Avoidant-Restrictive Food Intake Disorder (ARFID)

What is Avoidant-Restrictive Food Intake Disorder?

Avoidant-restrictive food intake disorder (ARFID) is characterized by patients being disturbed by, eating less of, or refusing to eat certain kinds of food. While some people don’t eat because they simply don’t have adequate access to potable water and palatable, not-rotten food, those afflicted by ARFID simply choose not to eat as much or consume certain types of food, at all.

The most current, 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, often shortened to DSM-5, recognizes ARFID as a valid mental disorder. Until recently, this condition was medically known as selective eating disorder.

Others call it food neophobia, where neophobia is defined as a fear of new or unfamiliar people, places, or things. Either way, this condition affects infants, children, adolescents, and adults alike. People afflicted with ARFID may only eat select brands of food, like Kraft or Great Value, or specific dishes, like chicken fingers or apples. Patients may only eat hot, cold, creamy or crunchy foods etc. as well.

Symptoms of ARFID

The frequently-cited DSM-5 features four main criteria for diagnosing avoidant-restrictive food intake disorder, the first of which has four sub-criteria.

Those with the ARFID must exhibit all four of the below characteristics. The first criteria is met by meeting just one of its four sub-criteria.

  1. Suffers disturbance in feeding or eating, evidenced by one of the four following sub-criteria: (a) Substantial weight loss, or, in children otherwise expected to grow, a lack of weight gain
    (b) Nutritional deficiency
    (c) Must depend on supplements or a feeding tube
    (d) Significant psychosocial interference
  2. Suffers disturbance not related to food unavailabilities or adherence to religious, social, or cultural norms
  3. Suffers disturbance unrelated to anorexia or bulimia
  4. Suffers disturbance that is not accurately, appropriately explained – including a mental disorder or medical condition that is not ARFID, or when exhibiting itself as a symptom of another disorder

The Diagnostic and Statistical Manual of Mental Disorders used to split eating conditions that now fit under the diagnosis of ARFID into three separate diagnoses. However, current diagnosis, regardless of its specific manifestation, fits under the catch-all of avoidant-restrictive food intake disorder.

While they aren’t necessarily symptoms, here are several warning signs to be mindful of in monitoring your child’s everyday behavior.

Sufferers might experience physical discomfort or exhibit various symptoms related to eating problem foods without having a diagnosable health condition. They might also not be interested in eating food in general, and exhibit perpetual lack of appetite.

Children and adolescents may voice their fears of choking, vomiting, or having an allergic reaction to certain types of food, or food in general. They also might not eat in front of friends, at school, or in public, opting to only eat at home or in private, even if it means starving themselves.

While virtually every child is a picky eater, opting to eat their favorite chicken nuggets or french fries as often as possible, selective tastes are usually resolved by late childhood or adolescence. If children don’t resolve such issues, it may be a sign of avoidant-restrictive food intake disorder.

Similarly, be wary of children whose tastes in foods become more selective over time. Most children experience opening up to other foods as they grow older. Those who become pickier may suffer from ARFID.

Children – and adults – suspected to have ARFID exhibit several unique characteristics. They may reject particular brands or only consume food of a specific brand. Likewise, people with ARFID may only eat certain food groups, or reject all food groups except for one. Foods of certain colors may be rejected by those with this issue, as well as those of various temperatures or textures.

Some people simply don’t like eating certain foods, and will not outwardly exhibit any medically-recognized symptoms. However, others may gag after eating or simply being in the presence of certain foods, and they may vomit, dry heave, or have other gastrointestinal issues.

ARFID Causes

While there are several possible explanations for ARFID, no particular causes have been identified as causing this condition. Eating disorders, like ARFID, often run in families, predisposing offspring to similar problems. ARFID also roots from sociocultural factors, in which some societies may not approve of eating certain types of food. For example, eating pork is frowned upon in many middle eastern countries. As such, people from that area who migrate to other parts of the world may still refuse pork, even though it’s acceptable in their new homes.

People with developmental disabilities often have some kind of feeding disorder. Those affected by autism usually resist new things and aren’t receptive to modifying their behavior patterns. While autism sometimes improves after childhood, some people are affected by autism throughout their entire lives. These people are more likely to have ARFID or other eating orders.

Anxiety manifests itself in a variety of ways, including ARFID. People sometimes avoid eating food because they’re worried about gaining weight or becoming contaminated by microorganisms on food. Some with anxiety problems may refuse to eat new foods or those with certain characteristics. Others may have had bad experiences with specific types of food during childhood, creating a response to avoid that food throughout their lives because they associate it with those negative experiences.

This eating disorder is often found in comorbidity with other issues, including sensory-based avoidance, a problem that many people on the autism spectrum disorder have. Others with ARFID might not be interested in eating a specific food, instead opting to eat something else that’s just as available. People with phobias of specific behaviors, objects, or processes may feature food phobias in conjunction with other, already-existing phobias.

ARFID hasn’t been shown to root from any one cause. Some people with this eating disorder may suffer from two or more causes outlined above, furthering necessary treatment needed to remedy the issue.

Treatments of ARFID

No medications have been developed specifically for avoidant-restrictive food intake disorder. However, those suffering from obsessive compulsive disorder may benefit from taking prescribed SSRI antidepressants, tricyclic antidepressants like Anafranil, or antipsychotics. Patients with anxiety disorders can benefit from selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, beta-blockers, buspirone, or benzodiazepines like Xanax or Valium, although these last drugs should be reserved for serious issues not resolved by other medications.

Although many medications can be used to lessen the symptoms of this condition, a majority of patients will benefit further from psychotherapy. There are several types of cognitive behavioral therapy (CBT), a popular form of psychotherapy that strives to meet goals of patients and modify their behaviors or ways of thinking that contribute towards mental health issues.

Exposure therapy is often used in those suffering from phobias, OCD, or anxiety disorders. This behavior therapy hopes to seed thoughts in patients’ minds that the foods they fear are not actually harmful. It involves exposing patients to foods they fear and discussing with them what they think is so scary about them. Mental health professionals ease those suffering from ARFID into exposure therapy, rather than forcing them to eat certain foods, touch them, or smell them. Also, this form of CBT is very different from simply exposing sufferers to food around the home or at school, as doing so may further manifestations of ARFID.

Family-based therapy is another common route taken for mitigating ARFID’s symptoms. This form of CBT involves family members helping patients deal with problem foods at home or other places outside of mental health facilities. Family members agree not to force any foods on sufferers, although they do ease them into being around foods, and, hopefully, eating them. They should also accompany those dealing with ARFID along to mental health appointments, learning important information from service providers.

Dialectical behavior therapy (DBT) is a relatively new form of psychotherapy that encourages patients to become cognizant and self-aware of the negative behaviors they engage in. DBT also helps patients understand their emotions and properly regulate them when exposed to problem foods. This psychotherapy is effective in calming down patients who freak out or have anxiety attacks when they smell, see, or even think about particular foods, improving their behavior in social settings.

Motivation to change therapy creates senses of urgencies in patients that are resistant to receiving professional mental health treatment. Even when they understand their behaviors might be unhealthy or problematic, they still aren’t open to changing their lifestyle. Mental health professionals help patients build motivation, in turn facilitating a more effective and speedier treatment process.

Psychotherapy usually requires meeting at least once every week with a professional for extended periods of time. Some people with avoidant-restrictive food intake disorder require only a few appointments to overcome their issues, while others may need long-term therapy lasting years to mitigate their symptoms. When combined with other forms of cognitive behavioral therapy, motivation to change therapy helps quicken the mental health treatment process, giving people who suffer from this disorder a strong reason to overcome their problems.

Most patients with mental health issues, related to ARFID or not, find that a combination of prescription medication and psychotherapy works most effectively.

ARFID Prevention

The causes of ARFID are not thoroughly understood, with the fields of neurology and psychotherapy far behind where they should be today. As such, it’s difficult to prevent children, adolescents, and even adults from succumbing to the throes of avoidant-restrictive food intake disorder.

Patients who suffered from this issue during their childhood, but were able to overcome it, should engage in regular psychotherapy sessions to stave off ARFID’s potential re-manifestation. Those with former food phobias or anxieties related to particular foods should try their best to expose themselves to those foods throughout everyday activities. Avoiding foods that once created problems for individuals and their families will do nothing positively for ARFID, and can only make it worse.

If a patient starts prescription medication in combination with psychotherapy, they should take that medication until a healthcare professional recommends otherwise. Many medications for anxiety, phobias, and avoidant-restrictive food intake disorder don’t cause dramatic changes in euphoria or mood when taken. As such, it’s easy for patients to forget just how important those medications are. It might be ideal to continue such medications throughout one’s lifetime indefinitely, especially if their use is not associated with any significant health issues.

Many people aren’t familiar with avoidant-restrictive food intake disorder. Parents whose children develop the issue may believe that their children are simply picky eaters, rather than having a diagnosable, treatable mental health condition. With most conditions, early intervention and treatment is often more beneficial than delaying medication, psychotherapy, and other forms of treatment. If you feel your child may be suffering from ARFID, don’t hesitate to contact your physician and mental health professional immediately.

Last Reviewed:
September 25, 2017
Last Updated:
November 14, 2017
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