In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is avoidant/restrictive food intake disorder.
Avoidant/restrictive food intake disorder (ARFID) is a type of eating disorder that involves restricting food intake, not with the aim of weight loss, but more along the lines of picky eating twisted to extremes. It’s not something many people have heard of, and I first learned of it from a fellow blogger.
ARFID is a new diagnosis in the DSM-5. It combines two diagnoses that were in the DSM-IV, selective eating disorder and feeding disorder of infancy or early childhood. ARFID can be diagnosed either in childhood or adulthood.
Symptoms
Symptoms include:
- food restriction that leads to significant weight loss, significant nutritional deficiency, reliance on meal replacement supplements, and/or marked impairment in overall functioning (including social functioning)
- the food restriction isn’t caused by lack of access to food, cultural practices, physical illness or illness treatment, or another eating disorder
- there’s no evidence of a disturbed perception of body weight or shape – this is a key factor in distinguishing it from other eating disorders
There can be difficulty sensing and interpreting hunger and fullness, and having even a small amount of food might cue sensations that are interpreted as fullness. Eating may take an extended amount of time, with careful chewing and small sips/bites.
Sensory characteristics, including texture, smell, and taste, can influence what’s eaten, and the range of acceptable foods becomes very narrow. Food phobias can also play a role. Eating may be avoided out of fear of choking or vomiting, or simply lack of interest. There’s a lot of room for variability, and it sounds like one person’s ARFID might look quite different from another’s.
Risk factors
Children who are highly picky eaters, or don’t grow out of picky eating, are at increased risk.
People with developmental disorders, including autism spectrum disorder, ADHD, and intellectual disabilities, have an increased risk of developing ARFID. As autism is more common (or at least more commonly diagnosed) in males, perhaps this has something to do with ARFID being more common in males than females.
More than half of people with ARFID have a co-occurring anxiety disorder. Sometimes there is another co-occurring eating disorder, like anorexia nervosa or bulimia nervosa.
ARFID may develop in response to generalized anxiety or fear of vomiting/choking. Like emetophobia (fear of vomiting), with which it sometimes co-occurs, it can begin with a distressing event, like choking or vomiting, that produces anxiety that then spirals.
Treatment
Cognitive behavioural therapy (CBT), including exposure to feared stimuli, is the primary form of treatment. Anti-anxiety medications are sometimes used. Any nutrient deficiencies also need to be addressed. Overall, what I found on treatment in adults was pretty limited; there seems to be more info available on treatment in children.
I only learned about ARFID recently. When I was a nurse, I never worked in settings where eating disorders were treated, so they weren’t really on my radar. Were you familiar at all with ARFID?
References
- Beat Eating Disorders
- Duke Health Center for Eating Disorders: ARFID (website no longer available)
- Merck Manual Professional version: Avoidant/restrictive food intake disorder
- NEDA: Avoidant/restrictive food intake disorder
- Wikipedia
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
I have not heard of this disorder. It’s interesting to me though.
Yeah it’s one of those diagnoses that flies under the radar.
As I research medications that my clients take (usually antidepressants) I’m always interested to see how a lot are used in higher doses to treat EDs. I’ve never seen this in my work either.
I find it so interesting how some of the neural circuitry appears to overlap between different disorders.
Yes
I’ve known about ARFID for some time now, but only because I’ve been doing so much eating disorder research. There are so many eating disorder “outliers” that many people have never heard of. Even orthorexia, which is rather common, is still unknown by most, including people who have it.
That’s a very good point.
I’d never heard of that particular disorder, although I have heard much of the more common ones regarding food and body ‘shame’. You did tell me the name of one of my phobias though, one I didn’t know – emetophobia. I’m not as bad as I have been in the past, when I’d go to extreme lengths to avoid throwing up; but it still severely bothers me. Someone else doing it around me will get an uninvited guest to their little party too. I think I know the root cause of my phobia – my social phobia. “Icky’ things (scents or especially tactile) just gross me out to the point almost of non-functioning.
I’ve come across several bloggers who have emetophobia. I can see that being a huge issue.
I didn’t know it had a name, but my college boyfriend would eat only like 5 things. I mocked it then, but as I age I find myself naturally gravitating to familiar foods that always agree with me as I have a sensitive tummy. I have knocked a lot of items off the table, so to speak…
My brother used to have quite a narrow range of foods he would eat, but he’s gotten a lot more adventurous as time has gone by, while I’m like you and have narrowed it down more to what’s familiar.
When you get your post up again I’ll link to it.
Ok
arfid entered our household as an official diagnosis during Covid. It arose from undiagnosed childhood emetophobia. It has been very challenging to treat because it seems fewer treatment providers are familiar with it relative to the standard Eating Disorders. Maybe its newness in dsm is the reason.
One point we want to emphasize is that not all arfid sufferers are dangerously thin. Due to co-occurring disorder, our arfid housemate experienced significant, rapid weight gain. The restricting during day gave way to overeating at night for other reasons.
Helping this person has taken much of our limited resources and so we have very strong reactions to reading and writing about it. Thanks for bringing awareness.
I’ve got my own issues with food – some from childhood concerning texture and now in old age I am simply bored with food – I buy it, I prepare it, I eat it – I just don’t care about. I eat fast so I can get it over with – I cook thinking “Oh this is going to be good” and then I stare at the plate and go “Meh” even when, in fact, it DOES taste good – so what. Just another boring chore…and the only reason I DO cook the one meal a day I do eat is because of my husband – otherwise, I suppose I would just live on M&Ms.
I could pretty contentedly get by on cereal and M&Ms.
Not together, though.
I don’t eat cereal but hey, throw a handful of M&M’s in the bowl – why not. Dinner for me most nights is a handful of M&Ms (dark chocolate) and a handful of nuts – sorta like trail mix I guess – whatever…
Sounds good.
I have had this…when I was younger although did not realise it at the time. I had to go on food supplements like complan at the time because I couldn’t stand the smell of food.
It wasn’t til decades later…I later found out I had a developmental type disorder due to relational trauma along with abuse and because of my eating, and my emetophobia, which was not picked up at the time, due to severe clinical depression and anxiety, I had many deficiencies develop…which led to many adult teeth not coming through to take over my baby teeth, (I still have many baby teeth even now) . I had iron deficiences/B12 injections and have been on iron ever since and even now have to have my blood tested regular to check levels as I don’t seem to get it from my food very well… and my periods did not start til 17… which is very late.
It is interesting to see where this fits in.
Thank you Ashley…
It’s crazy how much damage trauma can cause, and in so many different ways.
Yup… I seem to be along with many others a living consequence of it
I’ve only learned about ARFID being a thing relatively recently, and I really appreciate being able to learn more from your post as it sounds like it’s a really neglected and unknown condition. I suppose that, at some point in my life, I could have ticked the criteria for this as my diet was very restrictive due to emetophobia plus some additional issues like with texture of a lot of things or not wanting to have such basic needs like needing to eat. I’m at a way better place now, especially in regards to emetophobia as my no-no foods list has shrunk very impressively over the last 7 years, but it’s still something I can relate to, to an extend.
That’s great that you’ve been able to make progress!
I have a friend with this disorder. Its very stressful for her to go out to eat, or eating in general can be a huge thing for her too. XX
Yeah, it’s pretty shitty.