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Avoidant/Restrictive Food Intake Disorder (ARFID) and Options for Treatment
Avoidant/Restrictive Food Intake Disorder, more easily referred to as ARFID, has existed for quite some time but was not referred to as such until the Diagnostic and Statistical Manual of Mental Illness was released in its 5th edition in 2013. Researchers and professionals in the field considered what was missing in eating disorder diagnoses and created ARFID to “capture a cohort of patients who struggle with impaired and distressing eating behaviors and symptoms and who lack weight and body image-related concerns [1].”
ARFID is Different
This last part regarding the individual’s experience of body image is important, as that is what often delineates the difference between ARFID and other eating disorder diagnoses such as Anorexia Nervosa or Bulimia Nervosa. Individuals diagnosed with ARFID do not report body dissatisfaction, overwhelming fear of weight gain, or cognitive symptoms typically seen in AN.
Even so, the physical ramifications of their restrictive eating behaviors can appear similar to that of AN. Those that struggle with ARFID “exhibit restrictive or avoidant eating behaviors that result in significant weight loss, growth compromise, a reliance on nutritional supplements to meet daily energy requirements, nutritional deficiency (like iron deficiency anemia), or marked interference with the patient’s psychosocial functioning [1].”
ARFID Seen in Adults and People With ASD
While most often seen in children and adolescents, it would be dangerous to accept the common misconception that ARFID is a “children’s disorder.” Yes, research indicates ARFID prevalence among these ages to be approximately 14% of those surveyed.
Even so, many adults experience ARFID symptomatology as well, and for all age-groups, these behaviors are often minimized as “picky eating” or misdiagnosed as AN. Individuals with Autism Spectrum Disorder (ASD) and anxiety disorders are more likely to develop ARFID.
ASD and ARFID seem to be linked due to similar thinking profiles. Individuals diagnosed with ASD often avoid adverse sensory experiences related to the five senses, which can lead to the avoidant eating behaviors that characterize ARFID.
Treatments
Treatment for ARFID must involve a multidisciplinary team, as it impacts an individual physically as well as psychologically. Treatment will often involve a medical component, particularly if an individual’s ARFID behaviors have resulted in them being medically compromised.
Before working with the psychology of disordered eating behaviors, an individual must be medically and nutritionally rehabilitated. Many treatment facilities follow a nutritional rehabilitation method for treating ARFID known as “volume before variety,” wherein “patients who are underweight are encouraged to eat larger volumes of preferred food in the early stages of treatment, before increasing dietary variety in later stages [2].”
Once patients are nutritionally stable, they can be appropriately challenged to engage with foods that previously would have been avoided. Patients are exposed to these foods while being supported in effectively coping with the distress that this causes.
Psychotherapy also helps individuals to recognize the beliefs and thoughts behind their avoidant behaviors and explore the reality of these beliefs as well as their effectiveness, or lack thereof. Early intervention can be key for treating ARFID. The earlier symptoms are recognized, and the individual engages in treatment, the higher likelihood that they will achieve recovery.
Resources:
[1] Norris, M. L., Spettigue, W. J., Katzman, D. K. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12. [2] Brigham, K. S. et al. (2018). Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents. Current Pediatric Report, 6:2.About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published March 18, 2021, on EatingDisorderHope.com
Reviewed & Approved on March 18, 2021, by Jacquelyn Ekern MS, LPC
