An Introduction to ARFID: Avoidant Restrictive Food Intake Disorder

ARFID – More than just picky eating!

Have you, your child, or a loved one been dubbed as an “extreme picky eater”? While certain levels of picky eating can be normal, it’s possible that an individual’s lack of interest in eating, avoidance, or fear of food could indicate a more serious issue.

In this blog post, we will explore some of the basics of ARFID (Avoidant Restrictive Food Intake Disorder), including what it is, approaches to ARFID treatment, and how a Dietitian can help. If you suspect that you or someone you know may have ARFID, seeking a further assessment from a Medical Doctor, Psychiatrist, or Psychologist is recommended.

What is ARFID?

ARFID stands for Avoidant Restrictive Food Intake Disorder. It is a type of eating disorder which became more clearly defined when it was introduced in the 5th edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) in 2013 (American Psychiatric Association, 2013). As described in Brigham et al. (2018), ARFID is characterized by either an extreme avoidance of food (due to the sensory characteristics of food such as taste, smell, texture, colour…etc.), a lack of interest in eating, or even a fear of choking. As a result, individuals living with ARFID are usually quite restricted with their intake in terms of both variety and volume of food.

According to the American Psychiatric Association (2021), a diagnosis of ARFID requires that the food restriction must result in other health implications, such as nutritional deficiencies, weight loss, poor growth and/or reliance on nutritional supplements or tube feeds. Beyond the impact on nutrition status, they also note that individuals may also experience impairments in social functioning due to their inability to participate in social activities involving food.

Who is most at risk for developing ARFID? How does it develop?

While ARFID can be diagnosed in any individual at any age, a study by Fisher et al. (2014) has shown that it is more likely to affect males and young children. According to the National Eating Disorders Association (2018), individuals living with neurodiversity such as Autism Spectrum Disorder or ADHD are also more likely to develop ARFID. Currently, the cause for the development of ARFID is unknown, though Brigham et al. (2018) predict that it could be a combination of both genetic and environmental factors. Individuals who have had a bad or traumatic experience with food may also be predisposed to developing ARFID.

How is ARFID different from other Eating Disorders?

Unlike eating disorders such as Anorexia Nervosa or Bulimia Nervosa, the National Eating Disorder Information Centre (2022) highlights that individuals living with ARFID do not engage in restrictive eating patterns due to a fear of weight gain, dieting or body dissatisfaction. They also note that the food restriction should not be the result of limited or lack of access to food or another medical condition.

What is the treatment process for ARFID?

A multidisciplinary team approach is recommended when pursuing treatment for ARFID given that it can have significant implications on an individual’s physical and mental health. A treatment team should involve a Medical Doctor and a mental health provider such as a Therapist or Psychologist, and may also include a Registered Dietitian, a Gastroenterologist, an Occupational Therapist and Speech Language Pathologist (Brigham et al., 2018). While the severity of each case may vary in terms of the interventions needed, in general, the treatment for ARFID may include the following:

1. Achievement and maintenance of a normal body weight

2. Correction of any nutritional deficiencies

3. Reducing anxiety/fear related to food and eating

4. Increasing food variety in the individual’s diet

While a study by Couturier et al. (2020) reviews some of the current Psychological and Pharmacological interventions for treating ARFID, more research is needed to further understand how to best support individuals living with this eating disorder.

How can a Dietitian Help?

Having a Dietitian as part of your treatment team is critical to ensure proper assessment, evaluation, and monitoring of you or your loved one’s diet. In addition to providing guidance on potential nutrient deficiencies, they can offer support in other areas such as:

1. Dietary strategies for meeting nutrient needs

2. Implementing and adjusting tube feed care plans

3. Guidance on the reintroduction of fear/unfamiliar foods

4. Simplifying the meal planning and preparation process

5. Creating a safe and supportive environment for trying new foods

6. Reducing mealtime challenges for families with children

A Registered Dietitian will ensure that you are involved in the treatment process every step of the way, including the decision making on what foods or mealtime situations you would like to challenge first.

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References  

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

2. American Psychiatric Association. (2021, March). What are eating disorders? Psychiatry.org – What are Eating Disorders? Retrieved October 24, 2022, from https://psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders

3. Brigham, K. S., Manzo, L. D., Eddy, K. T., & Thomas, J. J. (2018). Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. Current pediatrics reports, 6(2), 107–113. https://doi.org/10.1007/s40124-018-0162-y

4. Couturier, J., Isserlin, L., Norris, M., Spettigue, W., Brouwers, M., Kimber, M., McVey, G., Webb, C., Findlay, S., Bhatnagar, N., Snelgrove, N., Ritsma, A., Preskow, W., Miller, C., Coelho, J., Boachie, A., Steinegger, C., Loewen, R., Loewen, T., Waite, E., … Pilon, D. (2020). Canadian practice guidelines for the treatment of children and adolescents with eating disorders. Journal of eating disorders, 8, 4. https://doi.org/10.1186/s40337-020-0277-8

5.Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 55(1), 49–52. https://doi.org/10.1016/j.jadohealth.2013.11.013

6. National Eating Disorders Association. (2018, February 22). Avoidant restrictive food intake disorder (ARFID). National Eating Disorders Association. Retrieved October 24, 2022, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid

7. National Eating Disorder Information Centre. (2022). Avoidant and restrictive food intake disorder. NEDIC. Retrieved October 24, 2022, from https://nedic.ca/eating-disorders-treatment/avoidant-and-restrictive-food-intake-disorder/