What is ARFID?

This post on ARFID is written by Victoria Stavropoulos

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Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating/feed disorder that was first introduced in the DSM-5. Before being added to the DSM-5, ARFID was previously known as “Selective Eating Disorder”. The disorder is related to a restricted food intake that isn’t related to distress about body shape or size.

Below, we break down how ARFID is more than just being a picky eater and is different than the other eating disorders in the DSM.

Etiology of ARFID

ARFID is a condition where someone has severe difficulties eating food; which can happen because they aren’t interested in eating, they dislike certain textures or smells of food, or they’re scared of getting sick or choking from eating.

As a result, they don’t get the nutrition or energy their body needs. This can lead to problems such as weight loss, not getting enough vitamins or nutrients, struggling to keep up with daily activities or emotions because their body isn’t fueled properly and more.

For people with ARFID, it’s not about dieting or wanting to lose weight—it’s more about the person’s relationship with food and how it affects their body and life. 

Possible Causes of ARFID

The exact cause of ARFID is currently unknown. However, a combination of temperament style, genes, and a triggering event may contribute to a person developing Avoidant/Restrictive Food Intake Disorder. Allergies and medical conditions, such as Gastroesophageal reflux disease (GERD) and Eosinophilic esophagitis, are also common medical conditions that may occur with ARFID or lead to feeding problems.

Risk Factors

Risk factors for ARFID include a range of biological, psychological, & sociocultural issues, including:

• People with autism spectrum disorder (ASD), attention-deficit-hyperactive-disorder (ADHD), and/or intellectual disabilities 

• Children who do not outgrow picky eating or exhibit severe picky eating 

• Individuals with a co-occurring anxiety disorder 

Keep in mind: two people with ARFID may have different perspectives, experiences, and symptoms. 

Symptoms for ARFID

ARFID may manifest or interact differently in each person, which includes a combination of behavioral, psychological, and physical symptoms.  

Behavioral & Psychological Symptoms 

• Dramatic weight loss 

• Dresses in layers to stay warm 

• Complaints of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy 

• Reports consistent, vague gastrointestinal issues that have no cause  

• Dramatic restriction in types or amount of food eaten 

• Will only eat certain textures of food  

• Fears of choking or vomiting 

• Lack of appetite or interest in food  

• Limited range of preferred food that becomes narrower over time  

• No body image disturbance or fear of weight gain 

Physical Symptoms 

• Stomach cramps & gastrointestinal complaints 

• Difficulties concentrating 

• Abnormal lab findings (thyroid, hormone levels, etc.) 

• Loss of menstrual period  

• Dizziness, fainting, sleep problems, dry skin, brittle nails, fine hair on the body, thinning of hair on the head, muscle weakness, cold hands & swelling feet, poor wound healing, impaired immune functioning 

Treating ARFIRD

Treatment for Avoidant/Restrictive Food Intake Disorder is recommended to come from a multidisciplinary team to address the medical, nutritional, and psychological symptoms that an individual may be experiencing. Multidisciplinary treatment for ARFID may include medical & psychiatric stabilization, nutritional rehabilitation, weight restoration, family/caregiver dynamics & involvement, a collaboration between providers and referrals, and psychoeducation depending on the person’s symptoms.

IN SUMMARY…

There are several treatment options for ARFID for both children and adults. Treatment options in children and teens may include desensitization therapy, exposure therapy, parent group therapy, or nutritional support. For adults, Cognitive-Behavioral Therapy (CBT).

Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), hypnotherapy, and nutritional support are common treatment options. 

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