An Introduction to Avoidant/Restrictive Food Intake Disorder (ARFID)

Many eating disorders such as anorexia nervosa and bulimia nervosa are well-known in the general populace, with general symptoms being fairly common knowledge. However,there is one eating disorder that most people still don’t know about – ARFID. Avoidant Restrictive Food Intake Disorder (ARFID). This disorderis occasionally referred to as Selective Eating Disorder (SED), especially in the past, while the newer acronym has become the norm in recent years. ARFIDis a type of eating disorder that has only recently become studied in depthand is beginning to be treated as part of a full continuum of care at eating disorder treatment centers. Despite these studies and the growing availability of treatment, however, loved ones of people with ARFID can and often do miss the symptoms. Here are some of the common questions associated with ARFID, selective eating disorder treatment, and more.

How Rare Is ARFID?

ARFID has been closely studied for less time and consequently less understood than bulimia nervosa or anorexia nervosa(or even the also-recently named binge eating disorder), so the statistics on its occurrence are not quite as voluminous as those disorders. In one study of adolescents in eating disorder recovery, about 14 percent of thepeople replying to the survey met the standards for a diagnosis of ARFID, according to the National Eating Disorder Association.

It’s very likely that ARFID is underreported simply because it’s so easy to confuse picky eating with disordered avoidance, especially in young children and adolescents. However, while many children are picky and won’t eat certain kinds of food (until they become a bit older), this is usually temporary. ARFID sufferers, on the other hand, have a disorder that can affect their health negatively. People with ARFID certain types of food to a point that it causes them malnutrition and severe weight loss. or have other health issues.

What Demographics Does ARFID Affect?

ARFID affects both men and women, but unusually for eating disorders, it affects men more commonly. Also, younger children seem to be more at risk than older children, since the picky eating tendencies smaller children display tend to disappear as they age. About 20 percent of children with ARFID also have an autism spectrum disorder, which is statistically significant and may indicate a link in brain patterns between the two disorders.

What Does the Psychiatric Community Say About ARFID?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the official register of mental health disorders, lists ARFID among the eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder. This means it has specific criteria for Diagnosis and is part of a psychiatrist’s training. Most accredited mental health professionals, including psychiatrists, psychologists, therapists, and of course eating disorder treatment specialists are expected to be familiar with ARFD.

Does ARFID Co-Occur With Other Mental Health Illnesses?

At least a third and likely much more of people who suffer from an eating disorder also have another kind of mental health illness. For example, 75 percent of individuals in treatment for ARFID also have an anxiety disorder in addition to ARFID. Depression is also common in people with eating disorders, often leading to higher suicide rates among these populations. A special mention should be made for PTSD and trauma – eating disorder treatment centers almost always have specialized programs to treat these co-occurring presentations because of how frequently they appear in eating disorder patients.

What Are the Root Causes of ARFID?

In many forms of eating disorders like anorexia nervosa or bulimia nervosa, a major underlying cause of the disorder is a fear of gaining weight or looking a certain way. This is tied to issues with body image, self-esteem, and perfectionism. However, ARFID differs from other kinds of eating disorders because weight loss or distorted body image is rarely a major contributing factor. Clinical studies and patient reports indicate anxiety may be a major contributing aspect of ARFID, as well as food-related phobias. For instance, half of the children that avoid certain foods in a manner consistent with ARFID do so not because of the flavor, but because they have developed an irrational fear of choking on them. Fears of food poisoning and similar concerns, whether based on a past experience or not, are also common.

How Is ARFID Treated?

After receiving a diagnosis of ARFID from a doctor or specialist at an eating disorder treatment facility, typical treatment can involve multiple levels of therapeutic care. Mindful eating and self-awareness training is usually the central focus, employing cognitive behavioral therapy, group therapy, food and nutrition counseling, and family therapy as a comprehensive continuum of care. The recovery process must be tailored uniquely to the individual, so while the structure of the treatment program may be similar, the details will change from person to person.

If you are afraid that your child is dealing with ARFID or another kind of eating disorder, reach out to a treatment facility to speak with admissions specialists who can help you get started.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.