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ARFID: Avoidant/Restrictive Food Intake Disorder

ARFID stands for Avoidant/Restrictive Food Intake Disorder. This is a new term for an eating disorder that has had a variety of names around the world. ARFID was added to the DSM (a handbook for naming and diagnosing mental illnesses) in 2013. 

People with ARFID are very limited in the types and qualities of food they are able to eat without extreme anxiety. ARFID has often been confused with anorexia nervosa because those affected are not eating enough, or are only eating a very limited range of foods, may be underweight and – in some cases – have a phobia of particular foods. Where ARFID clearly differs from anorexia is that it is not associated with a fear of weight gain, there is no calorie-counting, no body image distortion, and no exercise compulsion.

In addition to debilitating psychological symptoms, social isolation, and widespread misunderstanding of their challenges, people with ARFID often suffer medical consequences because of undernourishment or because they are missing some types of nutrients. 

A variety of presentations, causes and treatment methods

ARFID is a mixed bag, with different people failing to eat or thrive for all kinds of reasons. They may not have any interest in eating, or may find certain textures or tastes unacceptable, or have a debilitating fear of choking or vomiting. Some are on the autism spectrum.

  1.       Food is avoided based on sensory characteristics. People may only cope with bland food, or may become distressed when they chew, taste, bite or feel full
  2.       People have no appetite or no interest in eating
  3.       People avoid eating following a traumatic event such as choking, vomiting or diarrhoea

Accordingly, treatment for ARFID must be individualised. Parents may need to hunt for a clinician who has studied ARFID and is competent in your child’s presentation. The methods used to treat other eating disorders may not be appropriate. 

People with ARFID are not willfully or obstinately avoiding food. They experience overwhelming anxiety and distress that deserves our compassion and a supportive family and treatment team.

Diagnostic criteria

According to the DSM-5 diagnostic manual, ARFID is an Eating or Feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

  • Significant loss of weight (or failure to achieve expected weight gain or faltering growth in children)
  • Significant nutritional deficiency
  • Dependence on enteral feeding or oral nutritional supplements
  • Marked interference with psychosocial functioning
  • The behavior is not better explained by lack of available food or by an associated culturally sanctioned practice
  • The behavior does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way one’s body weight or shape is experienced
  • The eating disturbance is not attributed to a medical condition, or better explained by another mental health disorder. When it does occur in the presence of another condition/disorder, the behavior exceeds what is usually associated, and warrants additional clinical attention

More information:

Articles

Lauren Muhlheim , ‘ARFID is more than just picky eating’ https://www.verywellmind.com/what-is-arfid-4137232

‘The many faces of ARFID’, Julie O’Toole, Kartini Clinic https://www.kartiniclinic.com/blog/post/avoidant-restrictive-food-intake-disorder-arfid/

Dr Julie O’Toole, on DSM-5 diagnostic criteria and anorexia in very young children, ‘The very young child with anorexia’, http://tinyurl.com/pquwb7y

Lauren Muhlheim (2018), ‘Could your eating problems be a specific phobia of vomiting (emetophobia)’ verywellmind.com/specific-phobia-of-vomiting-4163645

BEAT Eating Disorders (UK): ‘Avoidant/restrictive food intake disorder (ARFID): ’https://www.beateatingdisorders.org.uk/types/other-feeding-disorders/arfid

 

Shared by Parents

On ATDT: ‘Anorexia vs. ARFID – two disorders, two different treatments’ https://www.aroundthedinnertable.org/post/anorexia-vs-arfid-two-disorders-two-different-treatments-8449992?pid=1295134267

On ATDT: HoneyBadger recounts her journey to teach her ARFID son who only ate a handful of very specific foods to take small steps out of his comfort zone. It took a good while but he will now try pretty much anything, eats a huge variety and will eat anywhere: https://www.aroundthedinnertable.org/post/new-here-13-yo-son-possible-arfid-7228819?&trail=25

 

Books

The following books were recommended by F.E.A.S.T. parents:

Here are two other relevant books:

Facebook groups for Parents

SED/ARFID Parents Support Group’ and ‘ARFID parent support UK/Ireland’ and ‘Mealtime Hostage

 


special thanks to our F.E.A.S.T. volunteer community on Workplace who helped compile this information page. Special thanks to Eva Musby for her leadership on the project.