ARFID is strongly associated with anxiety, and many ARFID treatment options aim to help with exposure, anxiety, and the thought processes that surround the avoidant restrictive food intake disorder. Because of the severe implications that may result from nutritional deficiencies and inadequate food intake, professional treatment and intervention are needed early on after diagnosis.

Exposure therapy for ARFID

Exposure response techniques are based on cognitive behavioral therapy (CBT), which helps an individual change the thinking patterns that may have prevented them from overcoming their fears. In ARFID, the individual is fearful of certain foods however these foods have nothing to do with weight gain or body image disorders, which differentiates ARFID from eating disorders. Exposure therapy involves “exposing” the client to their perceived fear, in this case, food that provokes anxiety, using smells, imagery, and mental visualization. Usually, therapists will work on a hierarchy of fear foods from the least fearful to most anxiety provoking. Over time the therapist will expose the client to the idea of the feared food, the smell of the feared food, the texture of the feared, the sight of the feared food and eventually the taste of the feared food until the client is no longer anxious around that specific food. This process will begin from the least feared food and eventually will graduate to the most feared food with the goal of easing the anxiety around any food. Exposure response therapy is known to be the most effective form of treatment for obsessive-compulsive disorder (OCD), and avoidant restrictive food intake disorder is considered to be on the spectrum of OCD.

Cognitive behavioral therapy

Cognitive behavioral therapy concentrates explicitly on patterns of abnormal thinking and distorted beliefs that are the underlying causes of irrational emotions and thought patterns that can lead to mental illness. This fundamental concept for this type of therapy approach lies within the idea that thoughts and feelings are directly related to behavior and therefore gaining control of one’s thoughts and emotions can better dictate their behavior. Individuals with ARFID will often experience negative thought patterns that can interfere with treatment. These negative thought patterns are driven by anxiety related to the food they fear. In CBT, individuals learn over time that their fears of specific foods are irrational and in reality, these foods will not be harmful. The goal of the functional analysis stage, the first stage of CBT, is for individuals to learn their problematic beliefs. The second stage of CBT, actual behaviors, focuses on teaching clients new skills so they can use practice them and apply them in the real world. These new skills can be coping skills to overcome the anxiety that is triggered by food as well as teaching them to eat foods that they once feared. The third stage, behavioral change, is the final stage and focuses on encouraging individuals to take steps to implement a developmental transformation. At this stage, individuals should be able to eat in public, attend social gatherings and feel anxious being around foods that they once feared. If they do become anxious around certain foods then they should be able to use their coping skills to overcome these anxious feelings.

Dialectal behavioral therapy

Dialectical behavior therapy (DBT) is a type of psychotherapy that combines parts of cognitive behavioral therapy with principles of mindfulness. With DBT an individual learns mindfulness within the moment, distress tolerance skills to manage high anxiety-provoking situations, as well as emotional identification. It teaches individuals to connect their emotions with their thoughts. Clients will learn to evaluate how they feel when they are around anxiety-provoking food. They will learn to ask themselves why they are anxious and what is the worst that can happen if they are around these foods? They then can process these emotions they are feeling while simultaneously working on cognitive coping skills that can ease their current anxiety.