Parents or caregivers are well aware of picky eating and mealtime challenges. It’s natural to worry about their child’s intake and nutritional status.
But for many parents, the the question arises: are these challenges more than just a phase and something more problematic, such as an eating disorder?
One such eating disorder, Avoidant Restrictive Food Intake Disorder (ARFID), results in such limited intake that a person does not meet their nutritional needs (in the past this has been referred to as a selective eating disorder). Let’s talk about 6 things to know about ARFID.
#1 What is ARFID?
ARFID is an eating disorder that occurs when individuals avoid or restrict food intake to the extent that they regularly fail to meet their nutritional and energy needs, many parents describe their kids as “extreme picky eaters.”
The DSM-5 explains that this eating or feeding disturbance is associated with at least one of the below:
Substantial weight loss, failure to reach expected weight gain, and faltering growth in children
Severe nutrient deficiency
Dependence on enteral feeding or oral supplementation
Significant interference with psychosocial functioning
Another eating disorder, medical condition, food insecurity, or cultural observance doesn’t explain the disturbance.
While it can coexist with other conditions, it cannot occur concurrently with anorexia nervosa or bulimia nervosa. If it occurs with a medical condition, the severity of the feeding disturbance must go beyond the norm for that condition.
ARFID is mainly seen in children and adolescents but can occur in all ages. There are three primary subtypes of ARFID described by the Eating Recovery Center:
Avoidant: Avoiding food because of sensory features like smells or textures
Aversive: Avoiding food because of fear, like fear of choking or vomiting.
Restrictive: Low appetite, little interest in food, and extreme pickiness are characteristic of the restrictive subtype of ARFID.
#2 ARFID often coexists with anxiety, mood, and spectrum disorders.
There are a number of factors that can cause ARFID, it typically involves a range of biological, psychological, and sociocultural factors. May times other conditions are occurring at the same time, like anxiety, mood, and spectrum disorders.
#3 ARFID is characterized by psychological and physical signs.
The National Eating Disorder Association describes these are the signs and symptoms of ARFID (which includes both psychological and physical warning signs):
Psychological signs of ARFID include:
Worsening picky eating
Missing food groups and textures
Anxiety around new foods
Lack of interest in food
Fears around food like fear of vomiting
Physical signs of ARFID include:
Dramatic weight loss
Brittle nails, dry skin, thinning hair
#4 ARFID is NOT associated with a concern about body image or weight loss.
What’s the difference between ARFID and other eating disorders? It is not associated with a desire to lose weight or a concern of body image. While weight loss often occurs in individuals with ARFID, it is not the reason for avoiding food.
#5 ARFID vs. Picky Eating
While ARFID and picky eating share similarities, it is important to note that they are not the same. Individuals with ARFID experience severe distress from eating and may even experience choking, swallowing, anxiety, and sensory sensitivities that lead to food avoidance and food aversion.
Picky eaters typically do not share this level of anxiety and worry at mealtimes. While picky eaters generally eat from all food groups over days or weeks, individuals with ARFID often avoid entire food groups.
In contrast to picky eaters, ARFID interferes with growth, weight gain, and nutritional status.
#6 ARFID Treatment
An ARFID diagnosis can be overwhelming, but treatment options can help. Effective options include family-based treatment and cognitive-behavioral approaches featuring consistent eating, food exposure, and response prevention.
Like picky eating, a positive, no-pressure feeding environment is the foundation for treating ARFID.
At Nutrition in Bloom, we take an individualized approach to help support your child.
This approach could involve:
Strategies to support the feeding environment, minimize anxiety, remove pressure, and limit distractions
The creation of a mealtime and snack routine
A plan to increase food exposures and introduce new foods
Multivitamin supplementation, if needed
If your child struggles with ARFID, or you have concerns, let’s chat! Set up a free introductory call to learn how we can support you and your child.