Diseases and Disorders

What is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder. It’s an eating disorder that causes people to avoid certain foods or eat very little.

People who have ARFID often feel anxious when they try new food items. They may also be afraid of gaining weight if they eat too much.

There are many types of ARFID. Some people only have one type, while others have over one.

What is ARFID or Avoidant/Restrictive Food Intake Disorder?

Avoidant / restrictive food intake disorder (ARFID) is an eating or feeding disturbance that is characterized by a persistent failure to meet appropriate nutritional and energy needs. This can lead to one or more of the following issues:

  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in a child)
  • Significant nutritional deficiency
  • Dependence on oral nutritional supplements or enteral feeding (the delivery of a nutritionally complete feed, containing protein, carbohydrate, fat, water, minerals and vitamins, directly into the stomach, duodenum or jejunum)
  • Marked interference with psychosocial functioning

Often associate aRFID with a psychiatric co-morbidity, especially anxiety and obsessive-compulsive disorder. The true prevalence of ARFID is unknown, because of a lack of understanding of the diagnosis. We know ARFID affects both genders and is more common in children and young adolescents; however, it can occur in late adolescence and adulthood as well. 

It’s also important to understand that ARFID is not;
  • Associated with body image issues or any abnormalities related to how one perceives their body weight or shape
  • The result of a lack of food
  • A culturally sanctioned practice
  • Explained by another medical or mental disorder (“If we treat that issue, then this eating problem will go away,”).

The health risks and developmental consequences for children and adolescents with ARFID can be serious and long lasting. As a further complication, ARFID is difficult to accurately diagnose. Assessment by a clinical professional trained in the disorder is essential.

Difference between ARFID and anorexia

ARFID is often confused with anorexia nervosa because weight loss and nutritional deficiency are common shared symptoms between the two disorders. However, the primary difference between ARFID and anorexia is that ARFID lacks the drive for thinness that is so common for individuals with anorexia. 

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

  1. Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
  2. Menstrual irregularities missing periods or only having a period while on hormonal contraceptives (it does not consider this a “true” period)
  3. Difficulties concentrating
  4. Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  5. Postpuberty female loses menstrual period
  6. Dizziness
  7. Fainting/syncope
  8. Feeling cold all the time
  9. Sleep problems
  10. Dry skin
  11. Dry and brittle nails
  12. Fine hair on body (lanugo)
  13. Thinning of hair on head, dry and brittle hair
  14. Muscle weakness
  15. Cold, mottled hands and feet or swelling of feet
  16. Poor wound healing
  17. Impaired immune functioning

Difference between ARFID and picky eating

In developing children, the range of types, textures, and amount of food eaten progresses until age six or seven. At around this age, many school-age children become more “picky” and favor carbohydrates, which fuel growth. Usually, by puberty, both appetite and eating flexibility increase, accompanied by a return to a wider range of intake and greater balance within and across meals. Many parents report concern around their child’s eating at a young age, but are told by others it is “normal” and not to worry about it.

Parents of children with ARFID often notice challenges in their child’s range of intake as early as 1 year of age. These children may show a strong preference for a narrow range of foods and may refuse to eat anything outside this range. Parents often report that their children with ARFID had trouble transitioning to mixed foods from single baby foods. They also often report they had a specific sensitivity to textures such as “mushy” or “crunchy.”

It can be hard for parents and health professionals to distinguish “normal pickiness” in a child from a diagnosis of ARFID. Eating behaviors and flexibility may exist on a continuum between those who are adventurous in trying new foods and those who prefer a routine diet. Most children can still meet their nutritional needs despite some pickiness.

10 common signs and symptoms ARFID eating disorder

  1. A short list of acceptable foods
  2. Eating foods of similar characteristics, such as crunchy in texture, or colorless
  3. Preferences for particular food preparation methods
  4. Avoidance of vegetables, protein sources (meat, beans, etc.), fruit
  5. Eliminates foods and never gains them back into the diet
  6. Poor weight gain and growth (child may also be of normal weight and growth)
  7. Nutrient deficiencies (iron, vitamin A, and vitamin C most common)
  8. Skips one or more entire food groups
  9. Becomes emotional or shows stress around unfamiliar foods
  10. Food limitations negatively impact normal social behaviors

6 Major risks and complications of ARFID

  1. Co-occurring anxiety disorders
  2. Failure to gain weight (children)
  3. Gastrointestinal complications
  4. Malnutrition
  5. Weight Loss
  6. Developmental delays

Causes of ARFID eating disorder

ARFID does not have one root cause; instead, researchers and clinicians have explored a variety of potential contributing factors, such as biological, psychosocial, and environmental influences.

  • Environmental or psychosocial situations may trigger a child who is already predisposed to ARFID, such as a traumatic event.
  • Since there can be disrupted eating patterns among other mental illnesses, co-occurring diagnoses such as anxiety disorders, developmental disabilities, and autism may exacerbate may also be present.
  • In autism and other developmental disabilities, an individual’s relationship to their body and senses is already very heightened.

Treatment for ARFID

The good news is that recovery is possible! Treating Avoidant / Restrictive Food Intake Disorder requires highly specialized care with an expert treatment team that is specifically trained in this illness, as well as any co-occurring illnesses. Speak to your doctor or pediatrician.

Learn about liver disease

  1. Is Arfid A Mental Illness?

    ARFID was previously known as a selective eating disorder (SED) but was renamed to more accurately encompass the disorder. ARFID often co-occurs with other mental health diagnoses, such as anxiety disorders or obsessive-compulsive disorder.

  2. Is Arfid Real?

    One of the eating disorders the world is less familiar with is known as Avoidant Restrictive Food Intake Disorder (ARFID), and has only recently become a recognized disorder. Often mistaken for “picky eating,” this disorder is very real and can lead to severe malnutrition and medical consequences.

  3. Is Arfid Serious?

    ARFID can cause serious health issues. One of the most common results of ARFID is significant weight loss, or failure to gain weight and grow, for those who should be in a growth spurt. Significant levels of nutritional deficiency may require higher levels of care for medical stabilization.

ARFID in adults

ARFID most commonly occurs in children and was once considered a disorder of childhood and infancy, but it is now known that ARFID in adults can occur.

Why is ARFID Becoming More Common In Adults?

ARFID is becoming increasingly more common in adults with the increase in specialized diet trends such as vegan diets, gluten-free diets, alternative fasting and other well known-popular diets that eliminate one or more food groups from the diet. Often ARFID in adults has a small range of foods that they will eat, sometimes less than 20 foods. Individuals may often refuse to try new foods, or report higher rates of texture or sensory issues to foods. Picky eating due to weight restriction or dieting leads to ARFID in adults, and new research is showing that ARFID can overlap with anorexia nervosa.

Studies have shown that adults who were diagnosed with ARFID are being treated for anorexia nervosa. Picky eating in adults has also been associated with higher rates of depression and obsessive-compulsive disorders and lower quality of life versus children and adolescents who are diagnosed with picky eating. This could be because adults are more hypersensitive about weight gain and body image than children and therefore picky eating in adults could be linked to weight and body type as opposed to the disinterest and avoidance of food. This hypothesis is not yet proven.

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Originally published in Eating Recovery Centre

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