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.