What Is Avoidant Restrictive Food Intake Disorder (ARFID)?

What is Avoidant Restrictive Food Intake Disorder (ARFID) and What Can You Do About It?

When I first started working with patients who suffered from eating disorders in the early 2000s,
there was no such thing as Avoidant Restrictive Food Intake Disorder (ARFID). Actually, there
was, but my colleagues and I didn’t know what to call this group of symptoms. We would see
children with such extreme picky eating that caused them to be underweight. We would see
other children who developed an intense fear of a previously beloved food after vomiting.
Neither group was concerned about their body shape or weight. So when ARFID was included
in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for the first time in 2013,
we finally had a name for the symptoms that wreaked so much havoc on our patients and their
families.

Symptoms of ARFID include anxiety or distress with eating, which then leads to significant food
avoidance. This can mean different things to different people. For example, one child may have
severe aversions to the texture of certain foods, while another child may be unable to get past a
food’s taste or smell. Another example is a child who, from an early age, is just not interested in
food to the point it affects their growth. Other children may worry excessively about what can
happen while eating, such as choking. For anyone suffering from ARFID, the displeasure or fear
of food is so great that they consistently avoid or restrict food intake to the point that it interferes
with their day-to-day life.

Because of such limited intake, some children with ARFID are at a low weight or have a
significant nutritional deficiency. Other kids with ARFID eat enough food so that their weight is
normal or even increased, but they eat only the same 4-5 foods everyday or depend on
supplements for their caloric intake. Some children with ARFID cannot tolerate the thought of
eating at a friend’s house or restaurant, or have a severe tantrum if served a different brand of a
preferred food. Even though it’s still pizza, if it’s from a different restaurant or made by a different
company, the child absolutely refuses to eat it. Families have to alter vacation or travel plans to
ensure their children will have preferred foods available.

It is important to note that ARFID isn’t just picky eating. Many children are described as “picky
eaters” but they have a range of foods they eat, and their preferences are not getting in the way
of their growth or development. These children often try new foods and expand their palates
over time. But if a child has ARFID and doesn’t try feared foods, they can experience ongoing
food avoidance into adulthood.

If there are any concerns about body weight or shape which lead to restrictive eating, then it
isn’t ARFID, but is another type of eating disorder such as Anorexia Nervosa or Bulimia
Nervosa. If these symptoms are due to another medical condition, are explained by a lack of
available food or related to a culturally sanctioned practice, then it isn’t ARFID. But if the limited
intake is getting in the way of health, social relationships, or emotional development, it’s time to
think about seeking treatment.

So what can you do about ARFID? It’s important to seek help from a specialized provider to
ensure the correct diagnosis and appropriate treatment. One type of treatment for ARFID is
exposure therapy, where new feared foods are slowly and consistently introduced. The patient
starts with less aversive foods, and over time, therapists help expose the patient to the idea,
smell, sight, texture and taste of the feared foods until the patient’s diet expands and they
become comfortable with more types of food. This doesn’t mean sitting at the table until all the
food is finished. Positive motivators may be used to help change behavior, and this is a
collaborative process. Although it may take some time to work up to more challenging foods, the
result is freedom from the severe anxiety or discomfort with a meal!

If symptoms around food are so intense that they interfere with therapy, a psychiatrist may
recommend medication management. Medications may help increase appetite, reduce anxiety,
or decrease the cognitive rigidity that can contribute to restrictive eating. Medications may also
be recommended to treat any additional conditions such as depression, OCD or generalized
anxiety. Patients of any age can benefit from these interventions, even if they have been
avoiding foods for a long time. By seeking help from providers skilled in diagnosing and treating
ARFID, patients will learn skills to reduce their fear and stress around food, leading to better
health and improving their day-to-day life.