Top 5 ARFID Questions Answered

Top 5 ARFID Questions Answered by Margot Rittenhouse, MS, PLPC, NCC

Avoidant/Restrictive Food Intake Disorder (ARFID) is a lesser-known eating disorder diagnosis that is no less serious than the more commonly-known Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder. Supporting earlier diagnosis and treatment of this disorder can be achieved by increasing awareness and understanding of signs and symptoms.

What is Avoidant/Restrictive Food Intake Disorder?

Criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines Avoidant/Restrictive Food Intake Disorder as “an eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs [1].” Symptoms used to diagnose ARFID include significant weight loss or nutritional deficiency, dependence on enteral feeding or oral nutritional supplements and marked interference with psychosocial functioning [1]. ARFID can be distinguished from Anorexia Nervosa or Bulimia Nervosa by a lack of “disturbance in the way in which one’s body weight or shape is experienced [1].”

Is ARFID the Same as Picky Eating?

This is a common misconception that can be dangerous, as underestimating ARFID symptoms as “just picky eating” can result in mis/underdiagnosis and lack of proper and timely support. The biggest difference between engaging in picky eating and ARFID symptoms is that picky eating behaviors do not result in long-term consequences. ARFID behaviors also tend to be more persistent despite potential consequences.

Clinical Psychologist Dr. Gillian Harris, BA, MSc., Ph.D., CPsychol, AFBPsS, distinguished, “The difference between a ‘picky eater’ and a child with ARFID, is that a picky eater won’t starve themselves to death. A child with ARFID will [2].”

Is ARFID a “Children’s Disorder?”

While ARFID is more common in children and teens, it would be unwise to assume it cannot present in adults as well. In fact, studies indicate that approximately 9.2% of adults experience ARFID symptoms [3]. The National Eating Disorders Association reports that those adults struggling with ARFID “might include those who went untreated as children and have a long pattern of selective eating based on sensory concerns or feelings of disgust with new foods [4].”

How do I Identify Avoidant/Restrictive Food Intake Disorder?

ARFID hurting childARFID can present similarly to other eating disorders as well as picky eating. Therefore, any display of symptoms should be considered concerning, and observing a combination of symptoms might mean it is time to seek a professional opinion.

Someone struggling with ARFID “may have difficulty chewing or swallowing, and can even gag or choke in response to eating something that gives them high levels of anxiety [4]. Additionally, “foods may be avoided based on physical characteristics such as texture, smell, and appearance, or based on past negative experiences like choking or vomiting [4].” Any presentation of avoidant food which is to the detriment of an individual’s health and not motivated by weight loss indicates ARFID and professional help should be sought for an official diagnosis.

What is an Effective Treatment for ARFID?

ARFID can be treated with many of the treatment methods used for other eating disorders. One method particularly helpful is Exposure and Response Prevention which involves an individual being exposed to that which provokes an anxiety response and learning to cope with thoughts and feelings this brings up in-the-moment.

Individuals with ARFID would, therefore, be exposed to the foods they have been avoiding in order to cope effectively with the responses that arise from these foods. This treatment can be effective long-term as the individual learns skills to support eating avoidant foods as well foods that may cause discomfort in the future.

Resources

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

[2] Unknown (2019). What is ARFID? ARFID Awareness UK. Retrieved from https://www.arfidawarenessuk.org/what-is-arfid.

[3] Hull, M. (2020). Avoidant Restrictive Food Intake Disorder Facts and Statistics. The Recovery Village. Retrieved from https://www.therecoveryvillage.com/mental-health/avoidant-restrictive-food-intake-disorder/related/arfid-statistics/.

[4] Lesser, J. K. (2018). More than picky eating – 7 things to know about ARFID. National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/blog/more-picky-eating%E2%80%947-things-know-about-arfid.

 

About the Author:

Image of Margot Rittenhouse.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.

Music Therapy Can Be a Vital Component of Eating Disorder Treatment

Music Therapy Can Be a Vital Component of Eating Disorder Treatment

By Timberline Knolls Staff

The thought of using music to help with behavioral health concerns can be traced back to the writings of Aristotle and Plato, but it became popularized in the 20th century after World War II.

As musicians went to veteran’s hospitals around the country to play for those who were struggling with symptoms of trauma from the war, the armed forces officially recognized music as a way to help begin to heal both physically and mentally.

Physicians noticed that the veterans who were present for those sessions were leaving the hospital sooner, and modern music therapy, in a way, was born.

Shortly thereafter, the National Association for Music Therapy (NAMT) was founded. It merged, along with the American Association for Music Therapy, into the American Music Therapy Association (AMTA) in 1998, uniting a profession that now helps individuals in a variety of therapeutic spaces.

One of those is eating disorder treatment. Participating in music therapy has shown to help people who are struggling with mental health disorders improve their quality of life, build social skills, and nurture relationships.

Music therapy helps to promote self-determination and collaboration in patients who are experiencing symptoms of behavioral health concerns by focusing on their strengths. As it relates to eating disorders specifically, it can offer motivation for recovery, distraction from negative thoughts and feelings, and a sense of autonomy and creative expression.

One researcher at Florida State University found six studies conducted in the 21st century that examined the specific effects of music therapy as a supplemental therapy for eating disorder treatment. The author found four primary goals of treatment:

  • Increase autonomy/self-confidence
  • Increase emotion regulation
  • Reduce stress and anxiety
  • Increase motivation for treatment

Some studies of the benefits of music therapy in eating disorder treatment have shown that participants have an increase in mental engagement and the ability to distance themselves from life’s problems. One particularly interesting study from 2015 looked at whether music therapy could decrease post meal-related anxiety in patients who have anorexia nervosa in an inpatient or residential setting.

Other research showed that post meal support therapy was beneficial for inpatient eating disorder treatment programs, but this study found that those who participated in the music therapy group — compared with standard post meal therapy — had a more significant decrease in anxiety levels after mealtime.

Music therapy isn’t just about listening to music. Many music therapists incorporate songwriting, playing instruments, lyric analysis, and music-assisted relaxation into their programming.

Each has different benefits. Songwriting gives patients a chance to express themselves in a judgment-free environment and can lead to conversations that allow for connection and understanding. Playing instruments can tie into emotion regulation (determining which sounds might best represent happiness, sadness, or loneliness, for instance). Lyric analysis can be built around different themes, such as empowerment or emptiness. And music-assisted relaxation can involve building playlists to help participants through challenging events, such as shopping or mealtimes.

As with any form of therapeutic intervention, music therapy may be more effective in certain contexts — and for certain patients — than in others.

The overarching goal in music therapy is to provide a path to healing. There is much research still to be conducted on the large-scale benefits of music therapy for eating disorders, but what we know so far is that emotional healing can be a key catalyst in physical healing. Music therapy can serve as a basis for patients to address body image, self-esteem, anxiety, and other key areas that often undermine eating disorder recovery.