What Is Avoidant Restrictive Food Intake Disorder?

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder (SED), is an eating disorder characterized by an individual severely limiting the amount and/or types of food consumed.

The avoidance of food is based on sensory characteristics, and/or concern about unpleasant consequences of eating, resulting in failure to meet individual nutritional needs.

It usually occurs in childhood, but can develop at any age. It is more severe than typical childhood “picky eating” and tends to affect the child's overall appetite, food intake, growth, and development.

ARFID is similar to the eating disorder anorexia in that it restricts food intake. However, ARFID differs in that it does not involve anxiety or obsession over bodyweight, appearance, or the fear of fatness.

Nonetheless, ARFID and anorexia have similar physical symptoms (and thus, medical consequences) due to both disorders involving a failure to meet nutritional needs.

Being a relatively new recognized eating disorder, there is still much unknown about ARFID, particularly as it relates to older adolescents and adults. Research is ongoing in this area and will hopefully shed more light on this important topic in order to help people who suffer from it.

Symptoms

Below are both behavioral and physical symptoms people with ARFID often exhibit.

Behavioral

Individuals with ARFID may exhibit the following behavioral, psychological, or physical symptoms:

• Significant weight loss
• Dressing in layers to hide weight loss or stay warm
• Complains of constipation, abdominal pain, cold intolerance, fatigue, and/or excess energy
• Complains of consistent, vague gastrointestinal issues around mealtimes that have no known cause, such as an upset stomach, feels full, etc.
• Sudden or severe restriction in types or amount of food eaten
• Will only eat certain textures of food
• Gags on food, or has fears of choking or vomiting
• Decreased appetite or interest in food
• Small range of liked foods that decreases over time (i.e., picky eating that gradually worsens)
• No body image anxiety or fear of weight gain

Physical

Physical symptoms may include:

• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities, missing periods, or periods stopping completely for a person who is post-puberty.
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts)
• Slowed heart rate
• Dizziness
• Fainting
• Feeling cold all the time
• Problems sleeping
• Dry skin
• Brittle nails
• Fine hair on body
• Thinning of hair on head, dry and brittle hair
• Muscle weakness
• Cold, mottled hands and feet, or swelling of feet
• Poor wound healing
• Impaired immune functioning

Diagnosis

Individuals with avoidant restrictive food intake disorder avoid eating and restrict their food intake to such an extent that they are not meeting their nutritional needs. Because of this, they may have one or more of the following symptoms for diagnosis:

• Significant weight loss, failure to gain weight as expected, or faltering growth patterns
• Significant nutritional deficiency
• Dependence on oral nutrition supplements or tube (enteral) feedings
• Considerably impaired psychosocial functioning
• No evidence of a disturbed perception of body weight or shape

Healthcare providers must exclude other diagnoses, such as physical illness, as well as other mental disorders that decrease appetite and/or intake, such as other eating disorders or depression. 

If left untreated, nutritional deficiencies can be life-threatening. In addition, social functioning can be noticeably decreased, such as not participating in family meals or spending time with friends when food is involved.

Risk Factors

While there are still some unknowns about ARFID, researchers have been able to identify some risk factors. Individuals may be more likely to develop ARFID if they have autism spectrum disorder, attention deficit hyperactivity disorder (ADHD) or other intellectual disabilities.

Children whose picky eating doesn’t go away after prolonged periods of time, or who have extreme picky eating have a higher risk of developing ARFID. Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.

Treatment

Therapy, such as cognitive-behavioral therapy, is commonly used to help patients normalize their eating and help decrease anxiety around food. Family-based treatment and parent training may also be beneficial.

Working with a multidisciplinary team of healthcare professionals, which includes physical, nutritional, psychological, and psychiatric interventions, can offer a whole-person approach to recovery.

Coping

How one person copes may be different from another person. One of the main goals in coping with an eating disorder is that you turn to healthy coping strategies, rather than dysfunctional or destructive ones. The following strategies may be helpful in coping with ARFID or other eating disorders:

• Be aware of personal triggers and come up with an action plan if you encounter one (or more) of your tiggers. 
• Surround yourself with a support system. Whether it be family, friends, neighbors, or coworkers, find some people in your life you can count on for support in your journey to recovery and beyond. 
• Be mindful and participate in self-care activities. Identify what you need to do in order to maintain good physical and mental health, while also meeting your social and psychological needs. Find ways to incorporate these activities of self-care into your lifestyle on a regular basis.

Parents and carers of people with ARFID play an important role in recovery. It’s important that those who care for individuals with ARFID have healthy coping skills as well. Parents and carers also need to be physically, emotionally, and spiritually healthy, as a loved one’s recovery can be just as difficult to cope with.

Engaging in self-care, joining a support group (in person or online), or participating in therapy are just a few ways to manage the responsibility of caring for someone with an eating disorder.