What is Restrictive Food Intake Disorder? (ARFID)
Avoidant or restrictive food intake disorder, also known as ARFID, is an eating disorder in which people will limit the amount and the type of food consumed (WebMD). Previously known as Selective Eating Disorder, it is similar to Anorexia Nervosa; however, it does not involve a preoccupation with body image or size.
Someone with AFRID will simply not eat enough calories or nutrients to meet their daily food intake requirements. This can lead to weight loss and undernourishment.
ARFID was first introduced to the DSM-5 in 2013 and affects children, adolescents, and adults. In adults, ARFID can become so severe that normal body functions no longer work the way they should. In children, AFRID goes far beyond picky eating. Many have delayed growth, a severe lack of energy, and are underweight for their age (Psychiatric Times). A child presenting with ARFID may display aversions to specific types of foods and simply refuse to eat (Very Well Mind).
Facts and Statistics
Because AFRID presents in different ways, the following criteria are used to determine typical causes of the eating disorder as per the DSM-5 (Psychiatric Times):
- Poor appetite
- Fear/anxiety surrounding food
- Food avoidance because of sensory issues or intolerances
Studies Concerning the Prevalence of ARFID
In an assessment of 48 children with an average age of 14 years, who had been admitted to a hospital for signs of ARFID, it revealed that 13% had presented with the above-mentioned criteria (Psychiatric Times).
In the UK, the prevalence rates outside of controlled studies and clinical assessments for restrictive food intake disorder are widely unknown. On average, 5 to 13% of tertiary-aged students were found to have ARFID in medical and psychiatric settings (BMJ Journals).
If we look at the number of people affected by eating disorders in the UK, we see that around 1.25 million people are affected by Anorexia Nervosa, Bulimia Nervosa, binge eating disorder, and ARFID. Of these cases, restrictive food intake disorder accounted for 5% compared to the 8% of Anorexia Nervosa (Beat Eating Disorders).
While ARFID is considered a new classification of eating disorders, around 3.2% of the general population is affected by it. ARFID is also one of the most common eating disorders in children with 22.5% meeting the criteria for the condition across outpatient programs for young individuals with eating disorders (NCBI).
What Causes Restrictive Food Intake Disorder to Develop?
Clinicians cannot determine a single cause for restrictive food intake disorder. It is believed that different environmental, biological, and psychosocial factors are responsible for its development (Center for Discovery). These include:
- Children with a predisposition to ARFID owing to biological factors, could have symptoms triggered by changes in environmental or psychosocial circumstances including trauma.
- Psychological disorders such as generalized anxiety, developmental conditions, and autism may contribute to poor eating patterns.
- Sensory sensitivities and intolerances (particularly in children with Autism) increase the possibility of developing ARFID.
Studies have also shown that children who have experienced trauma are at higher risk of developing co-morbid mental health conditions. Anxiety disorder is highest in both children and adults who are diagnosed with ARFID.
Patients with avoidance or restrictive food intake have also expressed a fear of eating food not for weight gain or body shame reasons, but rather because of stomach pain or an intolerance (allergic reaction). Younger individuals have also expressed fear of eating “Bad Foods” that would cause them to be unhealthy which leads to food avoidance.
Most adults and adolescents who develop ARFID have been selective eaters since childhood. While many children are considered “picky eaters” it is when the behaviour becomes extremely limiting and unhealthy leading to weight loss and ill health, that it is more than being a picky eater.
What are the Signs and Symptoms of Restrictive Food Intake Disorder?
The psychological signs and symptoms of restrictive food intake disorder (WebMD):
- Restrictions in the amount and types of food consumed.
- Gag reflexes or a fear of vomiting when eating food.
- Feeling self-conscious or uncomfortable when eating with others.
- Adults may wear baggy clothes to hide significant weight loss.
- No signs of concern over body size, shape, or weight (as with Anorexia).
The physical signs and symptoms of restrictive food intake disorder (WebMD):
- Rapid weight loss
- Poor appetite
- Abdominal cramps
- Poor concentration
- Fatigue, weakness, and lightheadedness
- Slow healing of wounds
- Slow heart rate
How Does Restrictive Food Intake Disorder Affect the Body and Mental Health?
Restrictive food intake disorder can cause many physical limitations on the mind and body. In women, abnormal or absent menstrual cycles may occur. Adults will also suffer hair loss and unhealthy weight loss because of malnutrition. This makes it difficult for the body to perform essential functions that can lead to heart problems, eye issues, and diabetes (Healthline).
The impact of ARFID is far-reaching. Children avoid foods that they have learned or believe will make them unhealthy. This also affects their ability to engage socially and disrupts their physical growth, energy, and normal development. Adults become increasingly withdrawn and feel overwhelmed, shameful, and anxious about eating food or consuming meals with others in social situations. Avoidance or restrictive food intake disorder can have a severe impact on healthy physical as well as social development in children as they continue to withdraw physically and psychologically.
If you, your child, or someone you care about is suspected of ARFID, seeking a professional diagnosis can help them with treatment and prevent disruptions across mental and physical well-being.
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Diagnosing Restrictive Food Intake Disorder
Individuals with ARFID will usually have a history or pattern of restricted food intake. To be diagnosed with ARFID, the behaviour of food avoidance should not be explained by the following factors:
- Cultural or religious practices
- A lack of access to food
- A medical condition
The presence of the disorder must result in the following symptoms (Very Well Mind):
- Show signs of nutrient deficiency or malnutrition.
- Severe weight loss in adults or a failure to gain age-appropriate weight (meet growth requirements) in children.
- Dependence on nutritional supplements or tube feeding to receive essential/daily nutrition.
- Feelings of anxiety and shame when eating with others or engaging in social situations.
Treatment and the Long Term Recovery from Restrictive Food Intake
The first stage of treating children and adolescents is assessing their physical needs. For young individuals who have poor growth rates or are underweight, a nutritional programme must be introduced to help them restore weight loss and catch up to their normal growth rates (Psychiatric Times).
Many adults who are severely underweight or malnourished will be placed on tube feeding in a hospital or will be required to take oral nutritional supplements that are overseen by their doctor. Both adults and children who go onto a weight management programme, will be monitored until the desired weight and health are reached.
Residential treatment is recommended for individuals (both children and adults) who have severe malnourishment, weight loss, and difficulty consuming a healthy diet. Residential treatment focuses on weight improvements and can include tube feeding to get individuals to a stable weight. Along with nutritional assistance, therapy provided in residential treatment is aimed at reducing the symptoms of anxiety and a “re-introduction” to previously restricted foods can be helpful for those with ARFID.
Therapy remains an important part of recovery from restrictive food intake disorder. Research has shown that family therapy that is used to treat Anorexia is particularly beneficial in cases of ARFID. The purpose is to equip parents with the tools and knowledge to help children and adolescents gain healthy weight while addressing any anxieties, fears, and guilt surrounding food. Parents are also educated on avoiding a punishing approach to forcing children to eat which can have the opposite effect on consuming a balanced diet.
Reaching out to a trusted therapist, GP, or pediatrician for children, can help you find the treatment you need to live a healthy, full, and better quality of life.