What Is ARFID?
Avoidant Restrictive Food Intake Disorder, or ARFID, is one of the eating disorder diagnoses listed in the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). ARFID is also sometimes known as extreme picky eating. However, ARFID is more than just picky eating. With ARFID, eating causes significant physical and mental distress. It is similar to anorexia in that those with both anorexia and ARFID limit the amount and/or types of foods they consume. But unlike anorexia or bulimia, ARFID does not involve any distress about body image, weight, shape, size, or fears of gaining weight. ARFID is most frequently diagnosed in children, but many teens and adults also struggle with ARFID.
In those with anorexia or bulimia, the term “fear food” is used to describe food one is afraid to eat due to negative thoughts and feelings about the nutritional content, or fear of gaining weight. Eating these foods may be associated with guilt and shame. But with ARFID, food fear stems from a lack of interest in eating, fear that the individual might not like or be able to tolerate the sensations of the food such as flavor, texture or temperature, fear of choking or becoming ill, or fear of eating a new or unfamiliar food. Someone with ARFID may have difficulty chewing or swallowing or may gag or choke in response to eating something that causes high levels of anxiety. As a result, food choices become extremely limited.
Types of ARFID
ARFID may present in different ways depending on the individual. These are some ways in which this disorder may present.
Lack of interest: individuals may have a genuine lack of interest in eating and food, and tend to get full quickly.
Sensory Avoidance: clients may struggle with aversions to different food tastes, textures, temperature and smells.
Fear of Aversive Consequences: fear of illness, choking, gastrointestinal distress, nausea and/or allergies
Causes and Risk Factors
Like other eating disorders, there is no one root cause of ARFID. There are a variety of possible contributing factors, including biological, psychosocial, and environmental factors. Two people with the same eating disorder can have very different experiences. Here are some things that researchers do know:
People with autism spectrum conditions, ADHD, and intellectual disabilities are at greater risk of developing ARFID due to already heightened body sensations.
Children who don’t outgrow normal picky eating or who have severe picky eating appear to be more likely to develop ARFID.
A traumatic event, or other environmental or psychosocial situations, can trigger ARFID behaviors in someone who is already predisposed.
Many individuals with ARFID also have a co-occurring anxiety disorder and may be at greater risk for other psychiatric disorders.
Symptoms and Warning Signs
A short list of acceptable foods
Eating foods of similar characteristics (based on taste, texture, temperature, or appearance)
Preferences for particular food preparation methods
Eliminates foods and never gains them back into the diet
Skips one or more entire food groups; Dramatic restriction in types or amount of food eaten
Becomes emotional or demonstrates stress around unfamiliar foods
Food limitations negatively impact normal social behaviors
Dramatic weight loss
Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause
Fears of choking or vomiting
Lack of appetite or interest in food
No body image disturbance or fear of weight gain
Nutritional and Physical Consequences:
It’s important to recognize that ARFID is more than just picky eating. It can have serious physical consequences on the body. Both anorexia and ARFID involve an inability to meet the body’s nutritional needs. Physical consequences can include, but are not limited to:
Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
Difficulties concentrating
Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
Dizziness or fainting
Feeling cold all the time
Sleep problems
Dry skin; dry and brittle nails
Fine hair on body (lanugo)
Muscle weakness
Poor wound healing
Impaired immune functioning
Poor weight gain and growth
Nutrient deficiencies or malnutrition
Treatment for ARFID
Though ARFID is a relatively new diagnosis in the DSM-5, there are effective treatment practices for this disorder and long-term recovery is possible. Treatment for ARFID requires specialized care with a treatment team trained in this disorder. Treatment teams should include, at minimum, a medical doctor, a licensed therapist or mental health professional, and a registered dietitian. Professionals may use different treatment modalities individualized to the person. These may include cognitive behavioral therapy, dialectical behavioral therapy, family therapy, and exposure-response prevention.
We at SD Nutrition Group are registered dietitians trained in the treatment of ARFID and other eating disorders. If you or a loved one is struggling, please reach out. We would love to discuss how we can support you in your recovery journey. You can find our contact information here.
If you’d like to learn more about ARFID and treatment strategies with children, we recommend the book, Helping Your Child with Extreme Picky Eating by Katja Rowell, MD and Jenny McGlothlin, MS, SLP. You can purchase it here.
We also recommend the workbook Conquer Picky Eating for Teens and Adults by the same authors, which can be found here.