ARFID (Avoidant Restrictive Food Intake Disorder)
Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder in which people do not get enough food or nutrition due to a disinterest in food or to concerns about the consequences of eating. These include certain sensory aversions, or fears about bodily reactions like choking or vomiting. The person is therefore unable to maintain a healthy weight and adequate nutrition needs. The difference between ARFID and anorexia is that those with ARFID don’t avoid food due to concerns of weight, size, or body image.
People with ARFID don’t consume enough to meet their nutritional or energy needs. The condition is classified as a feeding or eating disorder in the DSM-5, and a diagnosis would involve one of the following consequences:
- Significant weight loss
- Significant nutritional deficiency
- Dependence on enteral feeding or nutritional supplements
- Impairments to the person’s mental health or social life
A diagnosis is given if the person’s eating patterns were not due to a lack of available food, developmental stage, a cultural practice, another mental health condition, or a medical problem.
The condition mainly occurs in childhood, but it can occasionally occur in adolescence and adulthood as well.
Signs that someone may have ARFID include substantial weight loss, exhaustion, consistent lack of energy, always feeling cold, consistent stomach pain, sudden food restrictions, reliance on supplements, fears of choking, vomiting, or stomach pain, strong preferences for food textures, thin hair, brittle nails, and in women, loss of menstrual cycle.
It can be difficult to distinguish someone who is a picky eater from someone who has an eating disorder. As long as the person’s quirks about food don’t interfere with their ability to meet their caloric and nutritional needs, and they are functioning well in their daily life, they are likely just a picky eater. If not, they may have ARFID. Other potential signs of ARFID include avoiding foods due to sensory characteristics, becoming dependent on supplements, and the sudden emergence of self-imposed food restrictions.
People with anorexia refrain from eating due to concerns around body image and weight. But people with ARFID don’t have those fears; their aversion has to do with the experience of eating itself. Potential signs of anorexia include skipping meals, taking tiny portions, not eating in front of others, reading food labels religiously, shopping for others but not eating, and fearing weight gain.
Scientists don’t completely understand why ARFID develops, but a few factors may increase the likelihood of developing the disorder, according to the DSM-5. One is a history of medical problems that relate to eating, such as gastrointestinal problems, acid reflux, and vomiting. Another is being raised by parents who are anxious and mothers who have an eating disorder. Yet another is the presence of particular mental health conditions such as autism, OCD, anxiety, and ADHD.
Changes in brain activation may also play a role. Brain activity seems to increase in regions involved in processing attention, rewards, emotion regulation, and body signals in people with ARFID, research suggests.
There’s limited research on the prevalence of ARFID, but one study found that 1.5 percent of a small sample of 8 to 18 year olds in pediatric gastroenterology clinics were diagnosed with ARFID, and 2.4 percent had one symptom or more but did not qualify for a diagnosis.
Yes, higher rates of autism exist among those with ARFID than the general population. One of the reasons why people with ARFID avoid certain foods is because they are distressed by the taste, smell, temperature, color, or texture. People with autism also struggle with sensory sensitivity, so consistently avoiding certain foods to the point of being undernourished or underweight would lead to an ARFID diagnosis.
ARFID can arise for numerous different reasons—from food texture to fears of choking—so an effective treatment plan addresses those underlying challenges from a medical, nutritional, and psychological perspective.
Treatment also depends on the severity of the condition. An individual who is severely malnourished may need to be hospitalized or enter an outpatient treatment (daytime only) program. An individual with a milder case may benefit from an outpatient program or therapy.
The goal of treatment is to meet the person’s physical and nutritional needs while addressing underlying anxiety and strengthening their ability to eat. Research suggests that cognitive behavioral therapy, which helps change distorted or unproductive thought patterns, can benefit those suffering from ARFID, whether administered in an individual or family context. Therapy may focus on exposing the person to new foods, addressing fears and sensitivities around eating, and developing coping skills.
There are no medications designed specifically to treat ARFID, but some patients who struggle with anxiety may benefit from anti-anxiety drugs.