Clementine Portland Clinical Director Zanita Zody, PhD, LMFT guides her team with warmth and compassion as they provide comprehensive care to the adolescents who entrust their treatment in them. In this week’s blog post, Zanita shares an informative article on ARFID (avoidant/restrictive food intake disorder), an often misunderstood diagnosis.
Previously known as selective eating disorder, symptoms of ARFID, avoidant/restrictive food intake disorder, are often misdiagnosed, or minimized. According to the DSM, ARFID is defined as a persistent failure to meet nutritional and/or energy needs leading to one of more of the following:
- Significant weight loss, failure to achieve expected weight gain or follow expected growth trajectory in children.
- Significant nutritional deficiency
- Dependence on enteral feeding or oral supplements
- Marked interference with psychosocial functioning.
ARFID typically develops in response to a real or perceived threat of an allergic reaction, fear of vomiting, or a limited interest in food. As a result, the individual begins to cut out certain categories of food resulting in a severely limited range of foods they are willing to eat. This selective eating, intense anxiety around food and meal times, and low body weight lead many to the erroneous diagnosis of anorexia nervosa (AN). The primary and crucial difference being that individuals with ARFID report no body image dissatisfaction or drive for thinness while both are diagnostic criteria for AN. Other common misdiagnoses include OCD, anxiety disorder, somatic disorders, gastrointestinal disorders, and other medical complications. Symptoms may alternatively be minimized and attributed to “picky” eating that the child will outgrow. Over time, families often become confused and hopeless regarding how or even what needs to be addressed.
Compared to anorexia nervosa or bulimia nervosa, individuals with ARFID are younger, more likely to be male, more likely to have comorbid anxiety disorder and less likely to have comorbid depression. It should also be noted that autism spectrum disorder (ASD) has multiple, often overlooked similarities to the restricting eating disorders, including ARFID. Those diagnosed with ASD, AN, or ARFID tend to seek out rules, routines and rituals, use avoidance as a coping strategy, are highly sensitive to sensory stimuli, and have a high incidence of comorbid anxiety. In fact, research suggests that as many as 20% of individuals with AN also have ASD. That being said, differential diagnosis is essential to the implementation of targeted interventions.
Nutritional Exposure Therapy at Clementine makes re-nourishment a top priority. This therapy is designed to expose individuals to their fear foods following a hierarchy they develop collaboratively. Individuals take part in supervised food trials six days per week in a private room with no distractions. Through repeated exposure and response prevention they are able to challenge their fears and decrease their anxiety. Eventually, families and other providers are invited to join their loved one during these trials in order to learn these skills and further support them and their recovery.