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Understanding ARFID: symptoms, causes and treatment

Updated: Jun 27

Understanding the complexities of eating disorders is essential for overcoming the stigma around them. One such disorder, often overlooked, is Avoidant/Restrictive Food Intake Disorder (ARFID).


ARFID is more than just picky eating. It's a serious condition with significant health implications. Recognising ARFID symptoms early can lead to more effective treatment. However, these symptoms can overlap with other disorders, making diagnosis challenging.


This article aims to provide a comprehensive resource on ARFID. We'll delve into its symptoms, causes and treatment options.


We'll also explore practical advice for managing ARFID, including creating safe food lists. Our goal is to equip individuals, families and healthcare professionals alike with the knowledge to navigate the challenges of ARFID effectively.


What is ARFID?

Little girl refusing to eat

Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new diagnosis in the field of eating disorders. It's characterised by a persistent avoidance or restriction of food intake, leading to significant nutritional deficiencies or weight loss.


Unlike other eating disorders, ARFID is not driven by concerns about body shape or weight. Instead, individuals with ARFID may avoid certain foods due to their taste, texture, smell, or past negative experiences. This avoidance can severely limit their diet, affecting their physical health and mental wellbeing.


Distinction between ARFID and picky eating


While ARFID may seem similar to picky eating, there are key differences that distinguish the two. Fussy eating is common, especially in childhood, and usually does not interfere significantly with growth or development.


In contrast, ARFID goes beyond mere food preferences. It's a serious eating disorder that can lead to severe nutritional deficiencies, weight loss, and psychosocial impairment. When food avoidance or restriction starts to impact a person's health or daily functioning, it's time to seek professional help.


Prevalence of ARFID


ARFID is more common than many realise, affecting both children and adults. While it's often diagnosed in childhood, it can persist into adulthood if not treated. In a systematic review of 30 studies, the prevalence of ARFID in child and adolescent samples was estimated to range from 0.3% to 15.5%, making it a significant concern in paediatric healthcare.


Additionally, in 2018, eating disorders charity Beat received 295 calls regarding ARFID, accounting for 2% of its 20,535 inquiries that year.


Recognising ARFID Symptoms


Recognising ARFID symptoms is vital for early intervention and effective treatment.


Symptoms can vary widely among individuals, but there are common signs to look out for. These include a lack of interest in food or eating, avoidance of certain foods based on their sensory characteristics, and fear of adverse consequences from eating, such as choking or vomiting.


Here are some common ARFID symptoms:

  • Persistent failure to meet appropriate nutritional or energy needs

  • Significant weight loss or failure to achieve expected weight gain in children

  • Nutritional deficiencies or dependence on oral nutritional supplements

  • Interference with psychosocial functioning

  • The disturbance is not better explained by the lack of available food or cultural practices


Remember, early recognition of these symptoms can lead to timely intervention and better outcomes for patients.


Causes of ARFID


young girl struggling to eat food, potential ARFID

The exact causes of ARFID are not fully understood, but it's believed to be a complex interplay of genetic, psychological, and environmental factors.


Psychological factors such as anxiety or fear related to food can also contribute to the development of ARFID. For instance, a traumatic event like choking or vomiting can lead to fear of eating. It's important to note that each individual's experience with ARFID is unique, and the causes can vary widely.


ARFID Subtypes


ARFID is a complex disorder that can present in different ways, leading to the identification of three main subtypes. Each subtype is characterised by a unique set of behaviours and attitudes towards food and eating.


  1. Sensory-sensitive: Individuals with this subtype are often sensitive to the taste, texture, smell, or appearance of certain foods. This can lead to avoidance or restriction of these foods.

  2. Lack of interest: This subtype is characterised by a general disinterest in eating or food, often leading to inadequate intake.

  3. Fear of aversive consequences: Individuals with this subtype fear the consequences of eating, such as choking or vomiting, leading to avoidance of eating. Understanding these subtypes can help healthcare professionals tailor treatment approaches to the specific needs of each individual.


The physical and mental health effects of ARFID


ARFID can have significant health implications, both physically and psychologically. Physically, the restricted intake of food can lead to malnutrition, weight loss, and in severe cases, medical complications such as anaemia or osteoporosis.


Psychologically, ARFID can lead to increased anxiety, particularly around meal times, and can impact social functioning.


Some of the potential health impacts include:

  • Weight loss or failure to gain weight in growing children

  • Nutritional deficiencies

  • Growth delays in children

  • Social isolation or difficulties

  • Increased anxiety or stress


Diagnosing ARFID


Diagnosing ARFID can be challenging due to its overlap with other eating disorders and medical conditions. It requires a comprehensive evaluation by a healthcare professional experienced in eating disorders.


The evaluation typically includes a detailed medical history, physical examination, and psychological assessment. It may also involve nutritional assessment and laboratory tests to rule out other medical conditions. The diagnosis is based on the presence of specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It's important to note that ARFID can affect individuals of any age, gender, or background, further emphasising the need for a thorough and individualised assessment.


Treatment options for ARFID


mother and daughter in kitchen making a smoothie

Treatment for ARFID is typically multidisciplinary, involving a team of healthcare professionals such as doctors, dietitians, and therapists. The goal of treatment is to expand the individual's diet, address nutritional deficiencies, and improve their relationship with food.


The most common treatment approaches include:

  • Cognitive-behavioural therapy (CBT): This form of therapy helps individuals identify and change negative thought patterns and behaviours related to food and eating.

  • Exposure therapy: This involves gradually introducing feared foods to reduce anxiety and avoidance.

  • Family-based therapy: This approach involves the entire family in treatment and can be particularly effective for children and adolescents.

  • Nutritional counselling: A dietitian can guide you on meeting nutritional needs and creating a balanced diet.

  • Medication: While there's no specific drug for ARFID, medications may be used to address underlying anxiety or other comorbid conditions.


It's important to note that treatment should be personalised to the individual's needs, symptoms, and preferences. Patience, understanding, and ongoing support are essential aspects of recovery.


Nutritional rehabilitation and ARFID-safe foods


Nutritional rehabilitation is a key component of ARFID treatment. It involves addressing nutritional deficiencies and promoting a balanced diet.


Creating a list of ARFID-safe foods can be a helpful strategy. These are foods that the individual feels comfortable eating. The list can serve as a starting point for dietary expansion. Some tips for creating an ARFID-safe foods list include:

  • Start with foods the individual already eats and enjoys.

  • Gradually introduce new foods, starting with those similar to the safe foods.

  • Encourage the individual to try new foods in a supportive and non-pressured environment.

  • Regularly review and update the list as the individual's food acceptance improves.


Finding an ARFID specialist and support


ARFID is a complex disorder requiring comprehensive understanding and empathetic care. Continued education, collaboration, and access to resources can significantly improve patient outcomes.


Finding an ARFID specialist can greatly enhance the treatment process. Specialists have a deep understanding of the disorder and can provide tailored treatment plans. Support groups and online communities can also be beneficial, offering peer support and shared experiences.


Remember, every step forward, no matter how small, is progress in the journey to recovery.


Please don't hesitate to get in touch with our team at Schoen Clinic if you need support.


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