If you’ve never heard of ARFID, you’re not alone. It has been chosen for the theme for this year’s Eating Disorder Awareness Week in support of this campaign. This blog offers a comprehensive overview of what we know about this largely misunderstood illness.

What is ARFID?

ARFID stands for Avoidant and Restrictive Food Intake Disorder. It’s only been recognised as an eating disorder and a diagnosable mental health problem since 2013. It’s characterised by avoiding certain foods or restricting food intake and can affect anyone at any age, even as young as two years old.

Why Restrict or Avoid Food?

Food is essential for our survival so why restrict of avoid it? The reasons for this can vary across eating disorders but in ARFID, the three most common reasons for this are:

Sensory Sensitivities

Sensory sensitivities in ARFID refer to experiencing the taste, texture, appearance or smells of certain foods very unpleasant and therefore not wanting to eat them.

Fear of the Consequences of Eating

Fear of eating in ARFID involves feeling anxious about certain foods, or eating in general. You may be unsure what causes this fear and anxiety, or you may have specific fears about choking, vomiting or becoming unwell in some way. These specific fears may be due to having had an difficult past experience.

Lack of Hunger

You may find that you don’t feel hungry or you lack appetite and therefore have little or no interest in eating. You may even find that eating feels like a chore.

 

What are the Signs of ARFID?

There are a number of signs of ARFID that will differ between individuals. This is not therefore a list of symptoms but some possible indicators to consider:

  • Eating less food than is needed to maintain good health.
  • Struggling to recognise hunger.
  • Skipping meals completely.
  • Feeling full very quickly and then struggling to eat more.
  • Avoiding social events that involve food.
  • Finding meal times and eating a chore.
  • Eating the same meals repeatedly.
  • Only eating certain ‘safe’ foods.
  • Eating food that is different to what everyone else eats.
  • Feeling anxious at mealtimes.
  • Being very cautious about eating .e.g. taking small bites, chewing very carefully.

These signs can be missed, or put down to being a ‘fussy eater.’

Diagnostic Criteria for ARFID in DSM-V

You may read the above list and relate to some of these, but that doesn’t necessarily mean you have ARFID. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), specifies that ARFID is an eating or feeding disturbance manifested by persistently failing to meet necessary nutritional needs, along with at least one of the following problems:

  1. Significant weight loss (or not achieving expected weight gain in children).
  2. Significant nutritional deficiency.
  3. Dependence on nutritional supplements or assisted feeding (e.g. tube feeding).
  4. Marked interference with psychosocial functioning.

The DSM-V also specifies that the eating disturbance must be for reasons other that lack of available food or as a result of cultural or religious practices, such as fasting.

Risk Factors for ARFID 

We are still lacking in robust research into risk factors for ARFID, but we do know that there is a higher incidence of ARFID in people who are autistic, and that there is a high comorbidity of ARFID and anxiety, particularly in children.

How does ARFID differ from other eating disorders? 

The main difference between ARFID and eating disorders such as anorexia and bulimia is that the reasons for avoiding or restricting food is not attached to concerns about weight gain or body image. It is therefore not possible to have a diagnosis of ARFID at the same time as having a diagnosis of anorexia or bulimia. It is possible to have them at separate times, however.

ARFID and Anxiety

We know that 50% of mental health problems emerge before adolescence so spotting the early warning signs for mental health difficulties in children is key. It is not uncommon to experience more than one mental health problem at a time, such an anxiety and depression. With ARFID, research suggests that many children with ARFID also have an anxiety disorder and are at high risk for other mental health difficulties.

ARFID and Autism 

Some autistic people experience sensory overload and may avoid or restrict food to manage this. Autistic people may also have a tendency for repetitive behaviours and sticking strictly to routine. With eating, this may involve eating the same food repeatedly. Changes in these patterns or exposure to disliked sensory stimuli can be very distressing. It is estimated that up to one third of people with ARFID are also autistic.

 

What is the impact of ARFID

Food is our fuel and we need a balanced diet for our overall health and wellbeing. The avoidance and restriction of certain foods in ARFID increases the risk of nutritional deficiencies, low energy, and can impact on health. In children, normal growth and development may be affected and puberty may be delayed. In women, nutritional deficiencies may result in amenorrhea, where periods stop. ARFID can also be a risk factors for osteoporosis, which is a weakening of the bones.

Children with ARFID who are restricting food may not gain weight at a healthy rate. Conversely, if the ‘safe’ foods repeatedly eaten are ‘junk foods’ it is possible that weight gain may become problematic for both children and adults.

As well as nourishing us, food also plays a big role in our social lives. Plans for social events and holidays often revolve around food. Birthdays involve cake, Christmas involves a roast dinner, Easter has become about chocolate. We catch up with friends over coffee or a meal. For someone with ARFID, this can be a real challenge. You may find that you feel stressed or anxious ahead of these situations, or that you avoid them, make excuses or cancel at the last minute. This may have an impact on your social support and leisure activities which we know is important for our overall wellbeing,

 

Support for ARFID

The number of people affected by ARFID is unknown and treatment is not yet available nationwide. Further understanding and awareness of the illness is still needed to inform evidence-based treatments. Specialist eating disorder services or an experienced eating disorder therapist are likely to be best placed at supporting adults with ARFID and Child and Adolescent Mental Health Services (CAMHS) may be recommended for children.

Treatment for ARFID would typically aim to support with:

  • Achieving and maintaining a healthy weight.
  • Increasing the variety of foods eaten and develop healthy eating patterns.
  • Reducing and anxiety and fear associated with eating.

Your GP can advise of local services and treatments available. The eating disorder charity, BEAT, also offers information about ARFID and support available.

 

CBT For Eating Disorders with Brighter Minds

If you are an adult who relates to this, or think you may have an eating disorder, you may find Cognitive Behavioural Therapy (CBT) helpful in supporting you to overcome this. Get in touch to arrange an introductory call or book an initial consultation.