“My life revolves around when I can eat the foods that work for me.”
“I don’t think my kid can go to birthday parties because he won’t eat pizza!”
“How is my teen going to go on dates when she only eats chicken fingers and mac-n-cheese?!”
“We can’t go to a nice restaurant without worrying if my son will be able to eat anything?”
If you’ve said this or something similar about your child, you’re not alone.
What is ARFID?
Over the past few years, a new diagnosis in the DSM-V, called avoidant restrictive food intake disorder (ARFID), has become more well known. Often confused with “picky” or “selective” eating, ARFID is a combination of a restrictive eating disorder characterized by the limitation of food intake and sensory hurdles associated with food. Unlike anorexia nervosa, individuals with ARFID do not experience body image distress and there is no fear of weight gain present. This disorder often goes undetected by families and doctors, often under the belief that the child or adult will eventually, “just group out of it.”
This isn’t a problem to scoff at. ARFID can lead to intense social distress because individuals with symptoms may not prefer to eat with other people or they may take a long time to consume a meal. They may not want to eat whats available at all!
Do I Have ARFID? Signs to Look For
ARFID doesn’t always look like what people expect. It’s not about wanting to be thin. It’s not picky eating that a child will outgrow. For many people, it’s a daily struggle with food that gets dismissed, misunderstood, or missed entirely by well-meaning doctors and family members.
You might be dealing with ARFID if you or your child:
- Eat a very limited range of “safe” foods, and feel real distress when asked to try something new
- Avoid entire food groups or textures, not because of taste preference, but because of how they feel, smell, or look
- Have lost weight, failed to gain weight as expected, or rely on nutritional supplements to meet basic needs
- Feel anxious, nauseated, or panicked at the thought of eating something unfamiliar
- Have had a frightening experience with food, like choking or vomiting, that changed how you eat afterward
- Eat the same few meals on repeat, and mealtimes have become a source of tension in your home
- Have been told you’re “just a picky eater” by doctors or family, even though it feels like more than that
If several of these sound familiar, it’s worth an evaluation. ARFID is treatable, and the earlier it’s addressed, the easier the path to recovery.
Questions
Is ARFID an eating disorder?
Yes, and it’s different than the ones you typically see and hear about. This eating disorder is unique because the individual eats only certain foods and there may be no body image concerns. They sometimes indulge with a safe food because that specific item is a comfort to them. Any other food, thought, causes stress and worry.
Does ARFID only affect children?
No! In fact, more and more adults are starting to understand that they aren’t alone and are beginning to reach out for support.
Is ARFID present in other struggles with food?
There are other eating difficulties that have traits of ARFID, causing more glaring and intense symptoms. When a person starts to develop habits that make them feel in control, they mature physically. Psychologically, however, they may experience anxiety or avoidance, and this may show up in food and eating.
Is there a specific treatment approach?
Yes. We utilize CBT-AR which was created out of Harvard Medical School and Mass General Hospital to treat Arfid.
We are one of the only facility in the state of new jersey with over 7 trained ARFID specilists! EVERY CLINICIAN AT HILLTOP HAS BEEN TRAINED IN CBT-AR.
How do you approach the subject?
Consider if any of the following situations apply to the individual:
1. Super Taster. Is this individual a “super taster” and only feels comfortable with specific textures, tastes, and presentations?
2. No Appetite. Does this individual lack strong hunger cues?
3. Indecision. Does this individual feel stuck around making food choices?
4. Trauma. Has the individual experiencing symptoms experienced something traumatic, like being sick, which affected their relationship with food in a negative way?
Approaching the situation with compassion and understanding that an individual’s anxiety is high and difficult to escape is key. Additionally, they may not have the awareness that they are experiencing symptoms of an eating disorder.
What if approaching the issue feels like it’s too much?
This happens a lot. Take your time. Don’t pressure the situation. Find ways to ease worry through coping that can help distract the person or make them tolerant moment more easily. A trained eating disorder therapist can help make treating ARFID feel more manageable.
What can be done to treat ARFID?
We approach this systematically with a lot of education and support. Hilltop Behavioral Health is one of the first practices in the area to address ARFID using cognitive behavioral therapy for ARFID (CBT-AR) and family-based treatment (FBT). We often need to look not just at the amount of food, but also the selection of items and the anxiety your loved one is experiencing. We create an understanding that this disorder is biologically-based and proceed with informed, evidence-based care.
Always remember, eating disorders are no one’s fault, and healing is possible. Through direct education, informed approaches around fears and stress, and compassionate and supportive exposures, people are making impactful changes.
Further Reading?
My Kids Weird Eating Habits is an article to help answer any further questions you may have.