Understanding ARFID: A New Eating Disorder

Eating disorders is an umbrella term that consists of a host of conditions where a person has developed an unhealthy and dangerous relationship with how they see food and their body.

ARFID (Avoidant/Restrictive Food Intake Disorder) is a fairly new eating disorder, most frequently occurring in middle childhood but also in adolescence, and does occur in adults. However, unlike the common belief that it is “just picky eating”, it involves a disturbance in eating due to lack of interest, sensory issues, or an aversion to certain food textures or smells. It is distinct from Anorexia. 

A child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.

ARFID involves a person’s inability to meet their nutritional needs but without having any problems with their body image. Instead, the only problem they have is with the food itself and how it feels. There are several types of ARFID:

Adults with ARFID may have symptoms from their adolescent years, of the above types. They may have selective or extremely picky eating, food peculiarities, texture, color or taste aversions related to food. 

Typically people with ARFID only rely on a specific group of foods. Their refusal to eat other foods could be due to several reasons:

• Due to the smell, color, taste, or texture of food
• They may only eat foods with certain sensory qualities and avoid everything else
• They may avoid certain foods out of the irrational fear that consuming them can lead to pain swallowing, choking, vomiting, nausea or death

The causes of ARFID are not well known but are believed to involve biological, psychological, and sociocultural factors. Children are more likely to develop ARFID if they have one of the following conditions: 

• Autism Spectrum Disorder (ASD)
• Attention Deficit Hyperactivity Disorder (ADHD) 
• High Anxiety
• Obsessive Compulsive Disorder (OCD)
• Severe picky eating 

Common Symptoms

There is a wide range of possible symptoms. Note that with ARFID there are no body image problems or fear of gaining weight

• Big or sudden drop in weight
• Is not hungry, not interested in eating or food
• Picky about food texture
• Limited range of foods they will eat that gets less over time (i.e., picky eating that keeps getting worse)
• Fears of choking or vomiting
• Person has behaviors to avoid eating or drinking
• Significant nutritional deficiencies
• Constant, vague upset stomach, feels full, etc. around mealtimes with no known cause
• Social isolation due to eating habits
• Needs tube feeding or food supplements taken by mouth

Impact on Daily Life

ARFID can affect daily living activities, especially for children at school with limited willingness to participate in social functions involving food.

Children with ARFID more frequently have social or emotional problems, compared to those without ARFID. Children and adults with ARFID often have other mental health conditions, such as anxiety disorders or OCD. It’s also more likely in children with attention deficit hyperactivity disorder (ADHD) or intellectual disabilities.

Children with Autism Spectrum Disorder are more likely to have ARFID, but they are two different conditions. The sensory sensitivities that come with autism may be one reason these two conditions often go together. Children with ARFID often have trouble eating foods that don’t have the right color, texture, taste, or smell. If you are worried that your child with Autism has ARFID, see your doctor.

What is Anorexia?

Anorexia nervosa, commonly known as Anorexia, is an eating disorder where a person has an unrealistic perception of body weight, body image, diet, and body shape and size with a strong fear of gaining weight or becoming fat.

According to the Diagnostic and Statistical Manual (DSM-5), Anorexia Nervosa is defined as a serious mental health condition characterized by:

• A significantly low body weight
• An intense fear of gaining weight or becoming fat or a distorted perception of body weight or shape.
• Having a distorted view of your body size or shape, where self-worth is too tied to these views, or not recognizing how serious being underweight is.

People suffering from Anorexia have an extreme obsession with their food choices and body image. This can develop into a psychological disorder, causing the person to start relying on unhealthy ways to stay thin or lose weight, such as calorie restriction, calorie and steps counting, compulsive exercising, fasting, or self-induced vomiting (Bulimia).

People with Anorexia make excuses, deny they are hungry, or refuse to eat. They adopt rigid eating routines and restrict themselves to eating only small amounts of food out of the fear of gaining weight or looking fat.

A person suffering from Anorexia may malnourish themselves to such an extent that their body may stop performing its functions properly, and organs may start experiencing failure. 

• Women have anorexia at rates three times higher than males: 0.9% of the population versus 0.3% of the population.
• An estimated 0.5% to 3.7% of women will develop anorexia at some point in their lifetime.
• Around 10 million men in the United States will develop an eating disorder within their lifetime.
• Men make up approximately 20% of all people with anorexia [1].

The cause of Anorexia is not fully understood, but it is believed risk factors include a combination of genetic, biological, behavioral, psychological, and social factors.

Physical and Psychological Effects

• Extremely restricted eating and/or intensive and excessive exercise
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body or self-image that is heavily influenced by perceptions of body weight and shape
• Extreme thinness of the bones combined with muscle loss (emaciation)
• Denial of the seriousness of low body weight
• Obsessive thoughts and possible depression

ARFID vs Anorexia

While both disorders involve restrictive eating, the specific symptoms and effects can vary significantly, highlighting the importance of understanding these differences for diagnosis and treatment.

The most obvious similarities between ARFID and Anorexia are the common physical and medical symptoms. However people suffering from ARFID malnourish themselves because they only resort to certain types of food and deny eating anything else. 

The biggest difference between ARFID and Anorexia is that people who are suffering from Anorexia malnourish themselves out of the fear of looking fat or having body image concerns. Those diagnosed with ARFID do not, nor do they maintain a rigorous exercising routine or resort to dangerous ways to purge their foods like vomiting, or using laxatives. 

While ARFID can lead to weight loss, people with this disorder aren’t trying to lose weight. However, in adults, ARFID can cause dangerous weight loss and lead to the  body not being able to function as it should. 

ARFID can affect adolescents and adults, but primarily affects children. ARFID is also the only eating disorder where boys are more commonly affected than girls. However, the same is not the case with Anorexia. Therefore, the approach to treating them is also very different.

As with other eating disorders, genes play a big role in ARFID. One study found that almost 80% of a person’s chances of having ARFID come from genetics. The environment a child grows up in can affect ARFID, but not as much as the genes they were born with. ARFID is likely to run in families.

People with ARFID often have other coexisting mental health conditions as well such as Autism Spectrum Disorder, Obsessive Compulsive Disorder, Anxiety or Depression.

Treatment Available for Both Disorders

In both of these eating disorders, it’s essential to have medical and nutritional intervention with tailored assessment and diagnosis, including monitored eating plans and possibly medical or nutritional supplements.

Treatment for ARFID typically combines Cognitive Behavior Therapy (CBT) with a psychiatrist or psychologist, as well as exposure therapy. This involves a very specific selection, preparation and proportioning of foods acceptable to the patient, followed by gradual introduction or exposure of additional foods or methods of preparation and presentation. 

Anorexia typically involves psychoeducation about the illness, combined with CBT to help patients alter their cognitive framing of their body image as well as modify their attitudes to food. They’ll also deal with feelings about food and eating.

In both conditions, medical professionals will focus on helping patients get enough nutrients and calories. Additional approaches may include::

• Personalized meal plans by a dietitian
• Nutritional supplements
• Speech therapy to help with motor skills for eating
• Medicines to help appetite or ease anxiety

Long-term management and support from healthcare providers, mental health professionals, and peer support groups over the long term is often a critical success factor.

Sources

National Institute of Mental Health. 2021. Eating Disorders: About More Than Food

The Bulimia Project. 2022. Anorexia Statistics – Gender, Race & Socioeconomics.