
  • Sensitivity to aspects of some foods e.g. temperature
  • Gagging or retching at the smell or sight of a particular food(s)
  • Difficulty being in the presence of another person eating a non-preferred food
  • Having a diet that’s limited to (usually less than 10) ‘preferred foods’ (‘safe foods’)
  • Lack of interest in eating or missing meals completely (not feeling hungry)
  • Attempting to avoid social events where food would be present
  • Struggling to stay and/or eat at a table during family mealtimes; eats only with distraction e.g. television
  • Needing to take supplements to meet their nutritional needs and where energy intake is impaired
  • Weight loss, fatigue and impairment in daily functioning

Individuals of all ages and genders can have clinically significant avoidant/restrictive eating that doesn’t always begin in early childhood. Importantly, ARFID doesn’t always or only lead to weight loss and is experienced by individuals across the weight spectrum. 

Diagnosis

DSM5 describes the diagnosable criteria as:

  • An eating or feeding disturbance (e.g. apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
    • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
    • Significant nutritional deficiency.
    • Dependence on enteral feeding or oral nutritional supplements.
    • Marked interference with psychosocial functioning.
  • The eating/feeding disturbance isn’t better explained by lack of available food or by an associated culturally sanctioned practice.

     

  • The eating/feeding disturbance doesn’t occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there’s no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

     

  • The eating/feeding disturbance isn’t attributable to a concurrent medical condition or not better explained by another mental disorder.
  • When the eating/feeding disturbance occurs in the context of another condition or disorder, the severity of the disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

ARFID and disrupted eating patterns around food are more common in young children with developmental disorders including autism spectrum disorder and ADHD. Research shows children with autism are five times more likely to develop issues 

Treatment

Since ARFID is a relatively new diagnosis, little is known about its optimal treatment. There’s no evidence-based psychological treatment suitable for all forms of ARFID at this time but that’s not to say that nothing can be done.

Adults and older children with ARFID have experienced huge improvements to their health and quality of life from some of the same cognitive and behavioural interventions used to treat anorexia nervosa that have been adapted to treat ARFID.  Most encouraging is a new ARFID-specific form of CBT, CBT-AR.

There are different professionals who may be able to help you.  

  • Clinical Psychologists and Eating Disorder Specialists may work to extend an individual’s range of food using CBT-AR, or other treatments.

  • A dietician will assess the individual’s nutritional intake and may be able to prescribe dietary supplements and nutritional requirements for good health.

  • A hypnotherapist can help with overcoming phobias and anxiety and teach relaxation to reduce fear and anxiety about new foods and mealtimes.

  • Particularly with ARFID, it would be worth ruling out any problems within the digestive system.  Gastroenterologists specialise in this area and can diagnose and treat the causes of weight faltering, gastric-oesophageal reflux, constipation or diarrhoea.

  • Occupational therapists are concerned with how individuals carry out tasks of everyday living. They look at the person’s functional skills and provide aids to help them. This includes looking at the child’s sensory processing and providing activities or adaptions to the environment that will help a child function better.

  • Speech and Language therapists apart from working with communication, are also interested in eating and swallowing skills. After an assessment of a person’s eating and drinking, they will recommend the food textures that can be swallowed safely and that will develop oral skills. In addition, they look at sensory sensitivity and provide sensory desensitisation programmes.

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