Avoidant Restrictive Food Intake Disorder
Previously known as “Selective Eating Disorder.” Avoidant Restrictive Food Intake Disorder (ARFID) is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not necessarily involve distress about body shape or size or fears of fatness. The fear is focused on the food itself.
Many people, mostly children, go through phases of selective and picky eating. Anywhere between 13 to 22 percent of children will exhibit picky eating behavior between three and eleven years of age, at any given time. While most young children will outgrow their pickiness, between 18 to 40 percent will persist in their pickiness, into adolescence. However, a child with ARFID fails to consume enough calories for normal physical development. In adults, ARFID presents as being unable to maintain basic body function. In children and adults, the disorder may also result in social problems, especially when it comes to eating with others or finishing a meal in the time allowed.
It is important to note that ARFID goes beyond the scope of a person’s food preferences by severely restricting “allowed” foods to as few as 3 or 4, which may actually threaten the individual’s ability to survive.
Signs and Symptoms of ARFID
ARFID isn’t always easy to identify as everyone presents differently. Here is what to look for:
-
Selective eating such as sensory food aversions (not liking the texture, smell, or taste of a certain food), very restricted range of foods, or fear of new foods
-
Physical problems such as gastrointestinal symptoms, abdominal pain, or physical symptoms beyond what would normally be expected if a medical diagnosis is present
-
Phobia of a severe allergic reaction
-
Vomiting phobia (known as Emetophobia)
-
Choking phobia
-
Food avoidant emotional disorder which is a lack of interest in food, emotional problems that interfere with appetite and eating like anxiety, depression, trauma; with NO medical explanation or origin
These symptoms can be seen in any combination, while others may only have one of these symptoms.
Diagnosis
ARFID is a relatively new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It stands for Avoidant Restrictive Food Intake Disorder but is sometimes referred to as “picky eaters” disorder. According to the DSM-5, ARFID is diagnosed when:
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food or concern about aversive consequences of eating such as vomiting or nausea) 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 disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
-
The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
-
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder.
-
When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
How Serious is ARFID?
Individuals suffering from ARFID may have problems in social situations, family relationships, and work or school that can become extreme. In addition, I have treated patients that weighed less than 80 pounds as well as patients that weighed over 250 pounds, although the latter is much less common. The point is that low weight is not always a determining factor. It is important to understand that even if individual with ARFID is overweight, they are still likely to be malnourished.
Parents of children with ARFID experience a great deal of stress and anxiety because it is so difficult to find the foods that their child is willing to eat. Meals become tense battlegrounds disrupting the entire meal for everyone. This is especially difficult during holidays, when traveling, or going to restaurants. Parents with a child suffering from ARFID are often so desperate to find food that their child will eat that they inadvertently reinforce the disorder by going to great lengths to provide the one thing the child will eat.
For adults with ARFID, it can also interfere in marital relationships, as the spouse often resents the anxiety attendant to the disorder. In general, most loved ones feel as if their lives revolve around getting their loved ones to eat.
ARFID is also associated with other mental health conditions, such as anorexia nervosa, Autism Spectrum Disorder, Obsessive-Compulsive Disorder, and Depression.
What Causes ARFID?
It is not clear exactly what causes ARFID. It is often connected to an experience with food that was frightening, but not always. My theory is that conventional foods, which can cause a great deal of gastrointestinal distress for anyone eating them, could be part of the issue. In other words, if it makes your stomach hurt when you eat polluted foods, it’s not unreasonable to assume that you will not want to continue to eat those foods…
Another condition that seems connected among individuals suffering from ARFID is acid reflux, which is broadly defined as the result of acidic stomach contents regurgitating back into the esophagus. Patients suffering from gastroesophageal reflux disease (GERD) have a weak or relaxed lower esophageal sphincter. Factors that contribute include hiatal hernias, obesity, pregnancy, certain medications, or smoking.
GERD has been reported to impact roughly 18-27% of the general North American population with 20% of adults stating they have weekly heartburn.
The saddest thing about Gerd is that the treatment makes the condition worse. In other words, antacids do not help but actually make the condition worse as it is not too much acid causing the problem but a relaxed sphincter. The source of the relaxed sphincter can be purging brought on by bulimia in some cases. But I believe that in most cases the cause is fats or other non-organic foods, especially those containing glyphosate, GMOs, and other nasties, regularly found in conventional US foods. We are the most obese nation in the world, along with being the wealthiest/unhealthiest country in the world with the lowest rate of infant survival. Out food is the issue. It sucks. It also causes acid reflux.
What I have noticed in my practice is that many people suffering from ARFID also suffer from acid reflux. There needs to be more research on whether there actually is a connection and if so what it is.
