Understanding ARFID – Risks, Symptoms, and How It’s Treated

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What Is ARFID?

The eating disorder or feeding disturbance known as avoidant restrictive food intake disorder (ARFID) is a chronic inability to achieve adequate nutritional and energetic needs. Although it can develop in late adolescence and adulthood, this disorder is most common among children and affects both genders.

ARFID entails more than just “picky eating” or “selective eating.” People with ARFID may avoid food, eat very little, or limit their access to various foods, which can result in nutritional deficits. Picky eating and selective eating disorder comes under the umbrella of ARFID, and as such, there are a number of crossovers. However, the disliking of specific foods or general lack of interest in eating is typically more intense in people with ARFID.

Although picky eating is common, especially in children, it can become problematic when the refusal to eat interferes with their ability to meet energy and nutritional requirements. This can lead to weight loss, malnutrition, or a failure to maintain growth and development.

While ARFID is an eating disorder, it is also a mental disorder similar to that of anorexia nervosa and bulimia nervosa. Research has found that psychiatric co-morbidities, particularly anxiety and obsessive-compulsive disorder, are commonly linked to ARFID.

What Causes ARFID?

The exact cause of avoidant restrictive food intake is unknown. Many researchers and medical professionals believe that the disorder might be brought on by biological, psychological, and environmental factors. For example, a child biologically or genetically susceptible to ARFID may be affected by circumstances such as a traumatic event.

Eating habits may also be altered as a result of co-occurring conditions, such as anxiety disorders, developmental impairments, and autism where an individual’s connection with their body and senses is already greatly enhanced.

Types of ARFID?

  1. Restriction: people with restrictive food intake disorder have very little interest in food, and tend to eat and get full quickly.
  2. Avoidance: those with avoidance tendencies have difficulties with sensory characteristics of foods, including smells, tastes, and temperatures.
  3. Aversive: this type of ARFID involves people having fears or phobias of the aversive consequences of eating. This might include illness, choking, vomiting, or allergic reactions.

Symptoms of ARFID

The symptoms of ARFID can vary greatly depending on the person’s developmental environment. Common symptoms include avoidance of sensory triggers, restrictive eating patterns, and eating experiences based on fear.

An important first step to take before seeking ARFID treatment is to familiarise yourself with the warning signs and symptoms. To help determine whether you or your child may require professional eating disorder therapy, look out for typical ARFID symptoms such as:

  • Consuming meals with the same properties, such as those with a crunchy texture
  • Avoiding fruit, meat, beans, and other sources of protein
  • Eliminating certain foods from the diet
  • Struggling to gain weight
  • Nutritional deficiencies (iron, vitamin A, and vitamin C are most common)
  • Skipping one or more dietary categories entirely
  • Becoming anxious when eating unfamiliar foods
  • Food restrictions negatively impacting customary social practices

ARFID Health Risks

As a result of the body being deprived of essential nutrients, it is compelled to slow down its functions to preserve energy, posing serious health risks.

The body is generally resilient in dealing with the stress of eating disorders. However, similar to cardiac arrests, electrolyte imbalances within the body can be fatal without showing any warning signs. It is, therefore, vitally important to understand the various ways that eating disorders impact the mind and body.

The risks associated with ARFID include a variety of physical, psychological, and behavioural factors. These risk factors are unique to each individual which means ARFID sufferers will have different perspectives, experiences, and symptoms.

Physical

Anorexia nervosa and ARFID share many of the same physical symptoms and medical consequences as both conditions are characterised by an inability to meet dietary needs. Physical health risks include:

  • Dramatic weight loss
  • Gastrointestinal signs such as constipation and acid reflux
  • Digestion difficulties (such as an upset stomach or a feeling of fullness) around mealtimes that have no apparent cause
  • Menstrual irregularities such as missing periods
  • Issues with concentration
  • Abnormal laboratory results (anaemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Dizziness or fainting
  • Shivering or constantly feeling cold
  • Issues with sleep
  • Dry skin
  • Fragile and brittle nails
  • Thinning of hair
  • Muscle weakness and soreness
  • Discolouration of hands and feet
  • Immune system dysfunction

Behavioural and Psychological 

  • Reduced food intake
  • Wearing multiple layers of clothing to keep warm or cover up weight loss
  • Unusual high energy levels or extreme tiredness
  • Drastic changes in the types or amounts of food consumed
  • Worry of choking or vomiting
  • Lack of interest or appetite for particular foods
  • Limited range of preferred foods that become smaller over time
  • No body image disturbance issues or concern over weight change

How Is ARFID Treated?

In most cases, an intensive and specialised treatment approach is required due to the distinctive characteristics of ARFID and its prevalence among young individuals. Feeding therapy, counselling, and nutrition advice are all possible forms of treatment. A speech-language pathologist can perform a swallowing and feeding evaluation if choking is a worry.

The underlying reason for avoiding food, such as a phobia, an intolerance to texture, or a lack of interest in eating, will usually dictate the treatment’s objectives for ARFID. However, in most cases, the main goals of treatment are to:

  • Obtain and maintain a healthy weight and balanced diet
  • Eat a wider variety of foods across the food groups
  • Learn how to eat without fear of discomfort or choking

Doctors may recommend medications to relieve anxiety or to stimulate the appetite. If anxiety is a problem, healthcare professionals will show children and families how to deal with concerns about food.

Most children with ARFID can get care at home, but a small number will require admission to a more intense hospital-based programme. This tends to be for individuals who are severely underweight, malnourished, or suffering from serious health problems. Additionally, some children with ARFID will require food formula or tube feeding to increase food intake and avoid nutritional deficiencies.

ARFID can be challenging, but teaching children and young adolescents about healthy eating and addressing their worries can help them feel better and improve. Research studies have shown that children are more likely to adopt successful eating behaviours when the entire family collaborates.

The Wave Clinic

The Wave Clinic offers individualised eating disorder intensive outpatient programme (IOP) treatment for people and families impacted by ARFID. Our programmes provide specialised paediatric and adolescent programming, incorporating family-based therapy, which has been shown to reduce disordered behaviour, promote a healthier diet, and boost long-term recovery.

How Can Parents Help?

ARFID is associated with intense feelings and concerns over food, so encouraging healthy eating and exercise among family members is extremely important. Examples include:

  • Set a good example. Serve and consume a range of cuisines
  • Plan consistent meals and snacks
  • Maintain a friendly atmosphere at the table and refrain from conflict when eating food
  • Don’t force your child to eat; encourage them to try different things
  • Reward healthy eating habits

If you are a parent of a child who might be struggling with ARFID or other eating disorders, call your doctor for advice. The doctor can make recommendations for mental health and nutrition specialists who have experience in dealing with children and adolescents who possess eating disorders.

Contact Us

At The Wave, we are conscious of the difficulties posed by eating disorders like ARFID. It is possible for what began as a focus on healthy eating to spiral out of control. 

We acknowledge that your health should always come first. If you’re willing to seek professional help, The Wave will work with you to address the root causes of your eating disorder, create coping skills and healthy eating habits, and eliminate what may otherwise be a fatal condition.

We also use family-based therapy to help individuals regain their confidence and sense of self-worth as they work toward a happy and healthy future.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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