A Look At ARFID: Avoidant Restrictive Food Intake Disorder

ARFID, or Avoidant/Restrictive Food Intake Disorder, is a diagnosis reserved for people who are clearly struggling with food and eating issues, but do not fit the criteria for anorexia, bulimia, or binge eating disorders.

Because ARFID usually develops during infancy or childhood, the previous psychiatric diagnostic manual (the DSM-IV) described ARFID in a chapter called Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.

In the current diagnostic manual, the DSM-V, ARFID is detailed in the eating disorders section.

About ARFID

Those diagnosed with ARFID demonstrate a problem with feeding (infants, toddlers) or eating, so do not acquire sufficient nutrients or calories through diet. The reasons for this are varied. Individuals might refuse to eat certain textures or colors of food, have trouble digesting certain foods, will only eat small portions at one sitting, are fearful of vomiting or choking, or have no appetite.

Someone having ARFID might lose weight, or not gain weight as expected. Older children and adults with ARFID frequently have school or work issues related to eating such as making excuses to get out of work lunches, trouble completing homework because it takes so long to eat, or avoiding social events with family or friends when food is served. As you might expect, those with ARFID are at risk for developing other eating disorders (e.g., bulimia, anorexia).

Not About Size or Shape

In the DSM-V, ARFID is an eating or feeding disturbance that manifests as a chronic failure to satisfy energy or nutritional needs associated with at least one of the following:

• A significant deficit in nutrition.
• Significant loss of weight, not achieving expected weight gain, or the absence of normal physical development.
• Disruption in psychosocial functioning.
• Reliance on enteral feeding (e.g., feeding tube) or oral nutritional supplements.

The eating problem cannot be owed to the unavailability of food or to a culturally sanctioned food observance. ARFID is not accompanied by a distortion of one’s weight or body shape and is not concurrent with symptoms of anorexia or bulimia. An ARFID eating problem must be unrelated to a medical condition and not better explained by a different psychiatric disorder.

It’s Uncommon

So, kids with ARFID do not obsess about body image, and are not fearful of weight gain. They do not avoid food because it triggers symptoms related to a medical disorder—someone avoiding food because they are receiving chemotherapy will not be diagnosed with ARFID. Children living in poverty or areas of famine do not receive an ARFID diagnosis.

A girl who chokes on a bite of hamburger and subsequently stops eating solid foods, or a boy who shows no interest in food, never feels hungry, and loses weight could eventually be diagnosed with ARFID.

Though ARFID typically begins in childhood, it can persist into or begin during adulthood. For treatment, children and adults usually receive behavioral therapy such as gradual exposure to the avoided foods, and are also assessed for possible underlying symptoms of depression or anxiety.

It is good to be aware of ARFID, but having it is uncommon. Most children, and some adults, go through periods marked by strange eating patterns, such as only wanting hot dogs, or refusing to eat fruit. These patterns usually resolve themselves without professional intervention. If you have questions or concerns, consult your doctor.

Source: The Center for Eating Disorders
Photo credit: Bruno Caimi / flickr creative commons