When you think of eating disorders what is the first image that comes into your mind? For most people they see someone struggling with body image, fears of gaining weight, distorted perception of weight and as a result disordered eating. But eating disorders can go beyond body image and stem from a range of experiences and causes. Avoidant/ restrictive food intake disorder (ARFID) is a non body image based eating disorder and is less widely known.
Avoidant/ restrictive food intake disorder (ARFID) is characterized by selective eating habits and/or disturbed feeding patterns leading to malnutrition, failure to gain weight/weight loss and energy deficiencies. Although ARFID occurs more often in childhood it has no age limitations and can develop at any time. ARFID is commonly described as more severe picky eating. ARFID involves severe sensory sensitivities and impact to nutrition and psychological well being whereas picky eating is a behavior phase with mild and temporary impact. ARFID has many possible causes including triggering events such as choking or vomiting, gastrointestinal issues, witnessing a traumatic choking event, lack of interest in food and issues with sensory characteristics of food.
The diagnostic process for ARFID involves an evaluation of the patients’ eating habits, assessment of attitudes towards body image to rule out body image based eating disorders and symptoms related to malnutrition such as fatigue, dizziness, hair loss, dry skin, cold intolerance and abdominal pain. A clinical interview will be done to confirm diagnosis in which a mental health clinician will ask about a typical day of eating and foods that are usually accepted and avoided. Treatment can include cognitive behavioral therapy, and for more severe cases hospitalization may be required to ensure nutrition is given.
Early intervention for ARFID is the most effective approach to ensure successful treatment. Knowing the signs of ARFID is important to connect people with resources when needed. If you or someone you know is struggling with ARFID there are a range of resources and supports available to help. In addition to contacting your primary care physician to learn about next steps and inquire about diagnosis and assessment options, you may find valuable resources on the FEAST and NEDIC websites. These sites offer additional insight, tools and self assessment resources such as this short ARFID screening https://nedic.ca/media/uploaded/Short_ARFID_Screen_-_Self_fillable.pdf and more information on ARFID on the FEAST website. https://www.feast-ed.org/arfid-avoidant-restrictive-food-intake-disorder/. In addition registered dietitians and therapists with specialization in eating disorders can help create meal plans and provide guidance through food exposure therapy. Education and awareness around ARFID is important to reduce stigma, hold empathy and ensure individuals struggling with eating disorders get access to the support they deserve.
References
Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake disorder (ARFID). Current Problems in Pediatric and Adolescent Health Care, 47(4), 95–103. https://doi.org/10.1016/j.cppeds.2017.02.005
Todisco, P. (2021). Avoidant/restrictive food intake disorder (ARFID) in adults. Hidden and Lesser-Known Disordered Eating Behaviors in Medical and Psychiatric Conditions, 103–121. https://doi.org/10.1007/978-3-030-81174-7_10
