ARFID (avoidant/restrictive food intake disorder) is a serious condition that differs from “fussy eating”, explains dietitian Angela Phillips.
ARFID, or Avoidant/Restrictive Food Intake Disorder, is something I wasn’t even aware of until recently. The reason being, it’s a relatively new diagnosis, so it hadn’t crossed my path. That isn’t to say I haven’t seen people with ARFID, it just wasn’t labelled as such at the time. So what exactly is ARFID, and why is it any different from “picky eating” or “fussy eating”?
What is ARFID?
ARFID is a diagnosis for a type of eating disorder. One of the defining characteristics of ARFID is an inability to achieve adequate nutritional intake, whereas research around fussy eating shows that most children with fussy eating still meet their requirements through the foods they will accept, and typically grow out of it with no medical consequences. Children, adolescents, or adults with ARFID do not fit the criteria for anorexia or bulimia, so previously may have been diagnosed with “Eating Disorder Not Otherwise Specified” , or perhaps as a severe fussy eater with anxiety towards many foods. Another key difference between ARFID and anorexia or bulimia is that people diagnosed with ARFID are not driven by the desire to lose weight or body image issues. As it’s a relatively new diagnosis, the rates are hard to establish, but will likely grow as awareness grows. With this diagnosis, studies are assessing patients who are accessing eating disorder services. Eating disorder treatment is something that is constantly growing and developing, so hopefully ARFID will be recognized as something experts can help to treat. They may have previously been misdiagnosed with anorexia or bulimia and, in fact, have ARFID. A recent study in the Journal of Eating Disorders reported 22.5% of those in the study meeting the criteria for ARFID. While rates of anorexia and bulimia are significantly higher in females than males, rates of ARFID seem to be higher in males, perhaps even by as much as 2:1. Also of note is the age of those being diagnosed with ARFID tending to be younger than with other eating disorders.
How does ARFID differ from fussy eating?
The technical definition for ARFID from The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) may help you to distinguish between severe fussy eating and ARFID. It states: ARFID is an eating or feeding disturbance, eg 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 compared to height in children).
- Significant nutritional deficiency.
- Requiring tube feeding or nutritional supplements.
- Psychosocial abnormalities.
Triggers for ARFID vary significantly. Some examples:
- Short-term medical condition such as a severe gastro bug, during or following of which symptoms feel worse by eating creating a fear of eating that then continues once the bug has resolved.
- Someone having a traumatic experience with choking, gagging, or vomiting.
- Avoiding pain or nausea.
- A food allergy.
One client I have seen was avoiding eating large amounts and, while already lean, was presenting with weight loss. This person had a vomiting phobia and was suffering from pain due to a medical condition. The pain was causing nausea, thereby triggering the vomiting phobia and the desire to limit food. The food avoidance resulted in weight loss and an incorrect diagnosis of anorexia by a physician unfamiliar to the client (the client wasn’t trying to lose weight). The client was an inpatient at the time, and the misdiagnosis resulted in longer-than-necessary hospital stay. This was before ARFID was a diagnosis.
ARFID can present with many possible symptoms:
- Long history of “picky eating” since childhood
- Lack of interest in food and eating
- Lack of appetite
- Slow rate of eating
- Eating smaller portions
- Greater struggles around food Avoidance of foods because of dislike of colour, texture, smell or tastes
- Fear of choking, gagging or vomiting
- Gastrointestinal complaints like bloating, heartburn, nausea, constipation Weight loss and signs of malnutrition
- Avoidance of situations of social eating
ARFID does not involve obsessively looking at nutrition labels, calorie counting, or a fixation on wanting to lose weight.
How is ARFID treated?
Treatment is around addressing medical outcomes, such as any weight loss, or correcting nutritional deficiencies. However, for this to be successful, the main focus needs to be on addressing the underlying reason for the condition.
Due to the various underlying causes of ARFID, treatment needs will vary significantly from person to person. It also means the health professionals who need to provide support will vary. Some people will require tube feeding, or will use nutritional supplements to meet their requirements. A referral to a dietitian for support with this, and to a Speech and Language Therapist (SLT) to look at sensory issues, are often needed and very helpful.
A key concern with having a diagnosis is whether this is always helpful. Many times I have seen such relief from parents or clients when they finally have a diagnosis ? to the level of having symptoms significantly reduce or some even resolve! This demonstrates the impact of anxiety caused by the “fear of the unknown” . Being diagnosed with ARFID can allow families to focus on specific strategies, and get correct support in place. But without proper support, perhaps for others the opposite may be the case, and the increased focus and pressure of recovery may exacerbate the problem.
In saying that, if you suspect you or a family member do suffer from ARFID, it is important to get support straightaway, as early help can be key. Start with a visit to your GP and get support systems in place as soon as possible. At times diagnosis may not be straightforward. However, support groups can be of great help.
Angela Phillips is a dietitian specialising in paediatrics, food intolerances, and weight management. Her practice, FoodSavvy (foodsavvy.co.nz), is based in Wellington and Nelson.