Only added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013 under the “Feeding and Eating Disorders” section, avoidant restrictive food intake disorder (ARFID) is a recent diagnosis that was previously called Selective Eating Disorder.
Here, we will share what avoidant restrictive food intake disorder is, what the symptoms are, and how similar or different it is to anorexia nervosa.
What Is Avoidant Restrictive Food Intake Disorder?
Avoidant restrictive food intake disorder (ARFID) is an eating disorder that presents as someone avoiding certain foods or restricting their intake of certain foods, but not because they’re concerned about their body weight, shape, or body size — like anorexia nervosa.
Going beyond selective eating, people with ARFID have a limited selection of foods they’ll eat and possess a general lack of interest in food.
For example, a person with ARFID might avoid certain foods because of a certain taste, texture, color, or other quality. This can result in them having a very restricted choice of things they’ll eat or the amount they’ll eat and, therefore, can put their health at risk.
Studies into how common ARFID is are scarce. However, its prevalence ranged from 5% to 14% in tertiary care units of children and adolescent eating disorder programs. It even reached 22.5% in pediatric outpatient programs.
Everyone in the general population can develop ARFID, but it seems more common in children and young people.
Symptoms and Warning Signs
There are various physical, behavioral, and psychological symptoms of ARFID.
Physical symptoms and warning signs can include:
- Stomach cramps, constipation, acid reflux, etc
- Menstrual irregularities
- Problems concentrating
- Dizziness
- Fainting
- Always feeling cold
- Problems with sleep
- Dry skin
- Dry and brittle nails
- Fine hair on the body
- Thinning of hair on the head or dry and brittle hair
- Muscle weakness
- Cold, blotchy hands and feet or swollen feet
- Poor wound healing
- Impaired immune functioning
Behavioral and psychological symptoms and warning signs can include:
- Dramatic weight loss
- Wears many layers to disguise weight loss or to stay warm
- Complaints of constipation, abdominal pain, being too cold, lethargy, and/or too much energy
- Always describes vague gastrointestinal issues (sour stomach, feels too full, etc.) around mealtimes that don’t seem to have a cause
- Dramatic food restriction and selective eating
- Only chooses to eat certain textures of food
- Scared of choking or vomiting
- Low appetite or lack of interest in food
- Picky eating that continuously gets worse
- No problems with body image or no fear of weight gain
A few warning signs of ARFID specific to children are being highly fearful of new foods — this is called neophobia — or being scared of bad experiences related to unfamiliar foods.
Some children with ARFID might fear what will happen when they eat, such as experiencing pain, choking, or vomiting. Children who show no interest in food or eating may also deny being hungry.
In adults, a person with ARFID may depend on nutritional supplements.
Anorexia vs. Avoidant Restrictive Food Intake Disorder
As mentioned, the symptoms of ARFID can look similar to those of anorexia. But, as these comparisons made by Cambridge University Press in a 2019 paper demonstrate, there are marked differences in the characteristics of these two restrictive eating disorders:
- Those with ARFID were generally unbothered about weight gain or wanted to gain weight. In contrast, those with anorexia nervosa (AN) were bothered about gaining weight
- Those with ARFID limited food based on texture, look, and taste, while people with AN limited food based on calorie content
- A higher proportion of males develop ARFID compared to AN, which sees a higher proportion of females with the disorder
- The onset of ARFID most commonly occurred between 4–13 years, but the peak age of AN occurrence is older at 13–15 years
And as it related to other mental health concerns: While there were increased incidences of anxiety for people with ARFID, there were increased occurrences of depression for those with AN.
How Is ARFID Diagnosed?
For an ARFID diagnosis, the following criteria from the DSM-5, as published by the National Library of Medicine, must be matched. Diagnostic criteria include:
“An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated 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.
The eating disturbance is not attributable to a concurrent medical condition or is not better explained by another mental disorder. When the eating disturbance occurs in the context of another mental disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.”
If a doctor thinks that a child has ARFID, they’ll perform an examination and ask about their medical history, as well as enquire about the child’s eating habits and any emotional issues they may be experiencing that don’t revolve around weight or body image.
The child’s symptoms shouldn’t be appearing because of a lack of access to food or because of various other points that appear in the DSM-5 criteria, such as the diagnosis of another eating disorder or medical condition.
To cover all bases, a doctor may do blood tests, urine tests, or perform an electrocardiogram (ECG) to check for problems.
Causes of Avoidant Restrictive Food Intake Disorder
People with ARFID might show aversive behavior towards certain foods because of their sensory characteristics — an unease surrounding specific tastes, textures, or smells.
Others may avoid specific foods or stop eating entirely after experiencing or witnessing a traumatic experience with eating, such as choking, vomiting, or other forms of gastroenterological distress.
Risk Factors
When it comes to people being more likely to develop avoidant/restrictive food intake disorder, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), and intellectual disabilities are often predisposing factors.
ADHD can affect eating behavior because an individual tends to be distracted easily or lacks interest in eating.
Interestingly, children who were picky eaters when they were young sometimes don’t outgrow this and go on to develop ARFID into adulthood.
Furthermore, children with a family or maternal history of anxiety or eating disorders are more likely to develop feeding disturbances. Similarly, many children with ARFID also have anxiety disorders and are at high risk for other mental health conditions.
Unfortunately, parents who get frustrated with their child’s food avoidance and feed them their preferred foods while avoiding new foods continue to perpetuate the condition — in such cases, therapeutic intervention for the child may prove helpful.
Health Risks of Avoidant Restrictive Food Intake Disorder
Due to people with ARFID restricting their food, they may be susceptible to nutritional deficiencies. Because of this, the body can slow down to conserve energy, which leads to more serious medical consequences.
A lack of nutrition can lead to electrolyte imbalances. Electrolytes are important for our body to regulate the body’s pH levels, help with nerve and muscle function, hydrate the body, and rebuild damaged tissue. Severe electrolyte imbalances can lead to muscle cramps and seizures.
Decreased nutrition can also result in dizziness and fainting due to low blood pressure, a slow pulse, dehydration, and weakened muscles.
Children with ARFID are at risk of delayed puberty and not getting enough vitamins, minerals, and protein. The Journal of Eating Disorders published a narrative review in March 2023 that stated patients with ARFID who fail to identify and treat the condition run the risk of a long-lasting impact on their longitudinal growth and bone mass accrual.
Treatment Options
As with all eating disorders, the earlier disordered habits are recognized, the quicker they can be treated. There are various ways someone with ARFID can be helped, and they may need different kinds of care from various health professionals.
Medical Treatment
Avoidant restrictive food intake disorder treatment often focuses on helping a patient gain and maintain a healthy weight, preventing complications that could affect their mental and physiological health. Therefore, someone with ARFID may benefit from being treated by a doctor, a nutritionist, and a therapist. A nutritionist may be able to help a patient develop healthier eating patterns and increase the food varieties they’re willing to eat, while a doctor may prescribe medication that’ll increase appetite or treat anxiety.
Someone with severe weight loss, malnutrition, or serious health issues might need treatment in a hospital. For example, some children with ARFID need tube feeding or nutrition formulas to get the necessary calories and vitamins.
Therapy
Along with medical treatment, different therapies might help treat ARFID. For younger children and those on the autism spectrum, desensitization therapy and exposure therapy may prove successful. While for older children, cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), hypnotherapy, and eye movement and desensitization and reprocessing (EMDR) therapy may be more suitable.
ARFID May Require Therapeutic Intervention
While ARFID differs from other eating disorders, it can be just as severe and lead to several health complications. Therefore, if you recognize any ARFID symptoms in yourself or a loved one — maybe a child — it’s important to get the professional help of a healthcare provider. They may prescribe therapy; if they do, you’re in the right place.
Grow Therapy is home to many excellent, qualified therapists specializing in eating and feeding disorders. We also have therapists who help treat children. Simply filter by the specialty and insurance type you’re looking for, and find the right therapist for you or your loved ones.