“My life revolves around when I can eat the foods that work for me.”
“I don’t think my teen 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 daughter 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. This disorder can often be confused with “picky” or “selective” eating. ARFID is a restrictive eating disorder characterized by the limitation of food intake, but unlike anorexia nervosa, individuals with ARFID do not experience body image distress. There is also not a fear of weight gain involved. This disorder often goes undetected, yet ARFID can lead to intense social distress because individuals with ARFID may not prefer to eat with other people or they may take a long time to consume a meal.
Questions
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.
No! In fact, more and more adults are starting to understand that they aren’t alone and are beginning to reach out for support.
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.
Consider if any of the following situations apply to the individual:
1. Trauma. Has the individual experiencing symptoms experienced something traumatic, like being sick, which affected their relationship with food in a negative way?
2. Super Taster. Is this individual a “super taster” and only feels comfortable with specific textures, tastes, and presentations?
3. No Appetite. Does this individual lack strong hunger cues?
4. Indecision. Does this individual feel stuck around making food choices?
Approach the situation with compassion and with the understanding that this individual’s anxiety is high and difficult to escape. Additionally, they may not have the awareness that they are experiencing symptoms of an eating disorder.
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.
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.