We are all familiar with children being choosy about their food, particularly when it comes to consuming vegetables. Maybe even you, at some point, wrinkled your nose at greens or disliked rice pudding due to its texture. This is a typical phase of growing up—until it isn’t. When selective eating extends beyond the usual habits and begins affecting daily life, it might indicate the development of a condition known as ARFID.
What is ARFID?
ARFID stands for Avoidant/Restrictive Food Intake Disorder. It is a feeding or eating disorder characterised by limited food preferences, aversions to certain textures, colours, or smells of food and an overall restricted dietary intake. Unlike other eating disorders such as anorexia nervosa or bulimia nervosa, ARFID is not driven by concerns about body weight or shape. Instead, people with ARFID may have a narrow range of accepted foods and may avoid entire food groups.
Is ARFID just ‘picky eating’?
While picky eating and ARFID may share some similarities, they are distinct concepts. Picky eating is a common behaviour, especially among children, where people may have preferences for certain foods and may be resistant to trying new ones. This behaviour is typically considered a normal part of development and often resolves over time.
On the other hand, ARFID is a more severe and persistent feeding disorder that goes beyond typical picky eating.
It’s essential to distinguish between the two, and if there are concerns about a person’s eating habits, particularly if they are showing signs of ARFID, seeking the advice of a healthcare professional is recommended for a proper assessment and appropriate intervention.
The DSM-V criteria for ARFID diagnosis
To be diagnosed with ARFID, the DSM-V has outlined specific criteria. It is as follows:
Difficulty eating or feeding properly due to issues like lack of interest, avoidance based on food’s sensory aspects, or fear of negative consequences, leading to persistent failure to meet nutritional and energy needs. This needs to be coupled with one or more of the following:
- Significant weight loss 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.
- Persistent avoidance of food with certain sensory characteristics (e.g., smell, taste, texture, temperature).
- Concern about aversive consequences of eating, such as vomiting or choking.
- Limited variety in the types of food eaten or avoidance of entire food groups.
- The disturbance is not better explained by a lack of available food or by an associated culturally sanctioned practice.
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Does ARFID only affect children?
ARFID can affect people of all ages, but it is most commonly associated with early childhood and adolescence. Many cases of ARFID emerge during early childhood when children are learning to explore and accept a variety of foods.
Parents may notice that their child is exceptionally picky, has a limited appetite, or experiences distressing reactions to certain textures or smells of food.
During adolescence, people with ARFID may face additional challenges as social situations increasingly involve food and peer pressure to conform to typical eating behaviours intensifies.
However, ARFID is not limited to these age groups, and some people may continue to experience symptoms into adulthood.
Can ARFID begin in adulthood?
While it has been noted that ARFID typically begins in childhood, the majority of research has predominantly concentrated on ARFID in children and adolescents, with limited exploration of ARFID in adult populations.
As awareness of ARFID in adults grows, it is likely that more research will be conducted to better understand the prevalence, causes and effective treatments for adult-onset ARFID.
Child ARFID symptoms Vs Adult ARFID symptoms
It is worth noting that the symptoms of ARFID in children when compared to those in adults, exhibit some similarities as well as several distinct differences. These variations are typically attributed to age differences and disparate life experiences. For instance, while an adult may not resort to tantrums over food, they might instead display signs of anxiety.
Below, we compare both adult and child ARFID symptoms to show the differences in a clearer way:
| Symptom | Child ARFID | Adult ARFID |
|---|---|---|
| Limited food variety | Very restricted range of preferred foods | Limited range of preferred foods |
| Texture sensitivity | Aversion to specific textures | Sensitivity to textures, taste, or smell |
| Refusal to eat certain foods | Refusal to eat entire categories of foods | Difficulty trying new foods, reluctance to deviate |
| Mealtime tantrums/anxiety | Emotional reactions during mealtimes | Anxiety or avoidance of social situations involving food |
| Failure to meet nutritional needs | Nutritional concerns, growth and developmental issues | Nutritional deficiencies, potential health consequences |
| Dependency on brands/methods | Dependency on specific brands or preparation methods | Reliance on familiar brands or preparation methods |
| Social implications | N/A (more applicable to adults) | Avoidance of social situations involving food |
| Impact on mental health | N/A (more applicable to adults) | Contribution to anxiety, depression, or other mental health issues |
| Medical consequences | N/A (more applicable to adults) | Long-term consequences like weight loss, malnutrition, etc. |
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Are there different types of ARFID?
There are different presentations or subtypes of ARFID that can manifest in various ways. These subtypes may include:
Example:
Aversion to anything mushy or slimy, steering clear of mashed potatoes, pudding, or cooked spinach due to their textures.
Example:
Foods that are avoided could include nuts and shellfish out of fear of triggering an allergic reaction, even though allergies were experienced in the past.
Example:
You lack the usual enthusiasm for meals and snacks that the average person would often enthuse over, such as sweet treats. .
Example:
You have an extremely selective palate, insisting on only eating white or beige foods, such as plain pasta, bread and chicken nuggets. Any attempts to introduce colourful or diverse foods are met with strong resistance, as you prefer the familiarity of the limited range of preferred items.
Is having ARFID dangerous?
While the diagnosis of ARFID itself isn’t dangerous, the negative outcomes that ARFID can cause are certainly dangerous.
Research suggests that people with ARFID are susceptible to severe and irreversible harm due to malnutrition. This underscores the critical need for prompt diagnosis and intervention. Insufficiently addressing ARFID can result in severe health outcomes, such as stunted growth, organ damage and, in extreme cases, death.
Beyond the physical repercussions, those dealing with ARFID may encounter lower mental health-related quality of life and substantial functional challenges. ARFID can significantly affect social and emotional well-being, as well as daily functioning, including participation in school or work.
What causes ARFID?
ARFID is a relatively new diagnosis in the field of mental health, and its exact causes are not fully understood. However, several factors may contribute to the development of ARFID:
- Sensory sensitivities: people with ARFID often have heightened sensitivities to the sensory aspects of food, such as taste, smell, texture, or appearance. This can lead to a strong aversion to certain foods.
- Traumatic or negative food experiences: Negative experiences related to food, such as choking, vomiting, or other traumatic events, may contribute to the development of ARFID. These experiences can create anxiety and fear associated with eating.
- Comorbid conditions: ARFID is often associated with other mental health conditions, such as anxiety, OCD, depression, trauma and bipolar-related disorders. One study that studied patients with ARFID also suggests that 8% of ARFID patients showed suicidal tendencies, with 14% showing lifetime suicidality.
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Is there a link between autism and ARFID?
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by challenges in social communication and behaviour. Some people with autism may also experience sensory sensitivities, including those related to food. Due to these sensitivities, they might exhibit behaviours similar to ARFID, such as being selective about the types of food they eat, avoiding certain textures, or having strong preferences.
It’s important to note that not everyone with autism has ARFID, and not everyone with ARFID has autism. However, the co-occurrence of the two conditions is not uncommon, with research indicating that there is a co-occurrence of ARFID with ASD in approximately 12.5–33.3% of patients. Other research suggests that the presence of ARFID in young children should prompt consideration and suspicion of ASD.
How is ARFID treated?
The treatment for ARFID involves identifying its underlying causes. A comprehensive approach is necessary, requiring a multidisciplinary team that may include psychiatrists, dieticians, psychologists and other healthcare professionals. Various treatment strategies are employed, such as;
- Cognitive-behavioural Therapy (CBT)
- Family therapy
- Medication to address anxiety or depression
- Nutritional education
- Group therapy
- Individual counselling.
The focus of treatment is on addressing both the physical and psychological aspects of ARFID. This includes providing nutritional support to restore healthy eating patterns and psychotherapy to develop healthier ways of thinking and responding to food-related concerns. The ultimate goal is to restore normal eating behaviours whilst improving nutritional deficiencies.
What are the next steps?
If you suspect ARFID in yourself or a loved one, the next steps involve seeking professional help. Schedule an appointment with a healthcare provider or mental health professional to discuss symptoms, concerns and potential diagnosis. They can conduct a comprehensive assessment whilst providing guidance on treatment options.
Early intervention is crucial for managing ARFID and improving overall well-being. Remember, reaching out for help is a brave and essential step towards a healthier future.
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FAQ’s
The outlook often depends on several factors, including the specific nature and severity of the individual’s feeding difficulties, any underlying causes and the presence of additional support and interventions.
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