Treatment Pathway for ARFID

Treating ARFID

Since ARFID is a fairly new diagnosis, there’s not enough treatment evidence to support an optimal evidence-based treatment. That’s not to say that nothing can be done.

For older children and adults

Older children and adults 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 Cognitive-Behavioural Therapy, CBT-AR, that’s newly published for adoption by both medical practitioners and parents.

Any form of ARFID treatment however should take place under the supervision of a specialist team skilled in treating ARFID. Such a team is usually multidisciplinary and might consist, as a minimum, of a therapist and nutritionist/dietician.

Every ARFID sufferer and their relationship with food is different. ARFID treatment will always begin with setting goals surrounding eating and these may include:

Correcting growth deficiencies and micronutrient status
Eating a larger range of foods
Becoming comfortable eating in front of others
Becoming less fearful of choking or vomiting
Increasing interest towards food
Reducing anxiety surrounding eating

Nutritional support is an important part of recovery. Nutritional support involves identifying any nutritional deficiencies and determining whether additional supplements are needed, with acknowledgement there may well be difficulties in taking them.

For younger children and those on the autism spectrum

Desensitisation Therapy is often used with very young children and those on the autism spectrum. It involves a ‘play time’ approach which enables a child to feel comfortable with the feel, smell and sight of foods.

Exposure Therapy is used to help remove the fear and anxiety attached to certain foods. This therapy involves relaxation techniques; mental visualisation (writing and talking about the avoided foods); learning positive coping skills for overcoming the fear and anxiety surrounding food; and ultimately eating the avoided foods in a safe environment.

For older children with language (may or may not be suitable for those on the autism spectrum)

Cognitive-Behavioural Therapy For some people, unhealthy thought and behaviour patterns are at the root of their eating disorder. ARFID treatment will likely include cognitive-behavioural therapy, or CBT, a “talk” therapy that helps individuals identify and change self-destructive patterns of thought and behaviour. CBT also treats anxiety, depression and obsessive compulsive disorder, which often co-occur with ARFID.

Dialectical-Behaviour Therapy Dialectical behaviour therapy, or DBT, is another talk therapy commonly used in ARFID treatment. DBT helps people learn to live mindfully and within the moment in order to cope effectively with negative sensations and emotions. During DBT, individuals develop skills for distress tolerance that help them manage high-anxiety situations and identify the negative emotions they’re feeling. By understanding and mindfully accepting negative feelings and emotions, people with ARFID are able to work through them in healthy ways.

Hypnotherapy Can be useful if it’s carried out by a health professional as part of exposure and desensitisation programmes.

Eye Movement Desensitisation and Reprocessing Therapy EMDR therapy is an interactive psychotherapy technique used to relieve psychological stress. It’s an effective treatment for trauma and post-traumatic stress disorder (PTSD) and there are indications that when used properly, it can be effective in treating ARFID.