ARFID: Understanding Avoidant/Restrictive Food Intake Disorder

Avoidant/Restrictive Food Intake Disorder, commonly abbreviated as ARFID, is a recently coined eating disorder. ARFID is majorly characterized by limiting food intake. This eating disorder usually develops among younger children, but ARFID in adults is also quite common.

At the NuView Treatment Center, we provide comprehensive, specialized treatment and care for our clients suffering from ARFID. Our multidisciplinary approach focuses on identifying and understanding the unique challenges of each person, addressing underlying psychological factors contributing to the disorder, and promoting healthy eating patterns.

What is ARFID?

ARFID meaning stands for Avoidant/Restrictive Food Intake Disorder. It is an eating disorder, mainly characterized by limiting the quantity and types of food one consumes. In fact, ARFID is sometimes also called “selective eating disorder,” as it involves choosing some food items that are considered okay or good to eat. Moreover, ARFID also involves elaborate behavioral patterns when it comes to eating, like consuming food in a certain order.

ARFID also has different types:

• Avoidant – With the avoidant type, a person avoids certain types of food based on their sensory features. For instance, textures, colors, etc.
• Aversive – With the aversive type, a person refuses to eat food given the adverse reactions they may lead to, like vomiting, choking, and so on. These are usually fear-based reactions.
• Restrictive – With the restrictive type, a person shows a general disinterest in food. Low appetite, forgetting to eat meals are some signs of the restrictive type.
• ARFID “plus” – It is when there is more than one type of ARFID present, and a person may develop signs of other eating disorders like anorexia nervosa wherein there are concerns regarding body image and weight.
• Adult ARFID – Usually, ARFID develops during infancy and early childhood, however, it may persist during adulthood as well.

ARFID has only recently come to light. However, it requires proper attention, treatment, and care. Otherwise, it can lead to dangerous, life-threatening health conditions.

Symptoms of ARFID

There are certain signs and symptoms of avoidant/restrictive food intake disorder. These help identify the eating disorder and also differentiate it from other conditions, like picky eating. The ARFID symptoms to look out for are as follows:

• Extremely limiting the quantity and type of food one eats.
• Avoiding foods with certain smells or textures and only consuming food with a certain kind of smell, taste, and texture.
• Fear of consequences after eating, like vomiting and choking.
• Abdominal pain or cramps
• Constipation
• Lethargy
• Lightheadedness/fainting
• Irregular menstrual cycles
• Low body temperature
• Overall weakness
• Loss of interest in food
• Significant weight loss

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Causes and Risk Factors of ARFID

The exact reasons and risk factors of avoidant/restrictive food intake disorder are not known, however, experts believe that it can develop as a consequence of a combination of factors:

• Genes
• Temperament
• A triggering event, like choking or other trauma
• Certain pre-existing medical conditions, like eosinophilic esophagitis, gastroesophageal reflux diseases, and other allergies.
• Fear and anxiety

ARFID in Children vs. Adults

Avoidant/restrictive food intake disorder generally begins among young children, and this differs from ARFID in adults. In fact, the National Eating Disorders Association reports that nearly 0.5% - 5% children and adults suffer from ARFID.

Certain things to consider regarding ARFID among children are as follows:

• Selective eating among children, especially as foods with certain smells, tastes, and textures can lead to strong, negative experiences. These negative experiences lead to extreme fear of unfamiliar foods.
• On the other hand, some children generally have a low appetite and lack interest in eating. The reason being, food is not as rewarding or barely at all.
• Finally, some children can be scared of some of the consequences of eating, like vomiting or choking.

Usually, children with ARFID fall in one or more of the above-mentioned three categories. Among children, ARFID is usually confused with ordinary picky eating. However, ARFID is very different from picky eating in that it can lead to severe consequences that require medical attention. Moreover, children with ARFID are usually underweight, have a limited diet, and even experience problems in their school and social lives. In fact, many can also suffer from anxiety, obsessive-compulsive disorder, autism spectrum disorder, or attention-deficit/hyperactivity disorder.

Now, while ARFID generally develops during infancy and childhood, it can persist during adulthood as well. Some things to consider in cases of ARFID in adults are as follows:

• A family history of eating disorders.
• Aversion to foods with certain smells, tastes, and textures.
• Traumatic experience involving food, like choking, force-feeding, etc.
• Fear of the dangers food can inflict on the body.
• An underlying condition that can contribute to the development of ARFID, like anxiety disorders or depression.

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ARFID vs. Anorexia: Key Differences

Avoidant/restrictive food intake disorder or ARFID and anorexia nervosa fall under the umbrella of eating disorders. There are some similarities that can lead to them being mistaken for the other. So, certain differences to consider between ARFID and anorexia are as follows:

– ARFID is characterized by a general disinterest in food while anorexia is characterized by control over food and fixation on diet.

– The motivations for behaviors behind ARFID and anorexia are also different. In that, ARFID involves behaviors driven by fear of consequences associated with food, like vomiting or choking, and also aversion to certain smells, tastes, and textures. 

Meanwhile, behaviors behind anorexia are driven by extreme fear of weight gain and an obsession with thinness.

– ARFID has an early onset, as early as infancy and childhood, and is more common among males than females. 

Meanwhile, anorexia can develop at any age and is more common among females than males.

While ARFID and anorexia are different, there are also certain similarities between them that cannot be overlooked:

– ARFID and anorexia are characterized by limited food intake, which can lead to significant weight loss and malnutrition.

– ARFID and anorexia diminish nutrient intake, so they can lead to similar health complications like low energy, impaired immunity, low body temperature, digestive troubles, sleep difficulties, lowered focus, and hair loss.

– ARFID and anorexia overlap with anxiety disorders and obsessive-compulsive disorder. They also have strong links with autism spectrum disorder.

Health Risks and Complications of ARFID

Avoidant/restrictive food intake disorder can lead to a myriad of health risks and complications. These can even require medical attention to prevent the person’s health from deteriorating any further. Some of these risks and complications are as follows:

• Poor growth
• Delayed puberty
• Lack of nutrients, vitamins, and proteins, which may require tube feeding and providing the necessary nutrient supplements
• Dehydration
• Anemia
• Weakened bones, also known as osteoporosis
• Weakened muscles
• Irregular or no menstrual periods
• Low blood pressure
• Slow pulse rate

Treatment Options for ARFID

Treatment for avoidant/restrictive food intake disorder first involves early and accurate diagnosis, for which the healthcare practitioners will check for limited food intake (to the extent that one might rely on nutrient supply and tube food intake), and rule out limited food intake for religious/cultural reasons, body image reasons, and other medical reasons.

The main treatment for ARFID is cognitive behavioral therapy or CBT, as it will focus on identifying and changing maladaptive thinking and behavioral patterns that adversely impact food intake and health, reduce anxiety around food, and deal with other challenges like with certain smells, tastes, and textures of food.

Treatment for ARFID also addresses nutrient intake, and in maintaining optimal weight and health. In some cases, a feeding tube that allows food to go to the stomach or small intestine will be suggested as it will ensure that nutrients get into the body. Moreover, antidepressants and antipsychotics are also prescribed to increase appetite.

Overall, treatment options for ARFID seek to address the underlying reasons for the eating disorder and prevent/address the health complications arising from the same.

Read more about Nutrition In Recovery here.

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Frequently Asked Questions

Is ARFID just autism?

No, ARFID is an eating disorder, while autism is a developmental disorder. ARFID is strongly linked with autism, but they are not the same.

What are the 5 types of ARFID?

The 5 types of ARFID are avoidant, aversive, restrictive, ARFID “plus”, and adult ARFID.

What age is ARFID most common?

ARFID generally develops during infancy and early childhood.

Is ARFID part of OCD?

ARFID is closely linked with obsessive-compulsive disorder (OCD), however, it is not a part of OCD.