When we think of eating disorders, we tend to think about young individuals avoiding food to lose weight and change their appearance. Anorexia nervosa, bulimia nervosa, and binge eating are the most commonly known and talked about eating disorders. We assume that an individual develops an eating disorder because they are unhappy with their appearance. While these disorders are common, and for some, changing appearance is a primary motivator, there is also a common and less talked about eating disorder, avoidant restrictive food intake disorder, or ARFID.
ARFID usually begins at a much younger age than other eating disorders, although it can be diagnosed in adults too. When an individual has ARFID, they might be seen as a “picky” eater because they are very selective to certain foods based on smell, texture, taste, or color. One of the primary differences between picky eating and ARFID is that picky eating does not affect an individual’s appetite or growth. ARFID can cause a change in appetite and complications due to a lack of proper nutrition.
Common Symptoms
In addition to picky eating, there are a few common signs and symptoms of ARFID. Physical signs can include significant weight loss, lethargy, muscle weakness, stomach pain, and dizziness. There are also behavioral changes that might include feeling full before meals, lack of appetite, difficulty paying attention, only eating foods with certain textures, and being fearful of what could happen after eating. Both children and adults with ARFID might be very avoidant of trying new foods because of a fear of having a negative experience such as choking or vomiting. Some individuals might have a general lack of interest in eating, which presents as having a small appetite, frequently denying hunger, forgetting to eat, or being distracted during meals. It is common for children with ARFID to have rigid habituals associated with eating such as eating things in specific orders, or not allowing specific foods to touch other foods. Most of the time, individuals with ARFID are not concerned about their appearance, a common symptom of anorexia and bulimia. Avoidance of food is more closely related to the sensory aspects of food itself, or fears of negative consequences that eating might cause.
Risk Factors
In order for an individual with the eating patterns mentioned to be diagnosed with ARFID, there must be a significant interference with physical and psychological functioning. Like previously mentioned, ARFID is most common in childhood, however any age can be affected. An individual may be more likely to develop ARFID if they have an underlying condition affecting neurological functioning or development such as anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). The experience of a trauma, especially involving food, can also be a risk factor for the development of ARFID. A traumatic experience involving food can include the experience of food insecurity, choking, or the experience of being force-fed. For example, if a child choked on an orange, they might avoid eating oranges, all foods that are the color orange, and anything that smells similar.
Individuals can be impacted by ARFID at mealtimes as well as in daily life activities. Adults and children might avoid all activities where they know food is involved including social gatherings, going out to restaurants, or going to school or work. This can make it difficult to maintain positive relationships as well as stay on track in school or at work. This can also be very isolating for individuals since food is a large aspect of many social get togethers. Isolation can cause symptoms of depression and anxiety which can further exacerbate ARFID symptoms.
What can help?
ARFID is commonly seen in addition to anxiety, obsessive compulsive disorder (OCD), ASD, and/or ADHD. Treatment can be very similar to these co-occurring diagnoses and include cognitive behavioral therapy (CBT) and family-based treatment (FBT). During CBT, individuals can learn to manage anxiety symptoms and view their fears in a more rational way. They can then engage in exposure based therapy to gradually incorporate fear foods back into their diet. Children with ARFID might also benefit from feeding therapy to help form better eating habits.
How Parents Can Support
ARFID can cause strong emotions and worries related to food and eating. It might feel like there is nothing you can do to help your child with ARFID, but supporting, encouraging, and modeling positive attitudes surrounding eating can help. Starting by introducing small exposures to new foods, such as encouraging your child to take one small bite, can be more easily tolerated than introducing large portions of feared foods. Also, repeating the exposures helps to increase familiarity with the food and reduce anxiety around eating. Exposures can elicit high emotions and it’s important to show patience with your child as introducing new foods will take time. The earlier the interventions occur, the more positive the outcomes will be. ARFID is less likely to begin in adulthood, but is likely to continue into adulthood without treatment in childhood. It is important to not criticize your child for their struggles with eating, but instead reward positive eating behaviors and be a strong role model for them.
Also, check in on yourself, and be aware of your feelings that arise while supporting your child with ARFID. Finding the right interventions and supporting your child can be difficult and draining. Be sure to engage in self-care activities so that you can show up for your child as your best self.
Resources:
https://my.clevelandclinic.org/health/diseases/24869-arfid-avoidant-restrictive-food-intake-disorder
Written By,
Maria Mattox, Intern