Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder that differs significantly from anorexia nervosa or bulimia nervosa. ARFID is characterized by a strong aversion to certain foods or types of foods. This can lead to extreme selectivity that can impact physical health, social life, and emotional wellbeing. Unlike other eating disorders, ARFID is not driven by body image concerns. It is characterized by sensory sensitivities, fears around food, or a general lack of interest in eating.

This blog will define ARFID, look at common symptoms, how ARFID differs in children and adults, co-occurring conditions, and possible causes of ARFID. We will also discuss how it impacts daily life, treatment options, and strategies to support individuals with ARFID. We will also explore the connection between ARFID and other conditions, such as Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Sensory Processing Disorders (SPD), all of which may exacerbate or increase susceptibility to ARFID.

What is ARFID?

ARFID is defined by a pattern of restrictive or avoidant eating. This can lead to nutritional deficiencies, significant weight loss or inadequate growth, and/or psychosocial impairment. It was first introduced as a diagnosable condition in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) in 2013. Those affected by ARFID may limit their diet due to one or more of the following reasons:

1. Sensory sensitivities: Certain textures, tastes, or even the appearance of foods may overwhelm individuals with ARFID. This makes it difficult for them to eat various foods;
2. Fear of negative experiences: People with ARFID often avoid certain foods due to fears of negative experiences like choking or vomiting; and,
3. Lack of interest in eating: Some people with ARFID have a low appetite or find eating to be unappealing. This can lead to restricted eating patterns.

Common Signs and Symptoms of ARFID

People with ARFID can exhibit a range of behaviours and symptoms that interfere with their nutritional intake and social interactions. For example:

• Avoidance of specific foods or food groups: Individuals often restrict certain textures, colours, or flavours of food;
• Nutritional deficiencies: Limited diets can lead to a lack of essential nutrients. This can affect physical health and energy levels;
• Significant weight loss or lack of growth in children: ARFID can hinder healthy growth in children and lead to unintentional weight loss in adults; and,
• Social and emotional distress in food situations: Social gatherings or meals with others can cause stress for individuals with ARFID, leading them to avoid such situations altogether.

How ARFID differs in Children and Adults

While ARFID is typically recognized in childhood, it can persist into adulthood if it is not addressed.

• In children, ARFID often looks like “picky eating” but is more severe and does not improve over time. Without intervention, these restrictive patterns can impact growth, energy levels, and social development.
• In teens and adults, ARFID may lead to greater social isolation, as many avoid situations where food is a focus. Nutritional deficiencies can result in physical health issues, affecting work or academic performance.

ARFID and Co-Occurring Conditions

Several conditions are commonly seen in individuals with ARFID, as they can exacerbate sensory sensitivities or reinforce food-related anxieties:

• Autism Spectrum Disorder (ASD): Many individuals with ASD experience heightened sensory sensitivities, which can make a variety of foods feel intolerable. These sensory sensitivities often contribute to ARFID, as specific textures or flavours can become overwhelming.
• Attention-Deficit/Hyperactivity Disorder (ADHD): Research suggests that ADHD and ARFID often co-occur. People with ADHD may have sensory sensitivities or aversions that limit their food choices, and difficulties with impulse control or attention can complicate eating routines.
• Sensory Processing Disorders (SPD): Sensory processing issues are common in ARFID, particularly with respect to texture, temperature, and smell. Individuals with SPD may struggle with eating a varied diet, which is critical for balanced nutrition.

What causes ARFID?

The exact causes of ARFID are not yet fully understood. However, research points to a combination of sensory sensitivities, prior negative food-related experiences, and psychological and genetic factors. Individuals with a family history of anxiety or obsessive-compulsive disorder (OCD) are more likely to develop ARFID, which can be heightened by co-occurring ASD, ADHD, or SPD.

How ARFID Impacts Daily Life

The effects of ARFID can reach far beyond physical health and can impact social, emotional, and psychological aspects of one’s life. Some examples include:

• Family stress: Caregivers may struggle to encourage healthy eating without triggering stress or anxiety in the individual, creating tension around mealtimes;
• Social isolation: Due to food restrictions, individuals with ARFID may avoid social situations or family gatherings involving food; and,
• Health risks: Nutritional deficiencies from ARFID can result in fatigue, weakened immunity, and long-term health risks such as anemia.

Treatment Approaches for ARFID

Treatment for ARFID requires a multifaceted approach, often involving therapy, medical support, and nutritional guidance. Key treatments include:

1. Cognitive Behavioural Therapy for ARFID (CBT-AR): CBT-AR therapy focuses on gradually increasing exposure to new foods and challenging anxiety-provoking beliefs. CBT-AR helps children and adults increase their variety of food choices and manage food-related anxieties;
2. Behaviour Therapy: Behaviour therapy can address learned behaviours and anxieties around food. Using gradual desensitization techniques, a therapist may work with individuals to introduce new foods incrementally, reinforcing each small step with positive feedback. For children, behaviour therapy might include structured reinforcement to encourage tasting or interacting with new foods;
3. Dialectical Behaviour Therapy (DBT): With an emphasis on mindfulness, DBT helps individuals regulate their emotions and manage distressing feelings around food. This approach can support emotional resilience when trying new foods;
4. Occupational Therapy (OT) and Sensory Integration: Individuals with sensory processing difficulties can benefit from OT. OT may use sensory integration techniques to help make eating a more positive and manageable experience;
5. Nutritional Counselling: A registered dietitian can create a balanced meal plan that meets nutritional needs while respecting sensory preferences and food-related anxieties; and,
6. Family-Based Therapy (FBT): Particularly helpful for children, FBT actively involves family members in treatment. It focuses on supporting a non-pressured environment for food exploration and addressing family dynamics around mealtimes.

Practical Strategies to Support Individuals with ARFID

Whether you are a parent, friend, or partner, here are some practical strategies to help support someone with ARFID:

• Create a low-pressure environment: Encourage a relaxed mealtime without pressure to try new foods. Allowing individuals to interact with food at their own pace can reduce anxiety;
• Use gradual exposure techniques: Gradual exposure, starting with small steps like touching or smelling new foods, can help desensitize individuals to overwhelming sensations;
• Encourage participation in food choices: Allowing individuals to choose or prepare foods can increase their sense of control and willingness to try new things;
• Reinforce positive experiences: Acknowledge and celebrate small steps in food exploration. For example, tasting a new food or allowing new food on their plate; and,
• Practice patience and empathy: ARFID can be challenging, and support from loved ones plays a vital role in treatment and recovery.

Next Steps

ARFID can pose significant challenges for individuals and their loved ones. However, with the right support system and interventions, it is possible to make gradual progress toward a more balanced diet and a healthier relationship with food. Treatment that includes behavioural therapy, sensory support, and nutritional counselling can make a positive impact in the lives of those who are affected by ARFID.

If you or a loved one is affected by ARFID, Willow and Sage Counselling is here to support you. We provide tailored therapy services in Surrey and Burnaby, as well as online options, to help clients of all ages navigate challenges related to food intake. Reach out today to schedule an initial consultation and start the journey toward a healthier, more balanced approach to food.