What Is Avoidant Restrictive Food Intake Disorder (ARFID)?
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Medically reviewed by Kathleen Daly, MD
Avoidant restrictive food intake disorder—more commonly known as ARFID— is an eating disorder that causes you to restrict or completely avoid certain types of foods. Unlike other types of eating disorders (such as anorexia), people with ARFID don't usually have a skewed view of their body or a fear of gaining weight.
While many people can be picky eaters, ARFID goes far beyond that. Instead, ARFID causes extremely picky eating and a loss of interest in eating. Children with ARFID don't get the calories they need to properly grow and develop, while adults who live with ARFID aren't able to receive the nutrients they need to keep their bodies functioning. As a result, people with ARFID may experience symptoms like dramatic weight loss, stomach cramps, and dizziness, among others.
Symptoms
Spotting the signs of any eating disorder, including ARFID, is crucial for early intervention and getting the treatment you or your child need. Keep an eye out for the following behavioral, psychological, and physical symptoms.
Behavioral and Psychological Symptoms
ARFID can cause a variety of symptoms that affect your behaviors and emotional well-being. These include:
Restricting certain types of foods
Decreased appetite
Loss of interest in eating
A narrowing selection of favorite foods, as picky eating can intensify over time
Dressing in layers to hide weight loss
Only eating foods with certain textures
Having a fear of choking on food or vomiting
Trouble concentrating
Physical Symptoms
Aside from psychological symptoms, ARFID can cause a wide range of symptoms that affect your body and overall physical well-being. These symptoms include:
Unintentional or excessive weight loss
Having an upset stomach or feeling too full, despite not eating enough
Weak or brittle nails
Additionally, not getting the nutrients you need due to a restriction on eating certain foods can increase your risk of developing certain health conditions. These conditions include anemia, thyroid problems, heart issues, and low potassium.
Causes
Researchers don't know what exactly causes ARFID. However, several studies theorize that a variety of genetic, environmental, psychological, and social factors can play a part. These factors include:
Having a family history of ARFID
Living with co-occurring mental health conditions, such as anxiety disorders, phobias, autism spectrum disorder, and developmental disorders
Being young in age, as most cases of ARFID start to develop between the ages of 5 and 13
Because ARFID is a newer diagnosis among eating disorders, researchers are still studying what can increase your risk of developing the condition. As research continues, healthcare providers and mental health professionals alike can become more informed about how to help you properly treat or manage the condition.
Diagnosis
If you suspect you or a loved one are displaying signs of ARFID, it's important to reach out to a healthcare provider for proper testing. Getting a diagnosis for ARFID can help you or a loved one receive the proper treatment.
Generally, your primary care provider will be the first to learn about your symptoms. Your provider may also perform a physical exam and order urine or blood tests to get a better understanding of your nutrient levels and overall health. They will also likely refer you to a mental health specialist, such as a psychiatrist or psychologist to conduct further testing.
The diagnostic criteria to accurately give a diagnosis for ARFID, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), are as follows:
A lack of eating causes one of four changes: 1) dramatic weight loss; 2) nutritional deficiency; 3) a need to use a feeding tube or oral supplements; or 4) interference with your ability to carry out daily tasks and maintain social relationships
The limited intake of food is not a result of food scarcity or cultural practices
Your symptoms are not due to other eating disorders that affect your body image (e.g., anorexia and bulimia)
The restriction of your food intake isn't caused by another medical or mental health condition
In order for you to receive a diagnosis for ARFID, all four of the above criteria must be true.
Treatment
If you do receive a diagnosis for ARFID, getting treatment is essential for your recovery and overall emotional and physical well-being. Researchers suggest a combination of treatments that can help you improve symptoms and slowly treat ARFID. These treatments include:
Family-based therapy: This type of psychotherapy (or, talk therapy) is especially useful for teens and involves parents directly helping their child to establish healthy eating patterns
Cognitive behavioral therapy (CBT): Another type of psychotherapy that focuses on helping you recognize and change harmful thoughts and behaviors related to your eating habits
Nutritional guidance: Working with a nutritionist or dietician can also help you develop an eating plan that helps you get the nutrients you need and eat foods that you enjoy
Some people with ARFID also have co-occurring conditions such as anxiety or depression. In such cases, your healthcare provider may also recommend treating these conditions with medication and therapy to help improve symptoms of ARFID. It's also worth noting that it may take some time to find the treatment option that works for you—and that's OK. What's important is to keep trying to find a solution that fits your lifestyle as you work to heal.
Prevention
Eating disorders, like ARFID, can affect anyone regardless of age, race, and sex. Although ARFID tends to begin in middle childhood, you may still experience symptoms in later stages of life—especially if you haven't received an official diagnosis or treatment.
Because research on ARFID is ongoing and experts are still understanding if there's an exact cause of the condition, ARFID is difficult to prevent. However, parents can play a big role in helping their children develop healthy eating behaviors. These include:
Expose your child to a variety of food and snack options as they grow up
Eat food together and create a supportive and fun environment for family meals
Schedule meal times
Pack snacks for your child to take to school
Gently encourage your child to try new foods without forcing them
Avoid blaming your child for negative eating habits and instead reward them for positive eating habits (such as finishing their meal or trying new food)
Talk to them about any stress or anxiety they might be experiencing about eating
If you're concerned about your child's eating habits, contact their pediatrician for extra support. Consider also reaching out for help on how to cope with an eating disorder or help a loved one with their diagnosis by reaching out to the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237.
Related Conditions
If you think you or your child may be experiencing disordered eating, there are other related eating disorders that share a few similarities with ARFID. These conditions include:
Anorexia nervosa: Eating very little food or avoiding foods altogether due to fear of gaining weight or the urge to lose weight
Bulimia nervosa: Overeating food and then forcing yourself to vomit or participating in excessive exercise to counteract the earlier food intake
Binge-eating disorder: Not being able to control how much food you're eating which can cause you to overeat and increase your risk of developing obesity
Living with ARFID
ARFID can be difficult to manage, as this condition can have serious effects on your physical and mental health. While you can't always prevent ARFID, parents and caregivers can role model positive eating behaviors to help their children develop healthy eating habits.
If you think that you or your child may be experiencing ARFID symptoms, it's in your best interest to speak to a healthcare provider for support. They can connect you with a psychotherapist and nutritionist to help you develop better eating habits and reduce the symptoms of the condition.
Frequently Asked Questions
Is ARFID a symptom of ADHD?
ARFID and ADHD are two separate medical conditions, but they can co-exist. ARFID involves difficulty meeting nutritional needs, while ADHD causes symptoms of inattention and hyperactivity. Those living with ADHD seem to have an increased risk of developing ARFID.
At what age is ARFID most common?
ARFID is still a relatively new diagnosis, so researchers are still learning more about this condition. Children, adolescents, and adults can all develop ARFID and this eating disorder may start as early as age five.
What is the difference between food aversion and ARFID?
People with food aversion may feel completely repulsed by a specific food, leading them to avoid the food altogether. Those with ARFID, however, may avoid or restrict certain foods or types of food. Food aversion is quite common during pregnancy, while children and all adults regardless of sex can develop with ARFID.
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