What Parents Need to Know about Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID often begins in childhood or infancy, but not always. It depends on the subtype.

 When your child struggles with Avoidant/Restrictive Food Intake Disorder (ARFID), mealtimes can become a source of stress and frustration. ARFID is a complex eating disorder characterized by an aversion to certain foods or the eating experience, leading to restrictive eating habits that can impact a child's physical and emotional well-being. As a parent, it's essential to understand how to support your child effectively and explore available treatments to help them overcome their challenges. In this blog post, we'll answer some important questions to better understand ARFID and discuss some tips for how parents can support their children with ARFID.

What is ARFID?

ARFID is more than just being a picky eater. It can involve a persistent refusal to eat certain foods or avoid entire food groups, leading to nutritional deficiencies, weight loss, and impaired growth in severe cases. Children with ARFID may experience anxiety or sensory sensitivities related to food, making mealtimes overwhelming and distressing. Someone might be avoiding and/or restricting their food for a number of different reasons.

There are three main subtypes of ARFID:

1. Hypersensitivity to taste, texture, smell, or appearance of certain types of food, causing limited food variety, or hypersensitivity to interoceptive cue, like hunger or gastrointestinal symptoms.

2. Phobic response related to food or the experience of eating, such as choking or vomiting. This can cause the person to develop feelings of fear and anxiety around food or eating, and lead to them to avoid certain foods or eating altogether.

3. General disinterest in food. In this case, the pleasure that people often experience from eating is muted. It doesn't pass through the reward center of the brain in the same way it does for most. As a result, the person may not notice when they are hungry. They may experience eating as a chore, and just generally not have a desire to eat.

How does this eating disorder differ from picky eating? How can parents tell the difference between the two?

A great way to distinguish between picky eating and ARFID is the psychological distress that is associated with novel experience. In a child with picky eating, they may prefer their familiar or safe foods. If you asked them to try a new food, they may be willing to try the new food, even if they decide they didn't want to incorporate it into the daily routine. However, a child with ARFID may experience great distress, fear, and overwhelm with the idea of trying a novel food.

Can picky eating morph into ARFID?

Underlying ARFID is often anxiety. Anxiety often prefers sameness, familiarity, and certainty in order to feel reassured. However, over time, only eating the same foods can actually increase sensitivity to novel foods and/or create more anxiety. The more the person avoids certain foods, the more anxiety-provoking it becomes to think about trying something different. So catering to picky eating can reinforce the anxiety-avoidance cycle, which could lead to a worsening of symptoms and the development of ARFID down the road.  

At what age does ARFID show up? Does ARFID only affect children or can it affect adults?

This depends on the subtype of ARFID. For those that experience a hypersensitivity or have a general disinterest in eating, this often starts in infancy or childhood. However, for those with the phobic response, this will follow the traumatic eating experience.

Can ARFID become another type of eating disorder as kids get older?

While it is not common for ARFID to turn into other eating disorders, there are times in which a person with ARFID develops Anorexia Nervosa in adolescence. These are both restrictive eating disorders, but the motivations and underlying the pathology is different. It might be that the initial motivator to restrict was driven by ARFID factors, but then secondary gains emerged, such as others positively reinforcing a person’s small size. Over time, this improves self-esteem or becomes an identifier, so now emerges another adaptive function of restriction—to stay small. More research needs to be down to better understand these correlations.

What are the risks associated with ARFID?

The greatest medical risk is malnutrition, both due to low weight and nutritional deficiencies. Malnutrition can lead to serious medical complications, including cardiac arrest, growth stunting, hormone suppression, and more.

The greatest psychological risk is anxiety fueling avoidance, which then fuels anxiety. This harmful cycle can inhibit a person’s life experience, often increasing rigidity, risk aversion, and isolation.

Tips for Parents supporting a child with ARFID:

1. Create a Positive Mealtime Environment: Make mealtimes enjoyable by creating a relaxed atmosphere without pressure or coercion. Avoid power struggles and negative comments about your child's eating habits.

2. Offer a Variety of Foods: Introduce a variety of foods gradually, respecting your child's preferences and tolerances. Encourage exploration and experimentation with different textures, colors, and flavors. Your child does not need to complete new foods when trialing, but they should be exposed to them several times (6-12) before deciding they don’t like a food.

3. Set an expectation to complete meals in full with their preferred foods. Have a back-up option if the meal is too challenging, so that they're not missing out on much needed nutrition, like a pb&j sandwich.

4. Support your child with building coping skills to tolerate any distress that arises and give them a lot of praise for tackling their fears. Coping skills might include breathing techniques, like box breathing, pressure points to help with nausea and fullness, reframing negative thoughts into neutral ones, and approaching new foods with an open curiosity.

5. Be Patient and Understanding: Understand that progress may be slow and setbacks are normal. Patience and empathy are crucial in supporting your child through their journey with ARFID.

6. Seek Professional Help: Consult with healthcare professionals, such as pediatricians, dietitians, and therapists specializing in eating disorders. They can provide personalized guidance and support tailored to your child's needs.

7. Educate Yourself: Learn more about ARFID to better understand your child's challenges and how to support them effectively. Knowledge empowers you to make informed decisions and advocate for your child's well-being.

 If you are seeking eating disorder treatment or mental health therapy for you or your adolescent, Cypress Wellness Collective can help. Cypress Wellness Collective is located in the San Francisco Bay Area where they specialize in Family Based Treatment (FBT), therapy, and nutrition counseling for teens, adults, and families going through eating disorder recovery. They offer in person and virtual appointments throughout all of California. Call today for your free consultation to see if Cypress Wellness Collective is right for you!

References:

1. Fitzpatrick, K. K., Forsberg, S. E., Colborn, D., & Le Grange, D. (2015). Family‐based therapy for avoidant/restrictive food intake disorder: Treatment description and preliminary case series. International Journal of Eating Disorders, 48(1), 29-37.

2. Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., ... & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5. Journal of Adolescent Health, 55(1), 49-52.

3. Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8), 1-9.

4. Norris, M. L., Spettigue, W., & Katzman, D. K. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213.

5. Becker, K. R., Keshishian, A. C., Liebman, R. E., Coniglio, K. A., & Schaefer, L. M. (2020). Family-based treatment of avoidant/restrictive food intake disorder: A narrative review and case series. Clinical Social Work Journal, 48(2), 206-216.