What Is Avoidant/Restrictive Food Intake Disorder (ARFID)?

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by a person’s extremely limited eating habits that are unrelated to body image concerns or a desire to lose weight. ARFID differs from other eating disorders such as anorexia nervosa and orthorexia nervosa which are characterized by a person being afraid to gain weight and their eating habits are an attempt to control their body shape and/or size. The difference is with ARFID, the person struggling feels they have no choice other than to avoid these foods because they are dangerous to them. It is less about controlling body weight, size and/or shape. This disorder can quite literally become a life and death situation for the person suffering.

ARFID History

Historically, ARFID was considered a children’s eating and mental health disorder called selective eating disorder (SED). However, it is now recognized by the DSM-5 as avoidant/restrictive food intake disorder (ARFID) and is not limited to beginning in infancy or childhood. In fact, ARFID can occur at any time for children, teens and adults alike, such as after a scary incident like choking on a specific food or vomiting after eating. It may be influenced by hereditary or environmental factors, too.

In children, ARFID has been often overlooked or dismissed as selective eating. This is incorrect, and without a formal diagnosis and treatment, ARFID behaviors have carried over into adulthood. Unlike with common childhood picky eating, ARFID is more than choosing not to eat certain foods.

Symptoms of ARFID

Picky eating is a typical sign of ARFID, but there are certain symptoms that differ in severity. With ARFID, fear of eating may stem from a person knowing they have no interest in eating but that they must eat to survive. They may fear the consequences of not nourishing themselves but also be afraid of what will happen if they do eat. This is especially true if they are introduced to a new type of food outside their normal “comfort food” that makes them feel uneasy. Comfort foods may include plain foods like white bread, plain noodles, french fries and crackers.

Physical Symptoms of ARFID

People with ARFID may be afraid of the actual process of eating certain foods. Individuals may imagine the worst happening, such as choking, having an allergic reaction, being poisoned, becoming sick with nausea, vomiting or diarrhea, or even death. Therefore, physical symptoms such as throat-tightening, jaw-clenching, gagging and choking may occur when faced with foods they deem unsafe. It may even be physically impossible to swallow. As a result, they refuse to eat anything they are unfamiliar with outside their very limited realm of safety foods.

Emotional Symptoms of ARFID

Co-occurring disorders, such as anxiety, depression and compulsive disorders, are common conditions people suffering from ARFID may experience. Becoming emotional or stressed around unfamiliar foods can negatively impact social interactions and be a telltale sign of a person’s struggle with ARFID. Food restriction leads to a lack of nutrients and vitamins in the body which is related to anxiety and depression. People may withdraw from social situations due to questions and pressure from others about what they are or are not eating and why. Isolation causes sadness and loneliness, perpetuating the cycle of an unhealthy mental state.

Behavioral Symptoms of ARFID

Common behavioral symptoms of ARFID are serious enough to interfere with daily life. People may avoid one or more entire food groups such as fruit, vegetables or protein sources (meat, beans, etc.) They may show a lack of interest in eating, have a short list of acceptable foods, only eat foods that are similar in texture or color and show preferences for food preparation methods over others. Individuals with ARFID  may also eliminate food groups and never add them back into their diet.

How ARFID Is Diagnosed

According to the DSM-5, a person fits four distinct criteria when receiving an ARFID diagnosis that differentiates them from being selective eaters. These include:

  • 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

Other ARFID diagnosis requirements include sensory sensitivity, lack of interest in food and fear of adverse consequences of eating. It is important to receive a diagnosis from a qualified professional and seek treatment from reputable sources.

Causes and Risks of ARFID

ARFID does not have one root cause. Instead, researchers and clinicians have explored a variety of potential contributing factors such as biological, psychosocial and environmental influences. A child who is already predisposed to ARFID due to biological or genetic makeup may be triggered by environmental or psychosocial situations such as a traumatic event. Co-occurring diagnoses such as developmental disabilities and autism spectrum disorder may worsen by ARFID eating behaviors. In developmental disabilities, an individual’s relationship to their body and senses are already very heightened.

 If ARFID Is Left Untreated

While children typically outgrow selective eating habits, they do not simply outgrow ARFID. This serious disorder will not go away on its own when left untreated. People with ARFID may have sensory sensitivities that cause them to avoid eating foods. They may worry that the temperature of the food will be too hot or cold, causing discomfort. They may fear the texture of the food being too grainy, crunchy, soft, slimy or creamy. They may have an aversion to certain smells and avoid foods with those scents as a result. They may dislike the look of a particular food and only eat things that are a certain color or even colorless. The list of foods a person suffering from ARFID will eat is much smaller than what they won’t eat.

Unfortunately, there are many physical symptoms that may arise as a result of ARFID eating behaviors especially if treatment is not received. They may include:

  • Muscle weakness
  • Fatigue
  • Dizziness
  • Fainting
  • Sleep disturbances
  • Difficulties concentrating

Gastrointestinal issues such as acid reflux, stomach cramps and constipation may occur. Dry and brittle skin, hair and nails may surface. Feeling cold all the time is common, and the body may grow a thin layer of hair all over called “lanugo” to try and keep the body warm.

Serious medical complications may arise with caloric deficit such as nutrient deficiencies (particularly levels of iron and vitamins A and C) and failure to reach appropriate growth markers. Developmental delays in cognitive functioning are common. Impaired immune functioning leaves people more vulnerable to frequent sickness and disease. Increased risk of organ failure, cardiac arrest and death are the most serious consequences of untreated ARFID.

Treatment for ARFID

The good news is, there is treatment for ARFID. If you or a loved one are experiencing symptoms of ARFID affecting your daily life, it may be time to seek supportive treatment options. At Center for Discovery, we take a different approach to caring for our patients.

Our unique CARE-CFD dietary program and nutritional support ensure you’re never alone on your journey to well-being.

We offer multiple levels of care to suit your individual needs including residential (RTC), partial hospitalization (PHP) and intensive outpatient (IOP). Our virtual programming (for PHP and IOP) offers flexibility from the comfort of your home.

Plus, Discovery365™ is our exclusive app that uses breakthrough AI technology to help in the first year post-treatment.

Please don’t hesitate to reach out to one of our caring representatives today for more information.

More from Center for Discovery

 

References