What is Avoidant Restrictive Food Intake Disorder?

Avoidant Restrictive Food Intake Disorder (ARFID), was previously referred to as Selective Eating Disorder. Avoidant restrictive food intake disorder is slightly similar to anorexia as both involve limitations of food consumed, though ARFID does not involve stress about body image.

Most children are picky eaters at one time or another, but a child with ARFID is so picky they do not consume enough calories to grow, develop and maintain proper bodily functions. Children with ARFID will experience delayed weight gain and vertical growth, and adults will experience weight loss. This disorder can cause problems at school or work because of difficulties eating around others and the extra time they may need to eat.

ARFID is different from other eating disorders that stem from poor body image. ARFID patients have no desire to lose weight. This disorder does not apply to individuals who participate in random fasting rituals for religious reasons.

Causes and Symptoms of ARFID

Many contributing factors cause ARFID, such as biological, psychosocial, and environmental influences. A child with ARFID already in their genetic makeup may be triggered by a traumatic event or environment to obtain a fear of certain foods. This may occur after choking on an item or vomiting directly after eating an item. This situation will cause a person who is prone to ARFID to restrict that food, as well as similar foods, from their diet altogether.

An individual’s sensory experience with food can stray them away from many foods due to their texture, relatable smell, sound when being eaten, or the visual appearance. Many types of anxiety disorders and autism may also aggravate ARFID symptoms.

Psychological Symptoms

ARFID patients usually suffer from psychological symptoms which can affect their daily lives. Many of the psychological symptoms include the individual not being able to fathom eating certain foods due to a bad experience with the food or an irrational fear of eating that specific food. These psychological symptoms include:

  • Fear of choking or vomiting
  • Avoid certain textures of food
  • Only eats certain textures of food
  • Dramatic weight loss
  • Fatigue or excess energy
  • Lack of appetite
  • Dramatic restriction of types of food they will eat
  • Dress in layers to stay warm or to hide thinning figure
  • No body image disorder

Physical Symptoms

Because ARFID, like anorexia, involves a lack of nutritional needs, both disorders have similar physical signs and medical consequences. A few physical symptoms of ARFID include:

  • Difficulty concentrating and sleeping
  • Menstrual irregularities in women, or loss of period in teen girls
  • Stomach cramps
  • Muscle weakness
  • Dry and brittle hair and nails
  • Poor immune functioning
  • Dizziness and fainting
  • Cold hands
  • Slow wound healing

How is Restrictive Food Intake Disorder Diagnosed?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnosing manual used by mental health professionals, ARFID is diagnosed when the following is observed:

  • Significant nutritional deficiency
  • Weight loss
  • Interference with ideas of certain foods being harmful
  • Possible dependence on nutritional supplements

Avoidant restrictive food intake disorder is not related to the lack of available food. This is also not a typical diagnosis for an individual with disturbances in body image causing restrictive eating.

Who Is at Risk for Restrictive Food Intake Disorder?

As with all eating disorders, the risk factors for ARFID involve a range of genetic and psychological issues. The factors interact differently from one person to the next which means two individuals with ARFID can have very different experiences and symptoms.

Individuals diagnosed with autism are more likely to develop ARFID. Children who do not outgrow their normal, picky eating habits are also more likely to develop ARFID. Additionally, children who suffer from anxiety or other psychiatric disorders have a greater chance of having ARFID.

ARIFD in Children

The onset of Avoidant Restrictive Food Intake Disorder usually occurs during childhood. It is more dominant among children and young adolescents and less common in older teens and adults. No matter the age of the onset, ARFID occurs throughout the lifespan and affects men and women. Most adults with ARFID have had symptoms like what they experienced in childhood. If ARFID onset takes place in adolescence or adulthood, it is usually a result of a negative experience from certain foods, such as vomiting or choking.

The younger the person is at the onset of the disorder, the longer the duration of the illness.  Patients with ARFID have a lower body weight, suffering similar risk for medical problems like those that come with anorexia nervosa.

ARFID children often report an increase in worries, similar to those found in children with obsessive-compulsive disorder and generalized anxiety disorder. Also, children frequently express more concerns related to their physical symptoms, such as nausea.

ARIFD in Adults

ARFID symptoms are becoming more common in adults due to fad dieting that eliminates one or more food types from the diet. Similar to these diets, ARFID in adults tends to have a small range of foods that they are willing to eat, sometimes less than 20 food items. These would be adults who refuse to try new foods or report higher rates of texture or sensory issues to foods. These diets, with strict rules due to weight restriction, are linked to the onset of ARFID in adults.  Restrictive food intake in adults has also been associated with greater rates of depression and obsessive-compulsive disorders.

Avoidant Restrictive Food Intake Disorder Statistics

Unlike other eating disorders, men are more commonly diagnosed with ARFID. The disorder is more common in children and young adolescents and less common in adulthood. It affects approximately 5 percent of children in the United States. ARFID is often associated with a co-occurring mental disorder, around 75 percent with anxiety or obsessive-compulsive disorder and 20 percent show to have an autism spectrum condition. Nearly half of children with ARFID report having a fear of vomiting or choking on certain foods and 20 percent say they avoid certain foods because of sensory issues such as the texture of the sound it makes when eating it.

ARFID Treatment

There are three main areas to focus on the treatment of avoidant restrictive food intake disorder: medical treatment, nutrition counseling, and behavior therapy.

Medical Treatment: The first priority in ARFID treatment is to resolve any serious health issues, such as malnourishment, depression, heart issues, as well as addiction and other co-occurring disorders.

Nutritional Counseling: Some of the most important first steps to ARFID treatment include evaluating the individual’s nutritional needs, history and relationship with food, and understanding the development of eating disorder behaviors. With the understanding of their food intolerances, a personalized meal plan can be devised and used throughout treatment of ARFID and after recovery.

Counseling and Therapy: This treatment method focuses on the individual’s behavior and thinking process that hinders their recovery. Through individual and group settings, patients will learn to identify and replace any negative thoughts with healthier ideas about themselves and their relationship with food. Counseling can help patients move past their fears of specific foods and allow them to deal with tough emotions, stress, and relationship problems in a productive way.

Family-Based Treatment

Family therapy is one of the best methods of treatment for adolescents with ARFID. For adolescents, the dependence on families during the recovery process has great significance for those with eating disorders. In order for family-based therapy to work, the family must be supportive of the individual’s treatment and be willing to help with recovery. Family-based therapy is a selective eating disorder treatment that children can benefit from throughout recovery.

ARFID and Co-Occurring Conditions

Co-occurring disorders refers to two disorders occurring at the same time. When individuals are only treated for their specific eating disorder, ARFID, their depression, anxiety, substance abuse or other disorder goes untreated. This is problematic because the other disorder could very well be the underlying issue beneath the eating disorder. If the underlying problem remains untreated then the individual will most likely relapse and fall back into their ARFID behaviors.

ARFID and Anorexia Nervosa

When ARFID symptoms present themselves in an adult or older adolescent, it is possible that some individuals develop another eating disorder, such as anorexia nervosa. As they age and see the benefit of a thin, socially desired, figure due to their restrictive food intake, they may push their limits even more to retain the preferred appearance. On the other hand, anorexia may arise due to the poor body image gained through depression or anxiety caused by their malnutrition and other health issues that are symptoms of ARFID.

ARFID and Substance Abuse

Substance abuse is a common co-occurring disorder and can lead to severe addiction and dependence. Like all eating disorders, there is an underlying disorder behind ARFID most of the time, such as anxiety, fear, depression and OCD. These disorders can cause compulsive behaviors and substance abuse can be very dangerous for these individuals, possibly resulting in death. Because individuals with ARFID are often malnourished, they are affected more medically by alcohol and drug use than those without an eating disorder.

Drug Abuse as a Hindrance to ARFID Treatment

The recovery process for people living with ARFID and a substance use disorder should include treatment for the two disorders simultaneously. Improvements in only one condition often neglect the other, if the other condition is not treated simultaneously. Because substance abuse often amplifies impulsivity and mood instability, continued substance use can make ARFID recovery harder. Treatment must enable individuals to heal from substance abuse and eating disorders simultaneously. For all patients with co-occurring ARFID and substance abuse disorder, detoxification is essential. Detox should be followed by continued abstinence from alcohol or drugs before recovery can start.

Effects of Substance Abuse on ARFID Symptoms

Eating disorders and substance abuse are both considered mental illnesses and are a result of a combination of factors including genetics, biology, experiences and environmental influences.   About half of all individuals with an eating disorder also struggle with substance abuse.  The risk for substance use with ARFID is increase due to the malnutrition the individual already experiences. Feelings of depression and anxiety may be increased with substance abuse, making the individual’s disorder difficult to control if seeking treatment.

Statistics on ARFID and Drug Abuse

Approximately 35 percent of individuals who abused alcohol or other drugs have also had eating disorders. ARFID patients are usually children and do not have substance abuse issues. However, patients who continue experiencing the disorder into adulthood have a greater chance of abusing drugs or alcohol than people who do not experience the disorder. The substances most frequently abused by individuals with avoidant restrictive food intake disorder include caffeine, tobacco, marijuana, alcohol, appetite suppressants (amphetamines), heroin and cocaine.

If you or a loved one have a substance use disorder and co-occurring disorders, The Recovery Village can help. People who struggle with addiction and ARFID symptoms can receive help from one of The Recovery Village facilities that are in five states throughout the country. If you or a loved one lives with a substance use disorder and avoidant restrictive food intake disorder, call The Recovery Village to speak with a representative and begin treatment today.

Avoidant Restrictive Food Intake Disorder (ARFID)
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