Avoidant/Restrictive Food Intake Disorder is a new diagnosis in the DSM-5 and was previously referred to as “Selective Eating Disorder”. ARFID is an eating disorder characterised by a persistent avoidance or restriction of food intake that leads to significant weight loss, nutritional deficiencies, and/or impairment in physical or psychosocial functioning.
Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function.
ARFID differs from other eating disorders like anorexia nervosa or bulimia nervosa, in that it is not primarily driven by concerns about body image or weight.
Individuals with ARFID often have an extremely limited range of accepted foods, often preferring foods with specific textures, colours, or smells. They may avoid whole food groups, such as fruits, vegetables, or meats, and their diet may consist mostly of processed or “junk” foods. Some individuals may also have aversions to certain food textures or find eating in social situations to be distressing.
ARFID can lead to nutritional deficiencies, weight loss, impaired growth in children, and inadequate energy intake. It can also have significant psychosocial consequences, such as social isolation, anxiety around eating, and interference with daily functioning.
How is it related to PTSD?
There is a link between Avoidant/Restrictive Food Intake Disorder (ARFID) and Post-traumatic Stress Disorder (PTSD) in some cases. While ARFID is primarily characterised by restrictive eating patterns, it can sometimes be associated with traumatic experiences or co-occur with other mental health conditions, including PTSD.
Experiences of trauma, such as physical or sexual abuse, accidents, or other highly distressing events, can have a profound impact on an individual’s relationship with food and eating. Trauma can lead to heightened anxiety, fear, and aversions, including aversions to certain foods or eating situations. These aversions and anxieties can contribute to the development or exacerbation of ARFID symptoms.
It’s important to note that not all individuals with ARFID will have a history of trauma or develop PTSD, and not all individuals with PTSD will develop ARFID. However, for some individuals, trauma can be a contributing factor to the development of ARFID or complicate the treatment process.
Coping mechanisms people affected with ARFID engage in
Individuals affected by Avoidant/Restrictive Food Intake Disorder (ARFID) may engage in various coping mechanisms to manage their challenges with food and eating. These coping mechanisms can vary among individuals, but here are some common strategies that people with ARFID may employ:
Selective Eating: Individuals with ARFID often engage in selective eating, where they restrict their diet to a small number of preferred or “safe” foods. They may stick to specific textures, colours, or flavours that feel comfortable to them.
Rituals and Routines: Establishing rituals and routines around eating can provide a sense of control and predictability for individuals with ARFID. They may have specific ways of preparing or arranging food or follow rigid mealtime schedules.
Food Substitution: Some individuals with ARFID may replace certain foods with alternatives that feel less challenging or anxiety-provoking. For example, they may opt for processed or “junk” foods instead of nutrient-rich foods or use nutritional supplements to compensate for their limited intake.
Avoidance Strategies: Individuals with ARFID may employ various avoidance strategies to manage their anxiety around food. This can include avoiding social situations involving food, refusing invitations to eat out, or finding excuses to skip meals or events where food is involved.
Distraction Techniques: Distraction techniques can help individuals with ARFID redirect their attention away from food-related anxiety. They may engage in activities or conversations during meals to divert their focus from eating.
Food Preparation Control: Some individuals with ARFID find comfort and control in preparing their own meals. They may prefer to be involved in the cooking process to ensure the food meets their specific requirements.
Seeking Support: This is the most effective way of coping that some individuals opt for. Connecting with others who have similar experiences can provide support and validation for individuals with ARFID. Online support groups or therapy sessions with professionals who specialize in eating disorders can be beneficial.
It’s important to note that while coping mechanisms may offer temporary relief, they do not address the underlying issues contributing to ARFID. Professional treatment and support from a multidisciplinary team can help individuals develop healthier coping strategies and work towards expanding their range of accepted foods.
How to cope with eating disorders & improve relationship with food
Coping with eating disorders like Avoidant/Restrictive Food Intake Disorder (ARFID) and improving one’s relationship with food can be a challenging process, but it is possible with the right support and strategies. Here are some approaches that can be helpful:
1. Seek Professional Help: It’s essential to consult with a qualified healthcare professional who specialises in eating disorders. They can provide an accurate diagnosis, develop an individualised treatment plan, and offer guidance and support throughout the recovery process.
2. Therapy: Psychotherapy, particularly cognitive-behavioural therapy (CBT), is often a cornerstone of treatment for ARFID. CBT can help individuals identify and challenge unhelpful thoughts and beliefs about food, develop coping skills, and gradually expose themselves to feared or avoided foods in a controlled manner.
3. Nutritional Counselling: Working with a registered dietitian who specialises in eating disorders can be invaluable. They can provide guidance on balanced nutrition, meal planning, and strategies for gradually expanding the range of accepted foods. They can also address any nutritional deficiencies and ensure that the individual’s dietary needs are being met.
4. Exposure Therapy: Gradual exposure to feared or avoided foods, under the guidance of a therapist, can help desensitise individuals to their anxiety and expand their food repertoire. This process involves gradually introducing new foods in a safe and supportive environment.
5. Support System: Building a strong support system is crucial. Surround yourself with understanding and empathetic individuals who can provide emotional support, encouragement, and accountability throughout your recovery journey. Consider joining support groups, both online and in-person, to connect with others who have similar experiences.
6. Self-Care and Stress Management: Prioritise self-care activities that promote relaxation and reduce stress. Engage in activities you enjoy, practice mindfulness or meditation, get enough sleep, and manage stress through healthy coping mechanisms such as exercise or creative outlets.
7. Education and Self-Help Resources: Educate yourself about ARFID and eating disorders. Read books, articles, or reliable online resources to gain a better understanding of the condition. This knowledge can help you challenge negative beliefs and develop a healthier perspective on food and eating.
Remember that recovery takes time and patience. Progress may be gradual, and setbacks are normal. Be kind to yourself throughout the process and celebrate even small achievements. With the right support and a comprehensive treatment plan, it is possible to improve your relationship with food and overcome the challenges posed by ARFID.
(Inputs by Mehezabin Dordi, Clinical Psychologist, Sir HN Reliance Foundation Hospital, Mumbai)
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