What to Know About Avoidant/Restrictive Food Intake Disorder (ARFID)

Jeff Hayward

Published on January 20, 2021

If you’re a parent, then you’re probably familiar with how kids can be picky when it comes to the food you put in front of them – or perhaps their preferences will change from week to week, which is frustrating and difficult to navigate for caregivers. However, at a certain point, extreme pickiness can actually be a sign of a mental health concern.

Previously known as “Selective Eating Disorder,” it is now in the DSM-5 (the official manual of mental disorders) as Avoidant Restrictive Food Intake Disorder, which is similar to anorexia but not rooted in body image, says the National Eating Disorders Association (NEDA). Here’s what you should know…

Picky Eating Alone is Not ARFID

As mentioned, there are picky eaters, and then there’s something that’s more concerning than that. Picky eating on its own is not an eating disorder – but it becomes one when a person’s development is affected by aversion to foods.

Medical News Today says the main differences between picky eating and ARFID is that patients in their development stage do not consume enough calories, they stop gaining weight, and stop growing. Adults with the condition may lose weight, and it could “affect normal bodily functions,” it adds.

It’s Most Common In Kids, But Not Limited To Age

NEDA explains that this disorder is most commonly found in children and adolescents, but can also affect adults who went undiagnosed earlier in life. “This might include those who went untreated as children and have a long pattern of selective eating based on sensory concerns or feelings of disgust with new foods,” notes the source.

The source also notes that while some eating disorders are typically found more in females, ARFID levels the playing field. In fact, it might actually be more common in males, it adds – a claim that is backed up by several other sources.

It’s Not Based in Body Image

NEDA explains that ARFID is caused by an aversion to certain foods, and not caused by body image issues. This is an important distinction between diagnosing ARFID and other eating disorders such as bulimia, explains the source.

Medical News Today notes that studies have shown those with ARFID are more likely to be admitted to hospital with a lower body weight (compared to their estimated healthy weight) than those with anorexia.

Patients More Likely To Have Co-Existing Conditions

Those who are diagnosed with ARFID are commonly diagnosed with other conditions such as anxiety, as well as autism spectrum disorder, explains NEDA. Children with attention deficit hyperactivity disorder (ADHD) may also be at higher risk of the eating disorder.

While having another disorder (such as depression) may affect appetite, it’s not enough to for an ARFID diagnosis. “If a medical condition that impacts appetite or eating is present, the degree of food avoidance must go beyond what would be expected for the medical condition to be classified as ARFID,” explains the source.

There are Other Warning Signs

Medical News Today notes that there are some warning signs for parents/caregivers to keep an eye out for if they suspect an issue around eating. This could be only eating foods with a certain texture, or often seeming sick or full around mealtimes. They may also avoid eating with others.

The source says there could also be a “restricted range of preferred foods that becomes more limited over time,” and that the amount of food eaten can be self-restricted as well. You may also notice the child has a lack of energy or digestion issues such as constipation.

There Can Be Serious Health Implications

The most obvious impact of ARFID is weight loss, or failure to thrive when the patient should be having a growth spurt, notes NEDA. “Significant levels of nutritional deficiency may require higher levels of care for medical stabilization,” explains the source.

There can be other physical issues related to ARFID such as stomach cramps, irregular menstruation, difficulty concentrating, dizziness, fainting, and sleep problems, it adds. Medical News Today warns that eating disorders in general can cause “severe illness” and even death.

Diagnosis Can Be a Challenge

VeryWell Mind explains ARFID is a “less well-known disorder,” and therefore some health professionals might not recognize the signs. The assessment for the disorder includes feeding history, development progress, and family history.

Doctors may also look for obvious signs of nutritional deficiency, and compare current height and weight information to previous data. Other conditions (such as Crohn’s disease) that might be causing malnutrition will need to be ruled out, it adds.

There are Promising Treatments

NEDA assures that treatment for ARFID is effective, and that cognitive behavioral therapy “with a specific focus on exposure and response prevention” can be one approach to addressing it. There may be a range of healthcare professionals involved in the treatment plan, ranging from a registered dietitian nutritionist to occupational therapists to mental health professionals.

“With proper care, a child with ARFID can learn to accept different foods without fear and start gaining weight and growing again,” adds Medical News Today. There could be different triggers for ARFID – for example, those with a fear of choking or vomiting due to eating can benefit from specific behavioral strategies, it adds.

Jeff Hayward

Jeff has more than 15 years of experience writing professionally about health, travel and the arts among other subjects. He continuously looks to improve his own overall health through exercise, diet and mindfulness. He is also a proud stay-at-home dad that loves taking photographs both professionally and as a hobby.