ARFID

Avoidant/Restrictive Food Intake Disorder (ARFID)

Background

ARFID is a diagnosis that has been acknowledged relatively recently (in 2013). It may be informally known as Selective Eating Disorder (SED). ARFID may occur during childhood, but it can also develop in adults. Currently, little is known about effective treatments and interventions and the course of illness for individuals who develop ARFID. Other unknown factors include the age at which ARFID develops and whether or not it presents as a risk factor for later-onset eating disorders.

Myths and misconceptions

  • ARFID is a children’s problem
  • People with ARFID are underweight
  • ARFID is a fancy way of describing a fussy eater

What happens?

In ARFID, a person may experience food disturbances to the point that they do not meet their appropriate nutritional and/or energy needs. This may be underlined by factors such as avoidance due to the sensory characteristics of food (sensory food aversions, extreme picky eating), a lack of interest in eating or food (food avoidance, low food responsivity), or worries about the consequences of eating (phobia affecting food intake, fear of choking).

Consequences of ARFID: Impaired health and development

  • Clinically significant restrictive eating leading to weight loss, or a lack of weight gain
  • Nutritional deficiencies
  • Reliance on tube feeding and oral nutritional supplements
  • Disturbances in psychosocial functioning

Research has also identified behaviours and difficulties such as:

  • Food avoidance
  • Restrictive eating
  • Selective eating since childhood
  • Decreased appetite
  • Abdominal pain
  • A heightened fear of vomiting and/or choking
  • Possible food texture issues
  • Generalised anxiety
  • Gastrointestinal symptoms

There may be some body image concerns, though different to those seen in cases of anorexia and bulimia. Those with ARFID may be less likely to report typical eating disorder behaviours such as purging and excessive exercise.

Research has identified some possible contributory factors. In children, there may be a fear of physical illness related to shape/weight for example, high cholesterol and/or obesity leading to heart disease. Other children who were underweight due to feeding and eating disturbances have reported teasing from peers.

Diagnosis and treatment: Key factors

  • Current eating behaviour
  • Persistence of the problem
  • Interest in food and eating
  • Sensory issues
  • Fear/aversion related to eating behaviour
  • Nutritional adequacy of intake/ consequences
  • Oral supplement or tube feed dependency
  • Social and emotional functioning
  • Personal circumstances and context
  • Whether primary eating disorders and weight/shape concerns are a factor
  • Presence of other medical or psychological disorder
References:

Eddy, K.T. et al. (2014) Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. International Journal of Eating Disorders, doi: 10.1002/eat.22350

Fisher, M.M. et al. (2014) Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. Journal of Adolescent Health, 55, 49-52.

Kenney, L. & Walsh, B. T. (2013) Avoidant/Restrictive Food Intake Disorder (ARFID). Eating Disorders Review, 24(3). Accessed 23 September 2014. Available from: http://eatingdisordersreview.com/print/nl_edr_24_3print.html

Kurz, S. et al. (2014) Early-onset restrictive eating disturbances in primary school boys and girls. European Child & Adolescent Psychiatry,

Nicely, T.A. et al. (2014) Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders, 2(21).

Norris, M. L. et al. (2013) Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study. International Journal of Eating Disorders, 47(5), 495-499.

Wildes, J.E., Zucker, N.L. & Marcus, M.D. (2012) Picky eating in adults: Results of a web-based survey. International Journal of Eating Disorders, 45(4), 575-582.

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