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 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:

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.