ARFID: The Other Eating Disorder

ARFID stands for avoidant/restrictive food intake disorder. It is a type of eating disorder characterized by selective eating, sensitivity to textures, disinterest in food, strong fear of unpleasant eating consequences or a combination of these. These behaviors lead to

• Weight loss or delayed growth
• Nutritional deficiencies (not consuming enough vitamins and minerals)
• Dependence on oral nutrition supplements
• Interference with daily life and social functioning

There are three primary types of ARFID in children and adolescents: Avoidant, Aversive, and Restrictive.

• Avoidant ARFID is fear of an upsetting eating event, such choking, vomiting or stomach pain. For example, a child with a fear of choking may only eat soft foods or liquid supplements and stop eating foods that are hard, crunchy, or sticky.
• Aversive ARFID is strong preference to the sensory features of food, such as taste, texture, appearance, or temperature. Children with aversive ARFID may be very particular and specific about the foods they will eat. For example, pre-packaged foods appear consistent and uniform in appearance, which may be preferred over foods that are variable in appearance, such as fruits and vegetables.
• Restrictive ARFID is an overall disinterest in food with lack of appetite and/or motivation to eat. Individuals with Restrictive ARFID may frequently “forget” to eat without reminders, or not find food pleasurable.

ARFID differs from other known eating disorders, such as Anorexia Nervosa or Bulimia Nervosa, because it is not associated with body weight or shape concerns. ARFID is also commonly misunderstood as a form of picky eating. While toddlers, for example, may have strong food preferences or be unwilling to try new foods, this is typical for their age and expected to resolve as the child gets older. Conversely, ARFID is a complex mental health disorder that can affect a child’s physical, mental and social health. It is not a condition or phase a child will outgrow without proper treatment.

What Causes ARFID?

ARFID is a relatively new eating disorder diagnosis. The cause of ARFID is unknown, but it is likely a combination of genetics and environmental factors. Parents are not to blame for a child’s eating disorder. Children diagnosed with ARFID may also be diagnosed with anxiety, depression, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD). Research for ARFID is ongoing.

How is ARFID Treated?

Current treatment is designed to correct weight problems and nutritional deficiencies, while addressing the mental and behavioral aspects. This includes increasing exposure to food-related fears and managing associated thoughts/feelings. A multidisciplinary team comprised of therapists, dietitians and medical providers specializing in eating disorders is recommended.