We all have favorite foods. For example, I am a sucker for chicken and rocky road ice cream. If I had a choice, I would eat things like homemade mac and cheese more often than I do (it takes some time to cook), and probably opt for dessert before dinner. These are just a few of my food preferences when thinking about “what’s for dinner.” In the event these foods were not available, it would be fairly easy for me to find substitutes. I could eat potatoes instead of mac and cheese, beef or goat besides chicken. I could even swap out my rocky road ice cream for rice pudding or freshly sliced watermelon. However, if you are someone who suffers from avoidant restrictive food intake disorder also known as ARFID, the choice for alternatives may not be as easy or even an option. Commonly mistaken for picky eating, ARFID is in fact far more serious and could be a matter of life and death for those involved. ARFID is more than a matter of preference or picky eating.

What is ARFID?

Known as avoidant restrictive food intake disorder, ARFID can be described as a strict aversion to certain foods based on their taste, texture, smell, or appearance based in fear that have an impact on an individual’s weight and daily functions. Most common in children, ARFID is typically noticed by parents as their children tend to only consume a small range of foods, refusing other alternatives to their detriment. Parents in turn, may start to notice their child is not gaining weight or growing as they should. Additionally, ARFID may also lead to psychosocial development difficulties as their child’s body struggles to get nutrients that are dependent on their mental functioning.

How Can One Tell the Difference Between Picky Eating and ARFID?

According to the DSM-5, there are four main stipulations that differentiate picky eaters from those with ARFID,

          Significant weight loss or a failure to gain weight according to one’s growth chart

–          Significant nutritional deficiency

–          Dependence on tube feeding or oral nutritional supplements

–          Difficulty engaging in daily life due to shame, anxiety or inconvenience

Those who participate in picky eating typically do not experience the list above. Moreover, in a study conducted by Fisher and colleagues, results concluded from their research study found six categories that further substantiated a difference between behaviors exhibited with ARFID and someone who has a particular preference for certain foods.

          Persistence in picky eating since childhood

          Anxiety disorder

          Digestive disorders

          A persistent fear of eating that accompanies choking or vomiting

          Allergies that revolve around food

          Refusing to eat due other unforeseen reasons

These things coupled with additional symptoms like sudden weight loss, an impairment in interaction with others or in the presence of foods, or even a loss of interest in food all together, could point to ARFID as opposed to picky eating. It is possible that some children who suffer from ARFID may have had an episode with food in the past where they choked or vomited. Reliving this event may cause them to avoid foods as a result in an attempt mitigate the previous trauma they experienced.

In the case of of picky eating, it is not uncommon for most children to be restrictive in their food choices, but this does evolve over time, usually between the ages of 6 and 7, while choices expand. Children who are picky eaters also usually stay on track as it relates to growth charts and psychosocial development. In more severe cases of ARFID, some individuals may be assisted through a feeding tube to ensure enough food and nutrients are being delivered to not hinder psychological or physical growth. This scenario would be non-existent in someone who simply exhibited “picky eating.”

Is ARFID Just for Children?

Although it is found commonly in children, ARFID is not a disorder reserved only for children and adolescents. It can happen to anyone at any age. Sometimes, if not identified in childhood, people may continue to practice avoidant behaviors well into adulthood. Adults who suffer from ARFID are also found to struggle with depression and compulsive disorders. Like children, they reserve their diets to include a small range of foods. Failure to eat outside of what is chosen, could lead to substantial weight loss and psychological impairment as their bodies struggle to obtain nutrients to thrive.

What Makes ARFID Different than Other Eating Disorders?

Body image may not be in the center of one’s focus for ARFID. The disorder is less about what one may look like, but rather the psychological turmoil one may be in when consuming or considering consuming certain foods such as the fear of choking, vomiting, or dying. In a 2016 study, Zikgraf, Franklin, and Rozin found that ARFID was an eating disorder that exhibited behaviors not likened to that of anorexia nervosa or bulimia. Moreover, the researchers concluded that the impact of ARFID was similar to that of anorexia or bulimia, meaning that those who suffer from ARFID also suffer from a decrease in a the quality of life and may need professional help to overcome its symptoms and maintain a productive life after recovery.

What Treatment is Available for ARFID?

Thankfully, many treatment options are available for those who may suffer from ARFID. Different approaches may be taken based on what the individual desires to achieve. Perhaps they would like to expand their food choices? Conversely, they may only seek to be more comfortable in places where different food is without trying it. For adults, treatment can be different than that with children. For example, in children who have trouble consuming different foods based on sensory sensitivity, a feeding specialist may be utilized to use their skill set to introduce children to different food textures they can eat. For children who suffer from anxiety, other strategies may be used that help children to feel more in control in their relationship with food that helps to build confidence and ultimately translates into them experiencing less fear when trying new food.  

For adults, several therapeutic services exist that aim to reduce anxiety around trying new foods, as well as traditional therapies such as cognitive behavioral therapy and dialectal behavioral therapy that helps to redirect one’s thoughts around food intake, mindfulness, and tolerance in instances that make ne uncomfortable when confronted with foods outside of their spectrum of acceptance. Due to the variability in the cases of ARFID, treatment will vary based on a patient’s needs and desires. What is good to know is that help is available for those who need it.

What Can Parents and Support Systems do to Help?

         Don’t push. Although it may seem like a good idea to push someone to try something new, most of ARFID cases accompany anxiety or anxiety disorders that put individuals under great amounts of stress. If you have a loved one who is suffering from ARFID, allow their “no” to be no. Do not think by forcing them to eat something they are averse to they will be better for it.

          Be patient. Remember that ARFID doesn’t just show up in one’s behaviors. There is a psychological component to the disorder that is not easy for others to overcome. People who suffer from ARFID cannot simply wake up and decide to eat whatever they want.

          Be a cheerleader. Children will look to their parents for approval and adults to their friends for support. Remember to celebrate ALL victories no matter the size. There is a champion sprouting from treatment, and they need your support to blossom.

ARFID is a newer development in the spectrum of eating disorders but that does not mean that there is not treatment for it or that recovery is unattainable. Children do recover from ARFID to go one and live very successful lives in good health. Adults too, recover from ARFID and are able to manage anxiety, depression, and other comorbidities that couple with the disorder. If you think you are someone who suffers from extreme picky eating and do not know where to start, please consider contacting Center for Discovery to speak to one of our licensed professionals today. We also have resources readily available for parents with children who may have ARFID.