What is avoidant restrictive food intake disorder (ARFID)?
When young children make a habit of avoiding certain foods, their parents may simply call them picky eaters. However, when teens and adults avoid specific foods to the detriment of their health, it is known as avoidant restrictive food intake disorder (ARFID). ARFID is similar to anorexia nervosa in that both limit the amounts and/or types of food someone eat. The difference is that AFRID does not involve issues with body shape or size, or fears around body weight.
According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, a diagnosis of ARFID is made when the following criteria are met:
- 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 disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
- The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
- The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Signs and Symptoms ARFID
ARFID may simply begin as picky eating but may evolve into something more serious over time. The following are more commons signs and symptoms of ARFID.
- Dramatic weight loss
- Dramatic restriction on types or amount of food eating
- Fear of choking or vomiting
- Lack of appetite or interest in food
- Picky eating worsens over time
- No body image disturbance or fear of weight gain
- Constipation, stomach pains, lethargy
Health Consequences of ARFID
ARFID causes the body to lack essential nutrients for normal function, which can cause the body to slow down normal processes. Serious health consequences can arise including the following:
- Slow heart rate and low blood pressure; the risk for heart failure increases, as heart rate and blood pressure decrease
- Muscle loss and weakness
- Fainting, fatigue, and overall weakness
- Dry hair and skin, hair loss
- Growth of a downy layer of hair (lanugo) all over the body, including the face, in an effort to keep the body warm
- Impaired immune functioning
How We Treat
Pushing for Just One More Bite
Clients struggling with ARFID may often have an imaginary line that dictates how much food they believe they can consume. They may be fearful and argue that pain and discomfort will arise if they eat over their set amount. This combined with a limited range of acceptable foods greatly impacts a person’s physical health. A common approach for recovery from pica is known as pushing for just one more bite.
When a client has consumed what they deem their maximum amount, it may be necessary to encourage just one more bite of food. This approach may not significantly influence weight, however it will utilize behavioral exposure allowing clients to challenge their the psychological self-imposed food limits.
Exposure therapy is an evidence-based therapy with high overall success rates. This approach exposes a client to foods they refuse to eat repeatedly. With each exposure anxiety and fear decrease until nonexistent.
An example of this approach would be to imagine a young woman who has anxiety over eating bread. Initially she may begin exposure by slicing a loaf of bread. The next step may be making a sandwich using bread. As this progression continues anxiety is reduced and a comfort with bread will emerge, such as she might be comfortable taking a bite of the bread.
Testing Problematic Foods
Clients in treatment for ARFID frequently become overwhelmed by the idea of eating certain problematic foods, which is a normal emotion. One effective and helpful intervention is to add a sample portion to a plate of safe foods. This method allows clients to see the food on their plate and know that they won’t have to eat it. Alternatively, clients may try a bite of the food while having the safe food to eat before and afterward. This approach makes slow and steady progress, one meal at a time widening the range of acceptable food choices.
Cognitive Behavioral Therapy
Avoidant restrictive food intake disorder isn’t just about personal preference or being a “picky eater.” It is a mental health disorder, just like anorexia or bulimia, therefore requiring psychological interventions such as cognitive behavioral therapy.
In cognitive behavioral therapy (CBT), clients can begin to explore underlying issues correlating food habits or anxiety. CBT empowers clients to identify, challenge and change their unique thoughts, emotions and behavioral patterns
Group Support and Outings
Support systems are an integral part to the treatment of ARFID. A powerful component at Magnolia Creek are the healthy and meaningful connections you will establish with peers. Part of recovery entails expanding your meals so that you can be healthier and part is creating a recovery network to ensure your social health. The group outings help remind clients of the joy of social eating.
An outing might include a stop at a restaurant, where clients have less control over the food. Focusing on the company, rather than the food itself, can be helpful in the recovery process.
Magnolia Creek is a High-Quality ARFID Treatment Center
Finding a residential eating disorder treatment program in Alabama can feel challenging, but Magnolia Creek is a high-quality ARFID treatment center. Clients can expect collaborative therapies in a serene environment. Examples of therapies, amenities, and treatments include:
- Dialectical behavioral therapy
- Family therapy
- Recreational outings
- Outdoor therapy and space to explore
- Support for weight restoration as needed
An ARFID treatment center might be the right place to heal. At Magnolia Creek in Columbiana, Alabama, women can make real progress in a supportive environment. Call 205-650-8077 for details on how to get started.