All about ARFID: The three main subtypes
Your child won’t eat peas because they’re gross. In other words, because peas don’t taste like candy, which is what they’d much rather eat. Is this something to be alarmed about, or is it just picky eating/a phase they’ll eventually grow out of? Well, it depends.
Since the addition of Avoidant=Restrictive Food Intake Disorder (ARFID) to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), parents around the world have been asking themselves this question: Are my child’s eating habits a normal part of their development, or is something deeper going on here?
Unfortunately, picky eating and ARFID aren’t that easy to connect. ARFID is a diagnosable eating disorder, a psychological condition that makes it difficult for individuals to consume certain foods for a number of reasons.
Because this eating disorder—like all the others—is so complex, I feel it warrants further investigation. In this blog post, I’ll dig into:
key symptoms and diagnostic criteria of ARFID
how ARFID differs from other eating disorders
the three main subtypes of ARFID
treatment options for people with ARFID
What is ARFID?
Individuals with ARFID restrict the amount or variety of food they consume, which can cause nutritional deficiencies, unintended weight loss, and interference with daily activities, like social gatherings.
With ARFID, the avoidance of certain foods is typically based on sensory sensitivities, a lack of interest in eating, and/or fears of negative consequences from eating, like choking or vomiting.
ARFID symptoms and presentations
According to the National Eating Disorders Association (NEDA)’s website, to diagnose someone with AFRID means “the eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder.” Regard;ess of why people with ARFID limit their food intake (which I’ll get into later), they often fail to meet their body’s nutritional and/or energy needs.
Below are common physical symptoms that may be present in someone with ARFID:
Limited variety and/or volume of food intake, which may become more narrow over time
Constipation, abdominal pain, bloating, and other gastrointestinal (GI) issues
Difficulty concentrating, dizziness
Impaired immune functioning; poor wound healing
Menstrual irregularities (in women)
ARFID prevalence and demographics
It’s estimated that ARFID affects 0.5% to 5% of children and adults in the general population. ARFID most commonly begins to manifest in childhood, but it can develop at any age and persist into adulthood.
Unlike some other eating disorders, males and females tend to be affected by ARFID at nearly equal rates. According to the same study linked above, males accounted for 20% to 35% of ARFID cases in both children and adolescents.
What are the three main subtypes of ARFID?
Eating disorders are so complex that each major category (e.g., anorexia nervosa, bulimia nervosa) can have varying presentations and symptoms. ARFID, for example, can be sorted into three main subtypes:
Sensory avoidant: Avoiding foods with certain textures, tastes, smells, or appearances
Low interest in food: A lack of interest in or appetite for food in general
Fear of aversive consequences: Afraid of negative effects of eating, such as choking, vomiting, or allergic reactions
In addition to presenting differently, these subtypes also have different root causes. There may have been trauma around food in childhood that prevents an individual from finding certain food appetizing, or they may have had a negative experience with a certain food and fear eating it again.
Unlike most other eating disorders, ARFID is less likely to develop because of body shape or weight concerns, although it is possible.
Next, we’ll explore additional differences between ARFID and other eating disorders.
How is ARFID different from other eating disorders?
It’s not uncmmong for two (or more) eating disorders have overlapping symptoms, but ARFID stands on its own in a few ways:
Lack of body image concerns. As stated, those with ARFID typically are not driven by a fear of gaining weight or concerns about body size.
Reasons for fear and avoidance of food. Individuals with ARFID avoid food because of sensory sensitivity, disinterest in food, or fear of negative repercussions from eating.
Physical presentation. Although those with ARFID limit food intake, a low body weight is typically not associated with this eating disorder. Low body weight also is not a diagnostic criterion for ARFID, like it is for anorexia nervosa.
Comorbidities. Comorbidities are common with eating disorders. In individuals with ARFID, autism spectrum disorder is a common co-occurring condition.
Duration. When the onset of ARFID occurs in childhood and goes undiagnosed for many years, it can last well into adulthood, making ARFID one of the (potentially) longer-lasting eating disorders.
Impact on daily life. People with ARFID often face difficulties in social interactions revolving around food. They may feel pressure to eat certain foods and feel embarrassed if they don’t eat what everyone else is eating. This can cause tremendous anxiety around social situations and may even hinder their attempts to be social.
What are common treatment options for ARFID?
Like other eating disorders, ARFID typically can be treated with a combination of different approaches, including the following.
Multidisciplinary treatment
Eating disorders are rarely just about food. They often develop from unrecognized or unacknowledged trauma or psychological condition, like depression or anxiety. Therefore, individuals have the best chance of recovery when they have a team of providers, such as a therapist, psychiatrist, nutritionist, and primary care provider.
Family therapy
When family members are a part of treatment, professional teams can better explain and demonstrate the individual’s fear around certain foods. They can also help the family learn how to implement positive meal rituals to meet the needs of their loved one. Family therapy can be especially beneficial for families with children and adolescents.
Exposure therapy
Gradual exposure to new foods in a safe and supportive environment can help someone with ARFID reduce their anxiety and fear around eating.
Medical and nutritional counseling
Beyond individual and family therapy, individuals with ARFID can benefit greatly from medical and nutritional therapy. Often, those with ARFID have nutritional deficiencies that can cause immediate and long-term health problems. Professionals can run tests and keep a close eye on a patient’s nutrition to help them stabilize and meet their body’s nutritional needs.
Conclusion
ARFID can make daily life a serious struggle. Individuals with ARFID may face difficulty eating in social situations, meeting their own nutritional needs, and seeking a treatment provider who understands their behaviors. Although ARFID is a relatively new eating disorder according to the DSM-5, researchers have been studying it for decades. As more research is conducted and new insights emerge, there’s hope that treatment options and outcomes will improve, allowing individuals with ARFID to live full lives in recovery.
Pause & Prompt
Are you afraid of certain foods? Do you only allow yourself to eat what you deem to be “safe foods”? Write what this looks like for you.
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