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ARFID

What is Avoidant/Restrictive Food Intake Disorder (ARFID)?

Avoidant Restrictive Food Intake Disorder (ARFID) previously referred to as “Selective Eating Disorder” involves limiting the amount and/or types of foods consumed, which often leads to weight loss and/or not meeting expected milestones of development. ARFID is frequently noticed and diagnosed at younger ages due to concerns by medical professionals and family members related to stunted developmental trajectories. However, it is also possible to develop ARFID and be diagnosed as an adult.

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Some risk factors for developing ARFID include preexisting anxiety and experiencing a traumatic event (i.e., choking incident, food allergy testing via eliminations of certain foods, sensitivities, and intolerances to food, medical treatments with adverse side effects on foods that can be tolerated, etc.) that involved a change in eating habits. Additionally, it is important to note that body image concerns are typically not experienced the same for individuals with ARFID as with those struggling with other types of eating disorders. The dissatisfaction or feelings of self-consciousness that are sometimes expressed by individuals with ARFID tends to be associated with feeling too thin or appearing too unhealthy rather than fear of gaining weight or being in a larger body.

Learn More About ARFID from
our AVP of Clinical Services, Kate Fisch

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ARFID Subtypes: Avoidant, Restrictive, and Aversive

Avoidant ARFID: Individuals with this subtype tend to avoid certain foods due to the taste or texture of it and report experiencing sensitivities or overstimulation in relation to those foods. They also often are found to be biologically more attuned to certain tastes of foods than the average population. Additionally, individuals with the avoidant subtype of ARFID experiencing a higher rate of co-occurring autism spectrum disorder.

Restrictive ARFID: Individuals with this subtype tend to avoid food due to low appetite or misleading hunger and fullness cues. These individuals also tend to be disinterested in food and find it difficult to remember to eat or be motivated to eat. It is believed that these symptoms could be related to abnormalities in the appetite regulating center of the brain, but more research is needed.

Aversive ARFID: Individuals with this subtype also avoid certain foods, but the avoidance tends to be related to fear of experiencing aversive consequences of eating that food such as vomiting, choking, allergic reactions, or stomach upset. This fear is sometimes associated with an actual experience of trauma or witnessing a traumatic event, but not necessarily. It is also common for an individual with this subtype of be more biologically prone to anxiety

ARFID Warning Signs and Symptoms

  • Significant weight loss
  • Failure to thrive or meet developmental milestones in childhood
  • Lack of variety in foods eaten
  • Intense fear of choking and/or vomiting
  • Picky eating based on the type, texture. and/or other qualities of the food
  • Lack of appetite or interest in food
  • Recurrent and frequent experience of physical discomfort around mealtimes (i.e., stomach aches, feeling full, nausea, etc.)
  • Anxiety and other emotion-driven responses to trying new foods or changes to eating routine
  • Increasingly small number of preferred and comfortable foods
  • Tendency to have bland or simplistic flavored foods
  • Eating foods separately even when intended to be together (i.e., pulling apart sandwiches to each individual components, having foods plated in separate compartments)
  • Avoidance or hesitance of social situations that involve food and eating
  • Desire to gain weight due to dissatisfaction with low body weight

Overview of ARFID

Odyssey Behavioral Healthcare’s AVP of Clinical Services, Kate Fisch, LCSW, discusses ARFID and how Shoreline approaches treatment.

Health Consequences of ARFID

Some malnutrition-derived health consequences of ARFID include:
  • GI upset (e.g., constipation, acid reflux, stomach cramps, bloating, etc.)
  • Irregular menstruation including delay of first period and missing periods (when applicable)
  • Abnormal bloodwork results (i.e., iron, thyroid, potassium, blood cell counts)
  • Dizziness
  • Fainting
  • Cold intolerance
  • Sleep problems
  • Dry skin
  • Dry and brittle nails
  • Fine hair on body (lanugo)
  • Thinning of hair on head, dry and brittle hair
  • Muscle weakness
  • Slow heart rate
  • Weakened immune system and prolonged healing time for wounds
  • Difficulties concentrating

Treatment Approach

Due to the complexity of ARFID, individualized treatment goals that include the use of specific dietary and therapeutic exposures that target the underlying contributors to the eating disorder behaviors is imperative. At Shoreline, we know the importance of identifying ways to improve our clients’ overall lives and supporting an improved relationship with food and body. Our staff engage in continual training and learning to further expertise in treatment eating disorders such as ARFID and the co-occurring conditions that come with it. We utilize Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) along with family based treatment techniques to help both clients are their families.

REVIEWED BY

Sheena Gill, PsyD, CEDS

Sheena Gill is the Clinical Practice Director for Shoreline Center for Eating Disorder Treatment. She is a Licensed Clinical Psychologist and Certified Eating Disorders Specialist and with more than 9 years of experience working with eating disorders, she has helped to develop Shoreline’s residential treatment program by utilizing both her clinical expertise and experience working in other treatment programs.

FAQs

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.
  1. 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.
  2. 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.
  3. 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.
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.
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:
  1. Stage 1, Psychoeducation and early change
  2. Stage 2, Treatment Planning
  3. Stage 3, Address maintaining mechanisms in each ARFID sub-type
  4. Stage 4, Relapse prevention
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.
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