Treatment for Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder associated with the avoidance and restriction of food. It is more prevalent in children and adolescents and is less common in the general adult population. ARFID is new to the DSM 5 and is known to affect 22.5% of children in inpatient programs who are receiving treatment for severe weight loss and poor growth rates for their age.

The purpose of this guide is to create awareness around ARFID including the options for treatment so that affected children and adults receive the help that they need at the earliest possible stage.

What is ARFID?

Avoidant Restrictive Food Intake Disorder was formerly known as Selective Eating Disorder. It involves a chronic failure to meet the daily food intake for age and height leading to weight loss and nutritional deficiencies. ARFID can become so severe that individuals often have to receive enteral feeding. They also struggle with psychosocial function; however, the condition cannot be explained by distortions in body image, cultural beliefs, medical disorders, or a lack of access to food.

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What Causes ARFID?

ARFID typically presents in different ways and can be caused by a fear of the consequences of eating such as discomfort, stomach aches, or an allergic reaction. It is also associated with a general disinterest or avoidance of food owing to a perceived or psychological hypersensitivity.

We look at the 3 most common reasons for avoiding food and developing ARFID

Poor Appetite
Some people are considered as having a generally low appetite while children are described as being “picky eaters” when they show a lack of interest in food. Both adults and children may have a generally low appetite while others may be indifferent towards food. Many young children can learn about ‘unhealthy’ foods and refuse to eat for fear of getting sick, most cases of restrictive food intake occur in adolescence when there may be concerns about weight and body image.

Some children also feel fuller a lot faster than others or eat very slowly and when combined with an active day, it could lead to weight loss.

Some children will also show disinterest in eating when they experience anxiety, fearfulness, or stress. Trauma, conflict in the home environment, bullying at school, and separation anxiety are commonly associated with anxiety, fear, and food avoidance. Children with psychological challenges may show more interest in food when they’re relaxed or around the holidays but it is insufficient to meet their nutritional requirements.

A Preoccupation or Fear of the Consequences of Eating
Individuals who are concerned about food are not affected by a fear of gaining weight, but rather the possibility of experiencing pain, nausea, or discomfort when consuming food. Individuals can restrict the amount of food they eat or they can completely avoid food because they have a persistent or intense fear that it will cause complications such as an allergic reaction or suffocation.

Because ARFID is largely seen in young patients including children, further research is necessary to understand the causes of the condition in this age group. Some researchers believe that younger patients learn that certain foods are “bad” at some stage in their lives and because they don’t want to be unhealthy, they insist specific types of food should be avoided. For others, sudden weight gain or the experience of trauma such as choking on food can also lead to the avoidance of foods.

Perceived Sensory Difficulties with Food
Some people, adolescents, and children will completely avoid food because they have a hypersensitive experience when consuming or trying to consume food. They are also considered extremely picky eaters and will complain about the appearance of food or its texture. In the case of a child presenting with ARFID, an item of food must be cut into a specific number of pieces or certain foods cannot touch on the plate or they will not eat it. Many people and kids will only consider consuming foods when it is presented or prepared in a specific way adding to the complexity of the condition.

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    Getting Help for Avoidant Restrictive Food Intake

    The treatment for an individual who has ARFID will differ according to their personal needs and circumstances; however, therapy generally includes psychotherapy, family therapy, nutritional education, clinical monitoring, and medication. It is almost always treated on an outpatient basis. For patients who present with severe weight loss, poor growth (in teens and children), and malnutrition, medical intervention is implemented. Care providers adopt an aggressive approach when assisting children who do not meet the necessary growth rates for their age which includes medical care and family nutrition education. A multi-faceted treatment plan is necessary based on a physical and psychological assessment.

    As ARFID is a relatively new disorder, research into treatment in both adults and in children is underway. Clinicians suggest family-based therapy to help children and adolescents presenting with symptoms. Not only are patients educated about the importance of nutrition and the dangers of severe weight loss but so are their families, which is a necessary part of supporting their progress.

    For young children and children on the autism spectrum, techniques such as desensitisation and exposure therapy are aimed at improving children’s comfort around food. These strategies focus on reducing their anxiety and stress when eating daily meals. An important part of treatment for ARFID is teaching patients and their families to set goals surrounding their food intake and the importance of nutrition.

    In the UK, the following list of support services are available to assist you with a long term treatment plan:

    Frequently Asked Questions
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    Is ARFID Genetic?
    ARFID is an eating disorder that is closely related to disturbances in psychological and social functioning. It is also associated with disruptions in family environments where there is guilt or a lack of understanding surrounding food and nutrition. It is often linked to a learned behaviour in children who may have been taught about “bad foods” at school or those who’ve had a negative experience with food such as choking. Children will deliberately avoid eating or may be severely picky about the types of foods they eat.
    Is ARFID a Common Eating Disorder?
    ARFID is not a common eating disorder and is more prevalent in children and adolescents than adults. In the general population, ARFID is not widely known; however, up to 22.5% of pediatric inpatient cases are recognised as ARFID.
    What are the Recovery Options for ARFID for Children?
    The treatment of ARFID in children depends on the severity of the symptoms. While it is generally treated on an outpatient basis with special focus on individual and family therapy, cases that include severe weight loss and undernourishment in children will be managed as part of an inpatient program in a clinical environment. The purpose of inpatient care is to help patients reach a normal and healthy weight for their age group. Family therapy and individual psychotherapy are provided on an outpatient basis to support patients and their families with the guilt, stress, and anxiety surrounding food.
    Is ARFID a Mental Health Disorder?
    ARFID is an eating disorder that is categorised as mental illness and is treated by the relevant healthcare professionals. It may present in children, adolescents, and adults with underlying mental health comorbidities and is associated with psychosocial dysfunction. In children, ARFID can present with anxiety surrounding food and the consequences of eating, but it can also present in children on the Autism Spectrum.
    How to Support Someone with ARFID?
    The best way to support someone you suspect as having ARFID is to provide an encouraging and non-critical approach. Making them feel ashamed or pressured will simply push them further into their challenges and battles with their condition.

    Along with your unconditional support prior to individuals receiving help, showing your positivity during their therapy can help their progress. For children, it is important to engage with them and if you are unsure as to how to provide your support, speak to your trusted and experienced therapist for advice and guidance.

    How is ARFID Diagnosed?
    ARFID diagnosis is based on an individual assessment that is performed by a medical health provider such as a therapist. A physical examination performed by a healthcare provider is a necessary part of addressing the presence of ARFID. Children and adolescents are assessed by a paediatric healthcare professional in terms of weight and growth rates according to a paediatric scale. A psychological evaluation is necessary and monitoring in both inpatient and outpatient treatment will support the process of recovery.

    It includes the following signs and symptoms:

    There is the presence of a disturbance in consuming food such as a disinterest in food or concerns about the consequences of consuming food resulting in poor nutrition including:

    • Severe weight loss or a lack of appropriate growth rates in children.
    • Malnourishment.
    • Reliance on the intake of supplements or enteral feeding.
    • Difficulties in psychosocial function.

    The condition should not be associated with a lack of access to food or by cultural practices. It should also not be present in a course of Bulimia or Anorexia Nervosa, and there is an absence of distorted body image. The presence of the symptoms of ARFID should also not be explained by an additional or separate mental health disorder.

    Jason Sheirs
    Author / Jason Shiers / Dip. Psych MBACP
    Jason Shiers is a Certified Transformative Coach & Certified Psychotherapist who is a specialist in addiction, trauma and eating disorders. He has been working in the field of addiction for 25 years now.