Avoidant/Restrictive Food Intake Disorder (ARFID) is more than just picky eating. ARFID is distinguished by a refusal to try something new and, therefore is a much more extreme and clinically concerning the version of a ‘boring’ eater. Individuals who have ARFID refuse to try to new foods because of their aversion to the smell, texture, and taste. This extreme phobia of novelty foods results in individuals having a very selective diet, which can lead to health concerns. This eating disorder was once characterized as a disorder of childhood however now it is recognized as an eating disorder of all ages, although it is more common in children. Individuals with ARFID do not eat enough to meet their energy and nutritional needs. However, unlike individuals with anorexia nervosa, individuals with ARFID do not worry about their weight or shape and therefore do not restrict their diet for this reason. ARFID also does not typically emerge after a history of normal eating whereas anorexia nervosa and bulimia nervosa both usually transpire after an individual has had normal eating patterns. Individuals with ARFID usually have had restrictive eating all along, even if their picky patterns were not easily noticeable. The onset of ARFID most often occurs during childhood. Most adults with ARFID seem to have had similar symptoms since childhood. If ARFID onset is in adolescence or adulthood, it most often involves a negative food-related experience such as choking or vomiting. Diagnostic criteria for ARFID can be found below:
Diagnostic criteria for ARFID
Disturbed eating or feeding experience which results in one or more of the following:
- Nutritional deficiency as a result of inadequate intake of food
- Inadequate weight gain in children or weight loss in adults
- Dependency on oral supplements to maintain health
- Deterioration in psychological function
- Feeding disturbance results independently of a mental or physical illness
- Absence of distorted body image
According to a study in the Journal of Adolescent Health, there are six different types of ARFID presentations with the following prevalence rate within each population:
- Picky eating since childhood (28.7 percent)
- Having generalized anxiety disorder (21.4 percent)
- Having gastrointestinal symptoms (19.4 percent)
- Fears of eating due to fears of choking or vomiting (13.1 percent)
- Having food allergies (4.1 percent)
- Restrictive eating for “other reasons” (13.2 percent)
Additionally, there have been many proposed categories of ARFID depending on the individual’s presentation:
- Avoidant individuals refuse food based on negative or fear-based experiences such as choking, nausea, vomiting, pain, or swallowing.
- Aversive individuals accept only limited foods based on sensory features. They may have a sensory processing disorder.
- Restrictive individuals are those who do not eat enough and show little interest in eating. They may be picky, distractible and forgetful, and wish they would eat more.
- Mixed type includes features of more than one of avoidant, aversive, and restrictive types. The individual usually presents with features of one category first but then acquires additional features from another type.
- ARFID “Plus” individuals present with one of the ARFID types initially, but then start to develop characteristics of anorexia nervosa such as weight and shape concern, negative body image, or avoidance of more calorically dense foods.
ARFID is often challenging to diagnose as many friends, family, teachers, therapists, and clinicians believe the individual is just a “picky eater” and will grow out of it. However, if the individual is losing weight and/or not gaining weight, there should be a concern. The following are questions both clinicians and therapists should inquire when an individual presents with signs and symptoms associated with picky eating:
- What is the current food intake (range)?
- What is the current food intake (amount)?
- How long has the avoidance of certain foods or the restriction in intake been occurring?
- What is current weight and height and has there been a drop in weight and growth percentiles?
- Are there signs and symptoms of nutritional deficiency or malnutrition?
- Is intake supplemented in any way to ensure adequate intake?
- Is there any distress or interference with day to day functioning related to the current eating pattern?
Source: Fisher et all. J Adolesc Health. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. 2014 Jul;55(1):49-52.