ARFID: How does it differ from other restrictive eating disorders?

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Avoidant/restrictive food intake disorder (ARFID) is among the common eating disorders in teenagers. A study suggests1Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord. 2014 Aug 2;2(1):21. doi: 10.1186/s40337-014-0021-3. PMID: 25165558; PMCID: PMC4145233. that ARFID cases count for 22.5% of all eating disorders in youth.

Teenager denying food to eat due to ARFIDARFID is characterized by the persistent avoidance or restriction of certain foods, resulting in significant nutritional deficiencies and impaired psychosocial functioning.
However, if the individual with avoidant/restrictive food intake disorder (ARFID) takes the treatment on time, complete recovery has been seen in the majority of the cases.

What is Avoidant/Restrictive Food Intake Disorder (ARFID)?

AFRID, or Avoidant/Restrictive Food Intake Disorder, is an eating disorder characterized by a persistent avoidance or aversion to certain foods or textures. Unlike other eating disorders, AFRID is not motivated by body image concerns or a desire for weight loss. Instead, it stems from sensory sensitivity, fear of negative consequences, or past negative experiences related to eating.
AFRID is often misdiagnosed as anorexia nervosa owing to the similarities in symptoms. However, people with anorexia nervosa tend to have issues with their body image, size, or shape. People suffering from ARFID don’t intake enough calories, regardless of other problems.
Moreover, unlikely anorexia nervosa, ARFID is more prevalent in males than females.
This condition is highly evident among children and young adolescents. Children living with ARFID refuse to take meals and show picky behavior towards food. It can lead to nutritional deficits such as malnutrition, slow growth, and delayed weight gain in the affected child.
Although, adults with ARFID undergo extreme weight loss that disrupts their normal body response, including low blood sugar, abnormal heart rate, and low blood pressure.

What are the Signs & Symptoms of ARFID?

People with ARFID tend to show its symptoms at an early age. However, most of the signs and symptoms of ARFID are due to nutritional deficiencies caused by restricted food intake. Some of the AFRID symptoms2 are Brytek-Matera, A., Ziółkowska, B., & Ocalewski, J. (2022). Symptoms of Avoidant/Restrictive Food Intake Disorder among 2-10-year-old children: The significance of maternal feeding style and maternal eating disorders. Nutrients, 14(21), 4527. doi:10.3390/nu14214527 and signs:

  • Loss of appetite
  • Picky eating
  • Extreme weight loss
  • Irregular mensuration cycle
  • Severe hunger pangs
  • Constipation
  • Decreased attention span
  • Low heart rate
  • Depleted thyroid or iron levels
  • Frequent episodes of fainting
  • Dry skin, nails, and hair
  • Brittle and thin hairs
  • Cold fingers and toes
  • Puffy feet
  • Impaired immune system
  • Inadequate wound healing
  • Fatigue and muscle weakness

Consequently, people diagnosed with avoidant/resistant food intake disorder (ARFID) also show psychological and behavioral symptoms that include:

  • Restriction to eating different types or amounts of meals
  • Usage of excessive clothing to cover weight loss or stay warm
  • Inability to eat with individuals having a normal appetite
  • A constant fear of vomiting or choking

What Causes ARFID?

The exact cause of ARFID is still unknown. However, many healthcare professionals believe it can occur due to extreme sensitivity to certain tastes or textures.
In addition, people who have had a bad experience with food before can develop ARFID. These experiences may include episodes of vomiting or choking after having food. This can cause anxiety in people while having food. To stay away from such experiences, people with ARFID avoid eating food.
Following are a few risk factors for developing ARFID:

  • Attention deficit hyperactivity disorder (ADHD)
  • Anxiety disorders, including obsessive-compulsive disorder (OCD)
  • Autism spectrum disorders
  • Digestive conditions such as GERD
  • Unhealthy eating and drinking habits

How Avoidant/Restrictive Food Intake Disorder (ARFID) is Diagnosed?

The diagnosis of ARFID has been formulated by a thorough evaluation that includes clinical history and medical and psychosocial examination. According to DSM-5, there is a diagnostic criterion for ARFID3Lindvall Dahlgren, C., Wisting, L., & Rø, Ø. (2017). Feeding and eating disorders in the DSM-5 era: a systematic review of prevalence rates in non-clinical male and female samples. Journal of Eating Disorders, 5, 56. doi:10.1186/s40337-017-0186-7 that includes:

  • The individual presents with disturbed eating habits related to one or more consequences.
    1. Inadequate food intake that results in nutritional deficiency
    2. Inability to put on weight in children or severe weight loss in adults
    3. Consumption of dietary supplements to achieve nutritional health
    4. Loss in overall psychosocial function.
  • External factors such as shortage of food items and unavailability of food aren’t responsible for a person’s unhealthy eating habits.
  • The person isn’t dealing with a distorted body image
  • Another physical or mental illness is not restricting the person from taking regular meals. For instance, an ARFID diagnosis can’t be established if the person lost weight after having a common cold or food poisoning.

The diagnosis of ARFID can be made if the individual matches the aforementioned criteria.

How is ARFID Treated?

Studies suggest4Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/restrictive food intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8), 54. doi:10.1007/s11920-017-0795-5 that there are multiple approaches to treating avoidant/restrictive food intake disorder (ARFID) in children.
The treatment of ARFID aims at physical recovery and nutritional rehabilitation, followed by psychosocial rehabilitation.
Some of the effective ARFID treatments are:

Medical Evaluation:

A thorough medical assessment is conducted to rule out any underlying medical conditions or nutritional deficiencies that may contribute to the disorder. Addressing any physical health concerns is an essential part of the treatment.

Nutritional Rehabilitation:

A registered dietitian or nutritionist works closely with the individual to develop a structured meal plan that gradually expands the variety of safe and acceptable foods. The goal is to improve nutritional intake and address any deficiencies.

Behavioral Therapy:

Cognitive-behavioral therapy (CBT)5Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Current Opinion in Psychiatry, 31(6), 425–430. doi:10.1097/YCO.0000000000000454 is often used to address the psychological aspects of AFRID. This therapy helps individuals identify and challenge negative thoughts, fears, and beliefs about food. It also aims to gradually desensitize them to feared foods and develop more flexible eating patterns.

Exposure Therapy:

Exposure therapy is highly effective6Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, 78(101851), 101851. doi:10.1016/j.cpr.2020.101851 in treating ARFID. In this therapy, the doctor “exposes” the affected person to the food associated with negative feelings. The therapist uses smells, imagery, and mental visualization to trigger the affected person’s anxiety. Usually, therapists are more likely to work on a series of fear foods, from the least fearful to the most anxiety-provoking, until the person shows a normal response to eating food.

Family Involvement:

In the case of children or adolescents with AFRID, the doctor may utilize family-based therapy. This approach involves the active participation of family members in supporting and encouraging the individual’s progress, including meal planning and creating a positive mealtime environment.

Medication:

In certain cases, healthcare professionals may prescribe medication to manage comorbid conditions like anxiety or depression, which frequently accompany AFRID. They may utilize medication as a supplementary therapy approach to enhance overall treatment outcomes.
It’s important to note that treatment for AFRID should be personalized and tailored to the individual’s specific needs. Seeking help from healthcare professionals specializing in eating disorders is crucial to developing an effective treatment plan.
In a few cases, individuals with ARFID might have to stay at the hospital for a certain period to recover from the serious complications caused by this condition.

What are the Complications of ARFID?

Avoidant/restrictive food intake disorder (ARFID) tends to cause malnutrition in children that increase their chances of developing these complications:

  • Poor intake of proteins, vitamins, and minerals
  • Low bone mineral density predisposes early onset osteoporosis
  • Retarded body growth
  • Delayed onset of puberty
  • Diminished pulses
  • Dehydration due to inadequate intake of fluids
  • Frequent muscle spasms

Suitable treatments and preventive measures can manage the complications of ARFID.

How to Deal with ARFID at Home?

Although many hospitals contain intensive treatment regimes to treat avoidant/restrictive food intake disorder (ARFID).
Managing Avoidant/Restrictive Food Intake Disorder (ARFID) at home requires implementing specific changes in meal plans. While hospitals offer intensive treatment options for ARFID, home-based strategies can be effective. However, seeking guidance from healthcare professionals experienced in eating disorders is essential. They can provide personalized advice, monitor progress and ensure the safety and effectiveness of the management strategies performed at home.
The following tips can help to set healthy eating habits in children with ARFID:

  • Adding new food of different cuisines and flavors will attract the affected person to try eating their meal plans.
  • To enable the person with ARFID to take adequate nutrition, gradually increase the portion size of their meals.
  • Encourage the affected person to take their food on time by setting a proper diet schedule.

These lifestyle changes will aid the person with ARFID develop healthy eating habits and recover quickly from this condition.

ARFID vs. Picky Eating

People with ARFID don’t feel hungry most of the time. Even these people forget to take their meal plan because food is not on their priority list. Whereas picky eaters often feel hungry, they are very selective with food choices. Unlike people with ARFID, picky eaters are interested in meals satisfying their refined palate.

ARFID vs. Orthorexia

People with orthorexia tend to develop restricted eating behaviors due to their distorted body image. At the same time, people with ARFID avoid food without having issues with their body image.

The Bottom Line

Avoidant/restrictive food intake disorder (ARFID) is common among young children and teenagers. However, the drawbacks of this condition include severe nutritional deficiencies and weight loss. However, ARFID is a highly curable eating disorder if the affected person gets the right treatment on time.

Refrences
  • 1
    Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord. 2014 Aug 2;2(1):21. doi: 10.1186/s40337-014-0021-3. PMID: 25165558; PMCID: PMC4145233.
  • 2
    are Brytek-Matera, A., Ziółkowska, B., & Ocalewski, J. (2022). Symptoms of Avoidant/Restrictive Food Intake Disorder among 2-10-year-old children: The significance of maternal feeding style and maternal eating disorders. Nutrients, 14(21), 4527. doi:10.3390/nu14214527
  • 3
    Lindvall Dahlgren, C., Wisting, L., & Rø, Ø. (2017). Feeding and eating disorders in the DSM-5 era: a systematic review of prevalence rates in non-clinical male and female samples. Journal of Eating Disorders, 5, 56. doi:10.1186/s40337-017-0186-7
  • 4
    Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/restrictive food intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8), 54. doi:10.1007/s11920-017-0795-5
  • 5
    Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Current Opinion in Psychiatry, 31(6), 425–430. doi:10.1097/YCO.0000000000000454
  • 6
    Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, 78(101851), 101851. doi:10.1016/j.cpr.2020.101851
Dr. Safa Aamir
Dr. Safa Aamir
Dr. Safa is a Dow Graduate of year 2022. She is currently working as a Physiotherapist House Officer at Civil Hospital Karachi and Ojha Institute of Chest Diseases. Previously, she has been associated with SMBBIT and Tabba Heart Institute. Moreover, she has been pursuing Medical Content and Copywriting since last 3 years. Apart from her profession, she has published 3 poetry anthologies as a poetess under Aspiring Pens Ltd. and actively shares her creative writing content on her social media blogs.

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