February 8, 2023

In our series describing eating disorders in terms that make it easier for loved ones to identify them, we have thus far covered Anorexia, Bulimarexia and we will turn now to Avoidant/Restrictive Food Intake Disorder or ARFID. In other words, individuals suffering from ARFID  have a very narrow selection of food from which to choose. In many cases, they can only eat four or five foods. 

Many children with ARFID are often confused with  “picky eaters” and may go undiagnosed for years. This is a serious problem because at some point the eating disorder is so entrenched in the way the child lives their life that it is much more difficult to address. 

ARFID isn’t just an eating disorder found in children, indeed most of my patients are adults. I think that is probably because the individual suffering from ARFID as an adult has a better sense of how odd and dysfunctional the behavior is and seeks treatment for that reason, whereas children with ARFID are often mislabeled. 

Let’s Begin With the Signs of ARFID

People suffering from ARFID may not feel hungry. Indeed they are often turned off by the smell, taste, texture, or color of food. Some individuals with ARFID believe they will experience pain, choking, or vomiting when they eat which is what can cause them to be afraid of food. This is true for both children and adults. Many individuals with ARFID are underweight, especially children… But others are a normal weight or overweight, especially if they eat only junk food.

Individuals with ARFID are more likely to have:

Complications of ARFID

ARFID may lead to problems that stem from poor nutrition. 

  • Not getting enough vitamins, minerals, and protein

  • In severe cases needing a feeding tube 

  • For children stunted growth or delayed puberty

  • Individuals with ARFID are also more at risk for being overweight or obese

The lack of nutrition associated with ARFID can cause:

  • Dizziness and fainting due to low blood pressure 

  • Slow pulse

  • Dehydration

  • Weakened bones (osteoporosis) and muscles

  • Amenorrhea (loss of menses) or infertility

What Causes ARFID?

The exact cause of ARFID is not known. Many experts believe that a combination of psychological, genetic, and triggering events (such as choking) can lead to the condition. Some individuals with ARFID have gastroesophageal reflux disease (GERD) which may be the result of eating foods high in hydrogenated fats. I find that when I convince my patients to avoid those fats their ARFID improves dramatically. 

How Is ARFID Diagnosed?

Doctors and mental health professionals will look for:

  • Significant weight loss

  • Serious nutritional deficiencies

  • Poor appetite, lack of interest in food, or food avoidance

They will need to rule out lack of access to food, brought on by food insecurity another eating disorder such as anorexia, or a medical problem. To that and it may be necessary to order blood tests, urine tests, or an electrocardiogram (ECG) to check for problems. 

How Is ARFID Treated?

ARFID is best treated by a team that includes a doctor and a psychologist who specializes in eating disorders. Treatment may include nutrition counseling, medical care, and feeding therapy, if choking is a concern. Sometimes a speech therapist may be needed to do a swallowing and feeding evaluation.

The main goals of treatment are to:

  • Achieve and maintain a healthy weight and healthy eating patterns.

  • Increase the variety of foods eaten.

  • Learn ways to eat without fear of pain or choking

  • Doctors might prescribe medicines to increase appetite or treat anxiety. If anxiety is a concern, the therapist will teach children and families ways to handle worries around food.

How Can Loved Ones Help?

ARFID is linked to strong emotions and worries around food. Be supportive and empathic. Some individuals with ARFID do not know how to shop for or prepare food. A loved one such as a significant other could be very helpful in this context. When such individuals are not available, therapy must include support for developing these skills. To that end, I often shop with and cook with my patient, which is one of the advantages of having a home-based practice. Loved ones and practitioners need to reward small successes and encourage the individual to stick with the program so that they don’t give up. Getting frustrated with your loved one is not going to be helpful, so seek help yourself as well. 

If you were a loved one is suffering from ARFID reach out to us. We have experience and we can help 🙂