Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant restrictive food intake disorder (ARFID) previously referred to as “selective eating disorder” is like anorexia in that both disorders involve limitations in the amount and/or types of food consumed. However, unlike anorexia, ARFID doesn’t involve any distress about body shape or size or fears of weight gain.
Although many children go through phases of picky or selective eating, a person with ARFID doesn’t consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss and severe medical complications associated with malnutrition. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.
Although many children go through phases of picky or selective eating, a person with ARFID doesn’t consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss and severe medical complications associated with malnutrition. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.
Overview of Avoidant/Restrictive Food Intake Disorder (ARFID)
Odyssey Behavioral Healthcare’s AVP of Clinical Services, Kate Fisch, LCSW, discusses avoidant/restrictive food intake disorder and how Aster Springs approaches treatment.
Types of ARFID
There are four different types of ARFID, including:
- Avoidant Type: In this type, an individual avoids certain types of food based on the food’s sensory features. They may feel sensitive to the smell of food, texture of food, or general appearance of food, like color.
- Aversive Type: In this type, an individual refuses specific food because of a fear-based reaction. For example, someone may have a vomiting phobia that leads to them avoiding waffles because of a bad experience.
- ARFID Plus: In this type, an individual has more than one type of ARFID and/or has a co-occurring eating disorder. For example, someone may have a choking phobia, they won’t eat anything but soft foods in addition to restricting food intake out of a fear of weight gain.
- Restrictive Type: In this type, an individual has little or no interest in food, no appetite, or no hunger cues.
Signs and Symptoms of ARFID
Symptoms of ARFID include:
- Dramatic weight loss
- Dresses in layers to hide weight loss or stay warm
- Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
- Reports consistent, vague gastrointestinal issues (upset stomach, feels full, etc.) around mealtimes that have no known cause
- Dramatic restriction in types or amount of food eaten
- Will only eat certain textures of food
- Fears of choking or vomiting
- Lack of appetite or interest in food
- Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)
- No body image disturbance or fear of weight gain
Health Consequences of ARFID
Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar health consequences, including:
- Stomach cramps and other non-specific gastrointestinal complaints – constipation, acid reflux, etc.
- Menstrual irregularities – missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period
- Abnormal laboratory findings – anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate.
- Difficulty concentrating
- Dizziness
- Fainting/syncope
- Fine hair on body (lanugo)
- Thinning of hair on head, dry and brittle hair
- Impaired immune functioning
How We Treat ARFID
To treat ARFID, our clinicians create an individualized treatment plan for each client based on their specific needs and diagnosis. Some of the evidence-based clinical treatment modalities we utilize to treat ARFID include:
Frequently Asked Questions
What is a quick definition of ARFID?
Avoidant/Restrictive Food Intake Disorder is an eating disorder characterized by limited food preferences and avoidance of certain types of foods based on sensory aspects, such as texture, taste, or smell. Individuals with ARFID often experience anxiety or disgust towards particular foods, leading to severe dietary restrictions and potential nutritional deficiencies.
What are the three types of ARFID?
- Avoidant ARFID: Avoidance of foods in relation to features such as taste or texture, that cause sensitivity to overstimulation. Often found to be “supertasters” or have a biologically based heightened sensitivity to certain tastes.
- Restrictive ARFID: Avoidance of food due to low appetite, premature fullness, or lack of hunger cues. Adults will forget to eat or find eating a chore; children will often become distracted during mealtimes.
- Aversive ARFID: Food refusal or avoidance based on fear of aversive consequences such as vomiting, choking, GI pain, or allergic reaction. Sometimes based on an actual traumatic event or witnessing a traumatic event, but not always. Underlying pre-disposition for anxiety disorders and/or feeding disorders.
What does the treatment team look like for an ARFID client?
When it comes to treating Avoidance/Restrictive Food Intake Disorder (ARFID), a well-rounded and supportive treatment team is assembled. This team is made up of several specialists, each bringing their unique expertise to the table. The treatment team usually consists of a therapist, a dietician, a medical provider, a recovery coach, a speech and language therapist, an occupational therapist, and an applied behavior analysis professional. Together, this diverse team collaborates to create a comprehensive and personalized treatment plan.
What is one of the most effective types of treatment for ARFID?
One of the leading treatment modalities for ARFID is Cognitive Behavioral Therapy for ARFID (CBT-AR). This treatment is a manualized, 4-stage approach to treating ARFID through the framework of cognitive behavioral therapy across 20-30 sessions. The primary objective of CBT-AR is to guide the client toward a point where they no longer meet the diagnostic criteria for ARFID by the end of the treatment. The stages are as follows:
- Stage 1, Psychoeducation and early change
- Stage 2, Treatment Planning
- Stage 3, Address maintaining mechanisms in each ARFID sub-type
- Stage 4, Relapse prevention
What are the existing evidence-based approaches for ARFID?
Exposure Response and Prevention Therapy, Interoceptive Awareness Training, Family Based Treatment, Dialectical Behavior Therapy (DBT), and Cognitive Behavioral Therapy (CBT are the major evidence-based approaches for ARFID.
REVIEWED BY
Kate Fisch, LCSW
Kate Fisch is the AVP of Clinical Services for Odyssey’s Eating Disorder Network. With 17 years of clinical leadership and direct client care experience in the eating disorders field, she has a history of innovation, clinical training, and resource development in a variety of eating disorder treatment settings supporting families, clients, and clinicians.
If you’d like to learn more about ARFID treatment program or our other treatment offerings, the compassionate team at Aster Springs is here to help.
