What is an ARFID eating disorder? ARFID – Avoidant/Restrictive Food Intake Disorder – is an eating disorder characterised by an extreme and persistent avoidance of – or restriction to – certain foods or food groups. This disorder can have a significant negative impact on physical, social and nutritional health.
ARFID v “Picky eating”
ARFID should be distinguished from picky or fussy eating which is a quite different thing. ‘Fussy eating’ is not unusual during many children’s development; quite commonly children will express strong food preferences. They want a favourite or particular food – or will express a dislike of certain foods – despite being perfectly capable of eating a wide range of foods. Sometimes they can be very fussy about food looking perfect or unblemished (e.g they won’t eat a French fry with a dark spot on it). However despite being very picky and sometimes playing on the special attention or preferential treatment they get, fussy eaters are not phobic. Unlike ARFID sufferers, picky eaters are actually able to eat other foods.
By contrast ARFID is psychologically quite different – ARFID is a phobia related to certain foods. People with ARFID may even desperately want to try some appetising-looking food, but are unable to do so, or are unable to swallow it.
Diagnosing ARFID
ARFID has only relatively recently been recognized as an eating disorder – it was first identified in the American Psychiatric Association’s manual of Mental Disorders in 2013. ‘The Diagnostic and Statistical Manual of Mental Disorders’ (DSM-5) is the standard authoritative source for clinical practice used by mental health professionals across the world.
Because this is a relatively new diagnosis, many clinicians are unfamiliar with this new diagnostic category and the specific diagnostic criteria that define this disorder. There is evidence that ARFID is not widely recognised by health professionals and that regular tests for eating disorders fail to detect patients with ARFID.
Symptoms of ARFID
ARFID as a diagnosis encompasses a varied display of clinical presentations, but individuals share a primary disturbance in eating behaviour. Symptoms may include:
Severe food restriction or avoidance
Extreme pickiness or selectivity in food choices
Weight loss, poor growth, or a failure to thrive
Nutritional deficiencies and associated health issues (e.g. fatigue)
Anxiety or distress related to eating or to specific food characteristics
Poor mental health related quality of life
Dependence on nutritional supplements or meal replacement drinks
Disruption of social activities or withdrawal from mealtime interactions
Limited interest or pleasure in eating
Fear or avoidance of certain food textures smells, or tastes
Obsessive rituals or behaviours associated with food consumption
The onset of ARFID can be acute and occur at any point in a person’s life or be long standing with onset reported at an early age. Research illustrates a wide range of ages, ethnicities and socioeconomic backgrounds in individuals meeting diagnostic criteria for ARFID.
What are examples of ARFID?
According to the DSM-5 there are three ‘drivers’ of avoidant restrictive eating behaviour.
1) Avoidance based on sensory characteristics of food Some individuals may be considered ‘super sensors’ as they have enhanced experience of the texture, taste or smell of foods. They may enjoy some strong flavours and specific textures but avoid many others. Conversely, many individuals show a strong preference for low flavour, colour and single texture foods such as plain pasta and may only accept a ‘beige diet’.
2) Apparent lack of interest in food or eating This driver may result from a low appetite – the individual not experiencing hunger as intensely as others – they may need to be reminded to eat. Some may be easily distracted finding it hard to focus on meal4mes, ocean seen in those with co-occurring aenon deficit hyperactivity disorder (ADHD). Hunger can also be inhibited by over-arousal due to anxiety or sensory overload.
3) Concern about aversive consequences of eating This driver describes individuals who have strong avoidance or food restriction as a result of a fear of negative consequences of eating, such as vomiting, choking or gastrointestinal discomfort. This may have developed following a negative experience. In some individuals there is fear-driven avoidance based on the sensory characteristics of food. A combination of an anxious temperament, lived experience of threat from food and other psycho social factors may all contribute to fear-based avoidance of food.
Dealing with ARFID
Comprehending the signs and symptoms of ARFID is vital, especially when asking “what is an ARFID eating disorder.” Recognised formally, it can now be tackled personally and clinically. Appreciating the unique trials that adults and children with ARFID face opens doors to heightened public awareness, increased empathy, and more impactful ARFID treatment strategies. Through proper support and treatment, individuals wrestling with ARFID can rediscover a healthier connection with food, paving the way for fulfilling lives ahead.
Don’t forget to also read this post about Exploring the Efficacy of CBT for ARFID by clicking the link.
