What is ARFID?: More Than Picky Eating
ARFID is an often misunderstood condition, and in fact, many people haven’t even heard of it. If you’re one of those people, this article will give you more information about this eating disorder.
The acronym ARFID stands for Avoidant/Restrictive Food Intake Disorder. While most people are aware of anorexia and bulimia – the two most famous eating disorders – ARFID is rarely discussed and is almost never mentioned in the media. Many sufferers are simply labeled as “picky eaters.” Yet having a better understanding of this condition is key to knowing how to spot the signs and getting treatment.
How Is ARFID Different To Picky Eating?
A surprising number of people are picky eaters, however, some of them actually have another, more serious problem – ARFID. Most picky eaters won’t experience any negative impact on their growth, weight or daily function. However, those who have ARFID almost certainly will and may require professional help and treatment.
Picky eaters avoid a number of different foods due to the fact they dislike their texture, smell, appearance or taste. Lots of children are picky eaters – as many as 22% of children aged 3-11 have picky eating traits. Usually, they will eventually grow out of it, although up to 40% will continue with this behavior into adolescence.
As children grow, the range of textures, types, and amounts of food that they eat will progress until they reach the age of around 6 or 7. At this stage, they often start to develop “pickiness”, favoring carbohydrates that fuel their growth. Usually, but the time they reach puberty, their eating flexibility and appetite both increase and this usually encourages them to start eating a wider variety of foods and achieving a better balance across and within their meals. Many parents are worried about their child’s eating habits when they are young, but are often told that this sort of behavior is normal so they shouldn’t be too worried.
Parents whose children have ARFID will usually notice that their child has eating problems from around one year old. Such children will only eat a very narrow variety of foods, refusing to eat any other foods outside that range. Children who have ARFID struggle to transition from single baby foods to mixed foods and are often especially sensitive to different textures, including foods which are crunchy or mushy.
It’s difficult for parents and doctors alike at this stage to distinguish between normal childhood pickiness and ARFID. However, picky children can usually have their nutritional requirements met, those with ARFID may find this difficult. ARFID is characterized by refusing to try new foods and is sometimes described as “food neophobia”, in which challenges in accepting novelty results in a very limited diet.
A Recently Recognized Eating Disorder
ARFID was only recognized relatively recently as an eating disorder. Before 2013, people who suffered from this problem were diagnosed as having EDNOS (an eating disorder not otherwise specified). For this reason, it’s not as well understood by the general public as conditions like bulimia or anorexia, yet it still has some serious consequences.
People who have ARFID are unable to eat sufficient amounts of food to meet their essential nutritional and energy needs. Unlike people who have anorexia, however, people who have ARFID aren’t worried about their shape, size or weight and aren’t restricting their eating for those reasons. Also, ARFID usually doesn’t show itself after eating normally the same way that bulimia and anorexia do – sufferers have usually been restrictive eaters all along.
For somebody to be diagnosed with ARFID, their restriction of food mustn’t be due to lack of food, religious or cultural practices, or other medical problems which, if they were treated, could resolve the eating disorder. It must also cause one or more of the following:
- A significant amount of weight loss
- Nutritional deficiency
- Needing to be tube fed
- Having to rely on nutritional supplements
- Finding it hard to engage in everyday life because of inconvenience, anxiety or shame
Who Can Get ARFID?
At the moment, since ARFID is a relatively new diagnosis, it isn’t yet known how prevalent ARFID is in the population. It is certainly more commonly seen in children and adolescents, but some adults suffer too. Both genders are equally affected, with onset usually occurring in childhood. Adults who have ARFID also had symptoms when they were children and when they develop the condition later in life it’s usually due to a food-related negative experience like vomiting or choking.
Do Older Teens And Adults Suffer From ARFID?
Although most sufferers are children, older teens and adults can be sufferers too, and in order people with this disorder there is more likely to be an overlap with anorexia. Older adolescents and adults with ARFID are also more likely to suffer from OCD and depression together with a poor quality of life. ARFID is associated with difficult social interactions as well as difficulties concentrating at school or work because of co-occurring disorders or poorly met nutritional needs. Eating with others is virtually impossible and this causes isolation from family and friends. As a result, other mental health disorders are commonly seen in sufferers too.
Adolescents and adults with ARFID will usually have a selection of under 20 preferred foods and will have a high rate of texture or sensory issues when it comes to food. They will also struggle to try anything new, preferred a rigid diet from a very narrow food range.
Luckily, help is still possible for older teens and adults with ARFID. The key lies in knowing what they want to get from their treatment. Some people want to be able to eat with other people or outside their home, while others simply want to eat a wider selection of foods. There are a number of therapies available which can assist with anxiety, exposure and the thought processes which surround this eating disorder.
A skilled therapist can help sufferers to expose themselves to more foods by using techniques such as mental visualization, CBT, writing their steps to food exposure and distress coping skills. Another company technique used to address ARFID is Dialectical Behavioral Therapy which helps the sufferer to learn mindfulness and distress tolerance so that anxiety-provoking situations can be better managed. When the sufferer has all of these tools and techniques at their disposal, they can have a better understanding of their behavior towards food and how to control it better.
Group therapy is another useful tool employed with older teens and adults with ARFID. This type of therapy can involve group meals in a supportive environment which helps individuals to get support from others who are struggling with a similar issue and to manage situations in practice with help from a professional.
Are There Different Types Of ARFID?
There are several forms of restriction or avoidance which are present in cases of ARFID. Some people restrict their eating because they’re uninterested in food or eating. Others avoid certain foods because they don’t like their texture, color or smell. Sometimes, the avoidance is due to a fear of vomiting or choking. Usually, this third form of avoidance is due to a negative experience in the past. Some people have a combination of avoidance characteristics, usually presenting with one form at first but then acquiring features of another category. There are even some sufferers who initial present with ARFID but then develop features associated with anorexia like a concern about their shape, size or weight, a negative self-image or avoidance of high calorie foods.
Can ARFID Be Treated
For sufferers and their families alike, ARFID is a very challenging condition. Families often become very anxious that their child isn’t eating properly and power struggles often occur over food. In older sufferers, ARFID impacts on relationships since eating with others is an almost impossible experience.
ARFID won’t usually go away if it is left untreated. The primary goal of any treatment for this condition is to help the patient to become more flexible when faced with their non-preferred food so they can eat a wider range and variety of foods that will satisfy all their nutritional requirements. Often, people with ARFID eat one preferred food over and over again for every meal until finally they get bored of it. They will then refuse it in the future. Patients are therefore encourage to rotate their preferred foods and to introduce new items gradually into their diet. Some people with ARFID require a high level of care. They may need to be hospitalized or receive residential treatment with tube or supplemental feeding.
Once someone with ARFID is medically stable, their treatment will include teaching effective skills for anxiety management together with gradually introducing new foods. This is done through a process called “food chaining”. It starts with introducing foods which are similar to preferred foods then slowly progressing towards foods which are very different. Usually, sufferers need to be given the same item around 50 times before accepting it.
Are There Any Known Risk Factors For ARFID?
Just like with any other eating disorder, ARFID’s risk factors include a variety of sociocultural, psychological and biological issues. These can interact in different ways in different sufferers. That means that even though two people may have an identical eating disorder their experiences, symptoms and perspectives may be completely different.
Researchers aren’t yet entirely sure about all the risk factors for developing ARFID, however there are some known links including:
- People who are on the autistic spectrum have a greater chance of developing ARFID.
- People with intellectual disabilities or ADHD have a higher chance of suffering from this condition.
- Children who have severe picky eating or who never grow out of this stage are more at risk.
- Children who have anxiety disorders are more likely to develop ARFID.
What Are The Signs And Symptoms Of ARFID?
There are a number of signs and symptoms associated with ARFID, however as this is a newly acknowledged condition, medical professionals often fail to recognize that patients are suffering from this eating disorder and therefore confuse the symptoms with those of other medical problems.
Some of the symptoms to watch out for include:
- A significant amount of weight loss
- Wearing many layers to stay warm or hide excessive weight loss
- Constipation, intolerance to cold, abdominal pains, lethargy, or excessive energy
- Gastrointestinal problems during mealtimes with no obvious cause
- Significant restriction in amount or type of foods eaten
- Refusing to eat foods with a variety of textures
- A fear of vomiting or choking
- Lack of interest in food
- Poor appetite
- A limited selection of preferred food which becomes even narrower with time
- No fear about weight gain or body image
- Acid reflux
- Menstrual irregularities
- Difficulty in concentrating
- Abnormal lab tests such as anemia, low hormone or thyroid levels, low blood cell count, slow heart rate or low potassium level
- Dizziness or fainting
- Sleep problems
- Brittle, dry nails
- Dry skin
- Growth of fine body hair
- Hair thinning
- Brittle, dry hair
- Muscle weakness
- Swelling feet
- Mottled, cold feet and hands
- Poor healing of wounds
- Impaired immune system
What Are The Health Consequences Associated With ARFID?
When someone has ARFID, they’re unable to get sufficient nutrients to function in a normal way. This means their body has to slow all its essential processes to save energy. This can result in some severe medical consequences. Usually, the body can cope with disordered eating quite well, meaning lab tests may seem normal even if somebody has a very severe eating problem. Yet imbalances in electrolytes can be fatal, and a cardiac arrest can occur without any warning. Therefore, it’s vital to know how this eating disorder can impact on the body.
Although ARFID is a relatively recently recognized condition, it can still be a serious one. With a better understanding of its signs, symptoms and risk factors, it’s easier for sufferers of any age to get the professional help and support that they need to overcome their eating disorder. By addressing their issues around food as quickly as possible the chances of a better outcome overall are greatly improved and sufferers can go on to live a normal life.