Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder, or ARFID, describes eating or feeding difficulties that is characterised by a significant difficulty around eating certain foods or food groups based on their sensory characteristics, such as texture, taste, smell, or colour, or another aversion based reason. ARFID is different from most other eating disorders (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Otherwise Specified Feeding & Eating Disorder) in that the person is not concerned about shape or weight. Instead, the restrictive eating is due to issues such as:

• Sensory aversions to particular tastes, textures, or smells (common with autism and Sensory Processing Disorder)
• Lack of interest in eating (can be due to anxiety, depression, physical illness, food allergies etc.)
• Low appetite

That said, it is important to understand that individuals do not fit into neat diagnostic categories, and individuals with ARFID may sometimes experience shape and weight concern, and individuals with other eating disorders may experience ARFID symptoms. 

At Exhale Psychology Centre, we practice from a neurodiversity affirming approach, and as such we prefer to see ARFID as resulting from feeding and eating differences rather than a disorder. 

Traditional approaches to ARFID, such as Cognitive Behavioural Therapy (CBT) and Exposure Therapy, have been widely criticised by the lived experience community, and research has demonstrated that they can result in iatrogenic harm through leading increased sensory sensitivity and sensory trauma.* Instead, a neurodiversity aims to incorporate these biological sensory differences, rather than challenge this. This involves aiming to meet nutritional needs in a way that is the least stressful for the individual as possible. 

To learn more about our neurodiversity affirming approach to ARFID, go to: https://www.exhalepsychology.com.au/post/safety

What are the Symptoms of ARFID?

ARFID involves a variety of symptoms that can vary from person to person. One of the most common symptoms is a severe limitation in the types of food a person will eat. This isn't simply a case of being a picky eater; people with ARFID may restrict their diet to such an extent that they exclude entire food groups, often leading to significant nutritional deficiencies. Forcing individuals with ARFID to eat foods aversive to them can be compared to the sensory experience of being made to eat raw chicken.

Individuals with ARFID may also display a heightened sensitivity to the taste, texture, smell, or appearance of certain foods. This can lead to an intense aversion and avoidance of these foods. They may also have an extreme fear of eating new or unfamiliar foods, a condition known as neophobia. Other symptoms include a lack of appetite or interest in food and distress at the prospect of eating. In severe cases, individuals may experience such significant weight loss or failure to gain weight that it interferes with their growth and development, particularly in children and adolescents. It's also not uncommon for patients with ARFID to experience gastrointestinal symptoms, such as abdominal pain or discomfort, in response to eating.

ARFID symptoms include:
‍- Avoidance or restriction of certain food groups or textures
- Persistent failure to meet nutritional and/or energy needs
- Lack of interest in food and selective eating
- Significant weight loss or failure to gain weight during growth
- Nutritional deficiencies, such as anaemia or low bone density
- Dependence on nutritional supplements or tube feeding
- Interference with quality of life

What Causes ARFID?

The causes of Avoidant Restrictive Food Intake Disorder (ARFID) are not fully understood, but they are likely to be a combination of genetic, psychological, and environmental factors. Some research suggests that ARFID might be associated with a heightened sensitivity to tastes and textures, which could be genetically determined. This sensitivity can make certain foods seem unpalatable or even disgusting, leading to avoidance.

Psychological factors can also play a role in the development of ARFID. For example, a traumatic event related to food, such as choking or vomiting, can lead to fear and avoidance of eating. Anxiety disorders and obsessive-compulsive disorder have also been linked to ARFID. Moreover, some autistic children (medically known as Autistic Spectrum Disorder) or children with Attention Deficit Hyperactivity Disorder (ADHD) may also develop ARFID, due to their difficulties with sensory processing.

Environmental factors, including family eating habits and cultural food practices, can also contribute to the development of ARFID. 

How Is ARFID Diagnosed?

Avoidant Restrictive Food Intake Disorder (ARFID) is diagnosed through a comprehensive evaluation by a mental health professional such as a psychologist. Diagnosis is based on the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 TR). These criteria include an avoidance or restriction of food intake that leads to significant weight loss, nutritional deficiency, dependence on nutritional supplements, or interference with quality of life.

The professional will conduct a detailed interview with the individual to understand their eating behaviours, attitudes towards food, and any related fears or anxieties. It's important to differentiate ARFID from other eating disorders like anorexia nervosa and bulimia nervosa, which are related to concerns about body shape and weight. In ARFID, the avoidance of food is not driven by these concerns, but rather by a lack of interest in food, or avoidance due to the sensory characteristics of food or past negative experiences around food. That said, some individuals with ARFID may additionally experience shape and weight concerns (but these will not be the foundation of the eating difficulties).

Medical tests may also be conducted to rule out any underlying medical conditions that could be causing the symptoms. These could include gastrointestinal disorders, food allergies, or metabolic diseases. Additionally, because ARFID is often associated with autism (medically known as Autistic Spectrum Disorder or ASD), ADHD, or with mental health difficulties such as anxiety, a comprehensive psychological assessment may also be needed.

Tips for Managing Avoidant Restrictive Food Intake Disorder

Managing Avoidant Restrictive Food Intake Disorder (ARFID) involves a multi-disciplinary approach that combines nutritional rehabilitation, psychotherapy, and sometimes medication. The goal of treatment is to expand the variety and amount of food intake, meet nutritional needs, and reduce anxiety and fear around food.

Here are a few tips that may be helpful in managing ARFID:

Seek professional help: Reach out to eating disorder treatment centres or mental health professionals who specialise in eating disorders. They can provide a comprehensive treatment plan that addresses the physical, emotional, and psychological aspects of ARFID.

Create a positive eating environment: Make meal times as stress-free and enjoyable as possible. Avoid forcing or pressuring the individual to eat, as this can increase anxiety and resistance.

Nutritional supplements: In some cases, nutritional supplements may be necessary to ensure that the individual is meeting their nutritional needs. This should be done under the supervision of a healthcare provider.

Family support: Family support and involvement helps in the treatment of ARFID, especially in children and adolescents, provided that the support is neuroaffirming and collaborative

How to Find Treatment for ARFID

As ARFID is so new, there is currently no evidence-based treatment suitable for all forms of ARFID. Consequently, treatment is best tailored to the individual's needs and may include:

Nutritional rehabilitation
A registered dietitian can help create a personalised meal plan to address nutritional deficiencies. Neurodiversity affirming dietitians will strive to meet nutritional goals within the individuals food preferences.

Specialist Supportive Clinical Management (SSCM)
SSCM uses an individualised and flexible approach with the goal of not just improving eating disorder symptoms but also enjoyment and quality of life

Adolescent Focused Therapy (AFT)
AFT encourages the adolescent to take ownership over their intake by selecting preferred foods and communicating in what ways they need support.

Unfortunately, treatment for ARFID is not available under the Eating Disorder Management Plan (EDMP), but ARFID can be treated under the Mental Health Care Plan (MHCP), the Team Care Arrangement (TCA), private health insurance, and when paired with level two autism, under National Disability Insurance Scheme (NDIS).

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