What is ARFID? by Lisa Carroll, MS, RD, LDN
ARFID stands for Avoidant Restrictive Food Intake Disorder and it is a diagnosable eating disorder. So…
WHAT IS ARFID?!
ARFID IS: newly-recognized as a clinical diagnosis through the DSM-5 as of 2013
ARFID IS NOT: a “new” condition, but rather a newly-recognized condition
Due to the newness of ARFID being recognized by the DSM-IV ARFID is somewhat of a question mark for many clinicians as well as individuals struggling with this disorder.
ARFID can be confused with Anorexia Nervosa (AN) in underweight individuals:
Similarities: cold intolerance, food refusal, fear of food, and a dramatic reaction towards specific foods
Differences: lack of disturbances in the way they view their body
It’s very important to assess for thoughts regarding body image and weight
This helps to rule out AN, Bulimia Nervosa (BN), Eating Disorder Not Otherwise Specified (EDNOS)
ARFID IS…
A PHOBIA!
Sometimes called "extreme picky eating"
An eating disorder characterized by highly-selective eating habits
Impacts the individual mentally, emotionally, and physically
Restriction is not related to body image concerns
Hinders adequate calorie and/or nutrient intake
ARFID IS NOT…
Just picky eating!
This condition can often times be misunderstood resulting in being under-recognized and a very marginalized problem. Many think the individual with ARFID is choosing pickiness with food and this is simply not true. Since it is a phobia the individual with ARFID responds differently physically, emotionally and mentally to new foods and certain eating situations. Many individuals with ARFID have been mis-diagnosed and misunderstood, resulting in more stress around food due to an increase pressure put on food by others. Taking the pressure off of food and eating can be very beneficial for the individual with ARFID.
An individual with ARFID does not respond well to
Pressure
Bribery
Shame
Logical explanation
All of the above approaches to ARFID not only are not productive but also put an extreme amount of pressure on the food and the individual and can worsen the fear around food.
Indicators of ARFID May Include:
Avoidance of specific foods based on texture, smell, or taste
Fear of choking or gagging on certain foods
Social avoidance
Dramatic weight loss
Gastrointestinal disturbances such as constipation or abdominal pain
Lack of appetite
Abnormal laboratory findings
Impaired immune functioning
Anxiety or depression
Common Triggers for ARFID
Colic
Tonsillitis
GI issues
Allergic reactions to food
Reaction to medication
Tongue tie
Choking or vomiting associated with food
Difficulty moving from liquids to solids
Non-food stressors (home, school, etc.)
There are also many other origins for the development of ARFID as well. Someone with ARFID may have a lack of interest in food (often seen as the individual with ARFID gets older). A heightened sensitivity to texture, taste, smell, touch, appearance phobia based off of potential or perceived consequences of eating (such as gagging or strong discomfort) might also lead to ARFID. For children, modeling parents' fussy eating habits might even lead to the development of this condition.
Tips for Approaching ARFID
Respect quirks. All eaters can have quirks with eating not just individuals with eating disorders. Respecting quirks with eating is just that… Respectful! Creating a kind and safe space for someone to explore foods not only brings down stress during eating times and it is simply just more productive!
Your role is offering the food, the individual’s role is deciding what to eat and how much. It is okay if someone with ARFID does not try everything at the table and you can continue to offer foods they might not be ready yet to explore.
Offer a discard plate and encourage food exploring. Part of the process of tackling fears with foods is providing a space for curiosity. As the individual with ARFID might eventually move from intense fear to general disinterest it is important to keep in mind that just exploring food is an accomplishment!
Work in stages. Rome was not built in a day and moving away from ARFID is not going to happen in a day either. There are many stages in the process of eating and meeting the individual where they are at should be the first step for treatment.
Explain the food and keep in mind the food is NOT FAMILIAR. Even though a chicken nugget and piece of grilled chicken might seem “the same” to someone without ARFID they are very different in many ways. Explaining the food without pressure can sound like “this food is crunchy and has a robust flavor” and does not sound like “this is just like chicken nuggets, take a bite and I know you’ll like it.” Editing out pressure and assumptions can assist the individual with ARFID when they are ready to explore new foods.
Create a neutral and judgement-free zone! Judgement and shame only makes the exploration process of food that much harder. Creating a calm and gentle environment without judgement or demands can take down the individuals physical body reactions of fear and panic.
Ultimately, working with ARFID is unique to each individual and takes time. Seeking out professional help can help to ensure someone can safely understand and possibly even challenge their relationship with food!
Learn More!
If you are a professional wanting to learn more and gain CEU credit click here!
If you find yourself struggling, please reach out to Lotus Therapy Group at 708-552-7330.
