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Treating ARFID: Treatment Strategies for Eating Disorder Clinicians

Avoidant/Restrictive Food Intake Disorder, also known as ARFID, is a relatively new diagnosis; it was only added to the DSMV in 2013, and little is known about its true prevalence rate or effective treatment options. Yet, as clinicians in the field, we are seeing more and more clients present to treatment, at all levels of care, with ARFID symptoms. This presentation is intended to provide an overview of what we currently know about the symptoms and presentation of ARFID, and which existing treatments show promise to eventually be validated as evidence-based interventions.
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.

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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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