ARFID

ARFID, an acronym for Avoidant/Restrictive Food Intake Disorder, is a severe mental health condition characterised by highly selective eating behaviour. Individuals with ARFID may avoid certain textures, colours, or types of food, resulting in an inadequate intake of nutrients that can impede growth and overall health. 

Recognised as a distinct eating disorder by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ARFID aids healthcare providers in accurate diagnosis, setting it apart from other eating disorders primarily focused on body image concerns. Introduced in the DSM-5 in 2013, ARFID replaced the previously known “Selective Eating Disorder,” encompassing a broader spectrum of symptoms and behaviours associated with avoidant and restrictive eating. Unlike many other eating disorders, ARFID is not driven by concerns about weight or appearance. Its manifestations range from a general disinterest in food to a perceived aversion to specific textures or smells. ARFID often begins in childhood and, if left unaddressed, can persist into adulthood, underscoring the importance of early intervention and treatment.

Understanding ARFID’s different manifestations is crucial in effectively identifying and treating this disorder. ARFID can generally be categorised into three primary types based on the specific characteristics of the individual’s eating behaviours. Each type can pose serious health risks, resulting in malnutrition and other complications due to a restricted diet.

Sensory-sensitive ARFID 

Sensory-sensitive ARFID is avoiding foods with specific textures, tastes or smells. Individuals with sensory-sensitive ARFID may find certain foods too slimy, gritty or mushy, leading them to reject them entirely.

Avoidant ARFID 

Individuals with Avoidant ARFID exhibit a general lack of interest in eating. They may skip meals, eat very slowly or show a disinterest in food altogether. This type of ARFID is characterised more by apathy towards food rather than a strong aversion to certain food characteristics.

Conditioned ARFID

Conditioned ARFID often develops after a traumatic event involving food, such as choking or vomiting. The fear stemming from the traumatic event leads to avoiding the food(s) involved or sometimes food in general.

ARFID symptoms and behaviours

Identifying ARFID can sometimes be challenging due to its subtle nature and the common misconception that it is just picky eating. However, recognising ARFID symptoms and behavioural signs is a crucial step in seeking timely help. 

• Dramatic weight loss or failure to gain weight
• Nutritional deficiencies
• Gastrointestinal issues
• Psychosocial issues
• Developmental delays.
• Preoccupation with food, diet and body size
• Disruption in normal daily functioning
• Adverse reactions to food textures

What causes ARFID?

Similar to other eating disorders, ARFID arises from a complex interplay of biological, psychological and environmental factors. Understanding these causal factors can help tailor a suitable management and treatment approach. 

Genetic factors

Strong evidence suggests a genetic component in the development of ARFID. Families with a history of eating disorders need to be vigilant and proactive in monitoring young family members’ eating habits and behaviours to ensure early identification and intervention if necessary.

Psychological factors

• Anxiety disorders: Individuals with anxiety disorders are at a higher risk of developing ARFID due to heightened sensory sensitivity towards food attributes such as texture, smell, and taste. This fear of choking or vomiting, often linked to eating, leads to significant dietary restrictions.

• Autism spectrum disorders: ARFID often co-occurs with autism, as individuals on the autism spectrum may have sensory sensitivities that lead to restrictive eating patterns based on food attributes like texture and colour. Rigidity and routine-focused behaviours in autism can exacerbate these eating challenges, making introducing new foods into their diet difficult.

Traumatic events 

Those who have experienced trauma, like choking incidents or severe allergies, may develop heightened aversions to specific foods, leading to ARFID. Traumatic events create lasting psychological imprints, fostering food-related anxiety and extreme caution to avoid similar experiences.

Sensory sensitivities 

ARFID frequently appears in individuals with heightened sensory sensitivities, causing an aversion to specific food textures, tastes, or smells. This heightened sensitivity results in avoidance behaviours, making it difficult for individuals to include diverse foods in their diet. This sensory aspect is a key factor linking ARFID to autism.

Temperament

Certain temperamental traits, like inherent caution or a fearful disposition, can heighten the risk of ARFID. These individuals approach new foods with heightened apprehension, resulting in persistent restrictive eating patterns.

The ARFID diagnosis process entails carefully evaluating an individual’s medical history, dietary habits, and psychological profile. It is vital to differentiate ARFID from other eating disorders and to understand its unique manifestations in each individual.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a guideline for healthcare professionals in diagnosing mental health conditions, outlines specific criteria for ARFID. According to the DSM-5, an ARFID diagnosis can be given if there is a disturbance in eating or feeding, leading to a failure to meet appropriate nutritional and/or energy needs accompanied by one or more of the following:

• Significant weight loss or failure to achieve expected weight gain in growing children
• Significant nutritional deficiency
• Dependence on enteral feeding or dietary supplements
• Marked interference with psychosocial functioning

The DSM-5 also states that the disturbance can not be better explained by a lack of available food or an associated culturally sanctioned practice. Additionally, it must be distinct from anorexia or bulimia nervosa and not occur exclusively during anorexia or bulimia nervosa. It also should not be attributable to a concurrent medical condition or not better explained by another mental disorder.

To accurately diagnose ARFID, healthcare providers often employ a variety of tools, including:

• Physical examinations: To assess the individual’s overall health and to identify any nutritional deficiencies or other health issues associated with restrictive eating.

• Psychological evaluations: To better understand the individual’s mental health and identify any underlying psychological issues that might contribute to the disorder.

• Nutritional assessments: A detailed evaluation of the individual’s eating habits to understand the range of foods they consume, their daily caloric intake and any nutritional gaps in their diet.
• Family interviews: In cases especially involving children, healthcare providers often speak with family members to get a fuller picture of the individual’s eating habits and any family dynamics that might influence the disorder.

Diagnosing ARFID can be complex, requiring a careful and detailed approach to ensure a comprehensive understanding of the individual’s condition. It is a pivotal step towards planning a personalised and effective treatment plan to aid their recovery.

ARFID is notably more common in children compared to adults, a phenomenon attributed to various factors that converge at this developmental stage.

Three examples of the reasoning behind the commonality are as follows: 

1. Children are naturally more cautious and selective about the foods they consume, an evolutionary trait designed to protect them from potentially harmful substances. This protective mechanism can sometimes become overly pronounced, leading to the development of ARFID.
2. Children are in the stage of developing their tastes and preferences. During this time, they are exposed to different textures, flavours and smells, and their responses to these stimuli can be more extreme compared to adults. This heightened sensitivity can foster restrictive eating habits, laying the groundwork for ARFID.
3. Children with developmental disorders such as autism and anxiety or who have experienced traumatic events may also develop ARFID as a coping mechanism. 

Parents and caregivers need to be vigilant in noticing any signs of ARFID in children and to seek professional guidance if they suspect their child might be struggling with this eating disorder.

Addressing ARFID is a nuanced journey, meticulously crafted to align with each patient’s unique requirements. This multifaceted process encompasses a holistic approach, drawing upon diverse therapeutic methods and the collaborative expertise of a multidisciplinary team featuring dietitians, psychologists, and other healthcare specialists. At UKAT London Clinic, we offer tailored treatment approaches deeply rooted in evidence-based practices, ensuring the most effective care for our patients.

Nutritional therapy

An integral part of ARFID treatment is nutritional therapy, which addresses the nutritional deficiencies often accompanying this disorder. Dietitians work closely with individuals to create balanced meal plans that gradually introduce various foods into their diet, helping them overcome their fears and aversions to certain foods.

Cognitive Behavioural Therapy (CBT)

CBT is a therapeutic approach that addresses the thoughts and behaviours associated with ARFID. It works by helping individuals identify and challenge irrational beliefs about food and eating, encouraging a healthier and balanced perspective. 

Dialectical Behaviour Therapy (DBT)

DBT combines CBT and mindfulness strategies that help individuals to accept uncomfortable thoughts, feelings or behaviours. DBT then encourages the development of strategies to change them, fostering a balanced perspective and aiding in recovery.

Family therapy

Family therapy is often essential in treating ARFID, particularly for children and adolescents. This approach involves working with families to foster a supportive home environment, encouraging positive communication and understanding around the individual’s eating challenges. 

Holistic therapies

Holistic therapies, such as mindfulness, yoga and meditation, can be vital to the recovery journey. These therapies encourage a whole-body approach to recovery, fostering mental, physical and emotional well-being and helping individuals reconnect with themselves in a nurturing and healing way.

AFRID Medication

Medication may sometimes be prescribed as part of the treatment plan. While there are no medications specifically approved for the treatment of ARFID, some individuals may benefit from medications that address underlying issues such as anxiety or depression that can accompany the disorder.

At the UKAT London Clinic, our approach to ARFID treatment is truly bespoke. We recognise that each individual brings unique challenges and strengths to the table, so our treatment plans are meticulously tailored to address their specific needs. These customised plans embrace a holistic perspective on recovery, addressing not only the physical but also the psychological and emotional aspects of well-being.

The journey toward overcoming ARFID can be formidable, yet it promises improvement with the right support and treatment. Through close collaboration with seasoned professionals, individuals grappling with ARFID can access the guidance necessary to effectively manage their symptoms and cultivate a healthier, more harmonious relationship with food. Call us today to find out more.