The Rise of ARFID

You may have heard of the acronym, ARFID, but not know what it stands for. It is a lesser-known type of Eating Disorder, and it stands for Avoidant/Restrictive Food Intake Disorder. This disorder, by the name, is often thought of as a form of “picky-eating,” but it actually is much more complex than this.

According to Walden Eating Disorders, ARFID is “an eating disorder characterized by highly selective eating habits, disturbed feeding patterns, or both. It often results in significant nutrition and energy deficiencies, and for children, failure to gain weight” [1].

This disorder is often misdiagnosed or overlooked at first because the individual does not necessarily have the desire to control their weight, and actually, oftentimes realize that they do not look healthy.

Body image is not a part of this diagnosis in most cases, as the desire and urge to restrict and avoid certain foods has to do with a general phobia or instinct to avoid certain foods or food groups altogether.

How does one diagnose ARFID, or recognize it in an individual? The warning signs of ARFID include a disturbed eating pattern in the individual that is usually accompanied by, according to Walden Eating Disorders, “nutritional deficiency as a result of inadequate intake of food, weight loss, decline in psychosocial function, and dependence on supplements to maintain nutritional health.”

In contrast to Anorexia Nervosa, however, which also is characterized by malnutrition and weight loss, the person with ARFID does not have a distorted body image, which can make it difficult to diagnose if you do not know what to look for. The individual even usually identifies that they do not feel they look healthy and that they would like to put on more weight, but that they are struggling to do so.

Since the data on ARFID is limited, and it was only recently added to the DSM in the last 6 years, it is important to know what to look for. According to Lauren Mulheim, “One large study published in 2014 found that 14 percent of all new eating disorder patients who presented to seven adolescent-medicine eating disorder programs met criteria for ARFID.

“According to this study, the population of children and adolescents with ARFID is often younger, has a longer duration of illness prior to diagnosis, and includes a greater number of males than the population of patients with anorexia nervosa or bulimia nervosa.

“Patients with ARFID on average have lower body weight and therefore are at a similar risk for medical complications as patients with anorexia nervosa” [2].

Although the onset of ARFID is often childhood, it can occur later in life and also could have been misdiagnosed earlier in life. Therefore it is important to be aware of its symptoms and how to differentiate it from the other Eating Disorders.

ARFID can be difficult to treat due to the nature of the disorder, which is that the individual naturally wants to avoid certain foods. Usually, this avoidance is accompanied by some fear of the food, such as getting sick from the food.

It is important to note that ARFID commonly co-occurs with other disorders, namely, autism, ADHD, and OCD. We can recognize links between ARFID and OCD with its themes of anxiety, intrusive thoughts, and maladaptive coping strategies.

In the treatment of ARFID, then, it is key to be aware of and look out for other co-occurring disorders that may need to be treated. In looking for a treatment center for ARFID, Center for Discovery says, “You may require different forms of therapy approaches than the person sitting next to you with the exact same disorder.

Therefore, it is important to seek a treatment center that treats the individual and not the eating disorder. In other words, treatment centers should tailor the specific eating disorder to that individual instead of using a ‘cookie-cutter’ treatment approach.

It is vital to look for treatment centers that are reputable, have good reviews, and are upfront about insurance coverage and finances. It is also vital to check to see if the treatment center is certified and licensed by the state and treat co-occurring conditions” [3].

In other words, it is essential when looking for treatment for ARFID that the program understands the diagnosis, can treat co-occurring disorders, and would be able to provide an individualized program to meet the person’s specific needs.

Altogether, what makes ARFID so deadly, in addition to many medical complications that can happen from not getting adequate nutrition, is that not much is known about it and that it is therefore not always properly diagnosed and treated.

As a professional and a family member or loved one of someone who is struggling with an aversion or food phobia, look for the signs and symptoms of this disorder in order to know whether to rule it out. Figure out if there is the component of a disordered body image and a desire to lose weight.

If there is not, ARFID could definitely be the diagnosis. It is also imperative to be looking for co-occurring disorders and treating those alongside the eating disorder. ARFID is on the rise, and as it is, our awareness of this disorder must be on the rise as well.

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References:

Walden Behavioral Care. (2019). What is ARFID? https://www.waldeneatingdisorders.com/what-we-treat/arfid/

Muhlheim, Lauren (2019, August 31). ARFID Is More Than Just Picky Eating. VeryWell Mind. https://www.verywellmind.com/what-is-arfid-4137232

Center for Discovery Eating Disorder Treatment. (2019). Treating ARFID: How We Do It. Center for Discovery. https://centerfordiscovery.com/blog/treating-arfid/

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About the Author:

Emma Demar, LMSW is a therapist at Intrinpsych Woman on the Upper East Side of Manhattan. She holds an LMSW from Fordham University and holds a BA in Creative Writing from Trinity College. Emma recently completed a 2-Year Fellowship at Intrinpsych where she was expertly trained in Eating Disorders and DBT.

She uses a holistic approach in working with her patients, drawing from her background in Psychodynamic, CBT, and DBT, and she likes to begin where the client is and work from a strengths-based perspective. She specializes in Eating Disorders, OCD and related mental health disorders. Emma uses a direct, honest and open approach in working with her patients, who are generally women ages 12 to 32. She freelance writes for various mental health websites, and she blogs on her own website, thattrendytherapist.com.

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The opinions and views of our guest contributors are shared to provide a broad perspective of 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.

Reviewed & Approved on January 9, 2020, by Jacquelyn Ekern MS, LPC
Published January 9, 2020, on EatingDisorderHope.com