Are you a picky eater? Or do you know someone who is super selective about what they eat? Well, what if we told you that there’s an eating disorder that’s more than just picky eating? That’s right, we’re talking about Avoidant/Restrictive Food Intake Disorder (ARFID). It’s a serious condition that affects many people and can lead to malnutrition and weight loss. But don’t worry, we’ve got you covered! 

In this blog post, we’ll take a closer look at ARFID and cover everything you need to know about its diagnosis, signs and symptoms, and the amazing team of professionals who help those affected by the disorder. Let’s dive in!

What is ARFID?

Eating disorders are becoming increasingly prevalent in today’s society. While many people have heard of disorders like anorexia, bulimia, and binge eating disorder, there are others that are less commonly known. One of these lesser-known eating disorders being ARFID. 

ARFID is a type of eating disorder that is characterized by a persistent avoidance or restriction of food intake that leads to weight loss, malnutrition, and/or other medical complications.¹ Unlike other eating disorders, such as anorexia nervosa and bulimia, individuals with ARFID are not motivated by a desire to lose weight or change their body shape.¹ 

It’s common for children to go through phases of being picky or selective with their food choices. However, when someone has ARFID, they may not be getting enough calories to support proper growth and development, which can lead to weight loss in adults and stalled weight gain and vertical growth in children.¹

Signs and Symptoms of ARFID

The signs and symptoms of ARFID can vary from person to person, but here are the most common ones:¹

Behavioral and psychological:

• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• 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
• Dramatic restriction in types or amount of food eaten
• Will only eat certain textures of food
• Fears of choking or vomiting
• Lack of appetite or interest in food
• Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).
• No body image disturbance or fear of weight gain

Physical:

• 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)
• Postpuberty female loses menstrual period
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Dry skin
• Dry and brittle nails
• Fine hair on body (lanugo)
• Thinning of hair on head, dry and brittle hair
• Muscle weakness
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

Types of ARFID

If you or someone you know is dealing with ARFID, it’s important to understand that there are different types of this eating disorder. Each type has its own unique symptoms and challenges. Here’s a breakdown:²

1. Avoidant ARFID: In this type, individuals avoid certain foods due to sensory issues, like smells, textures, or appearance. For example, they might be sensitive to the smell of certain foods, textures like soft or prickly fruits and vegetables, or the way food looks.
2. Aversive ARFID: This type is characterized by fear-based reactions to food. People with Aversive ARFID may experience fear of choking, nausea, vomiting, pain, or swallowing difficulties, which leads them to avoid certain foods altogether.
3. Restrictive ARFID: In Restrictive ARFID, individuals have little-to-no interest in food, a low appetite, get distracted during mealtime, or are extremely picky eaters. This can lead to limited food intake and nutritional deficiencies.
4. Adult ARFID: ARFID isn’t just for children and adolescents; many adults can experience it as well. Adults with ARFID may still have symptoms from their adolescent years and can fall into any of the three types of ARFID.
5. ARFID “Plus”: When someone experiences more than one type of ARFID, they can develop features of anorexia nervosa, which can include concerns about body weight and size, fear of weight gain, negative body image without body distortion, and preference for less calorie-dense foods. This combination of symptoms is called ARFID “Plus”, and it is considered a co-occurring eating disorder.

Diagnosis of ARFID

ARFID can affect anyone, regardless of age or gender, but it is more commonly diagnosed in children and adolescents. According to the DSM-5, ARFID is diagnosed when:¹

• An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
  • Significant nutritional deficiency.
  • Dependence on enteral feeding or oral nutritional supplements.
  • Marked interference with psychosocial functioning.
• The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
• The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
• The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

Treatment of ARFID

Treatment for ARFID typically involves a multidisciplinary team approach, including a dietitian, mental health professional, and physician. The team will work together to address both the physical and psychological aspects of the disorder.

The treatment plan might include a combination of nutrition counseling, medical care, and feeding therapy. If choking is a concern, a speech-language pathologist can evaluate your swallowing and feeding to make sure everything is working smoothly.

The main goals of treatment are to:³

• achieve and maintain a healthy weight
• increase the variety of foods eaten
• and learn how to eat without fear of pain or choking. In some cases, doctors may prescribe medications to increase appetite or manage anxiety, and therapists will teach you ways to handle any worries you may have around food.

Most children with ARFID can be treated at home, but for some, a more intensive hospital-based program may be necessary. And in rare cases, tube feeding or nutrition formulas may be required to get the right amount of calories and vitamins needed to support healthy growth.

Bottom Line

ARFID is a serious eating disorder that can have a significant impact on an individual’s physical and psychological health. Remember, everyone’s journey with ARFID is unique, and there is no one-size-fits-all treatment approach. But with the right support and guidance from a dedicated team of professionals, it is possible to manage the disorder and develop a healthy relationship with food.

At our private practice, we understand the challenges that come with eating disorders, including ARFID. Our team of dietitians is specially trained to help individuals with ARFID develop a healthy relationship with food and overcome their aversions to certain foods. If you or someone you know is struggling with ARFID, we encourage you to apply to work with us here!

References

1. AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID). Nationaleatingdisorders.org. Retrieved May 2, 2023. 
2. ARFID symptoms & treatment. Eating Recovery Center. Retrieved May 2, 2023. 
3. Ban, Q., Cheng, J., Sun, X., Jiang, Y., Zhao, S., Song, X., & Guo, M. (2020). Effects of a synbiotic yogurt using monk fruit extract as sweetener on glucose regulation and gut microbiota in rats with type 2 diabetes mellitus. Journal of Dairy Science, 103(4), 2956–2968. https://doi.org/10.3168/jds.2019-17700
4. Zucker, N. (2016). Avoidant/restrictive food intake disorder (ARFID). In Encyclopedia of Feeding and Eating Disorders (pp. 1–4). Springer Singapore.