What is ARFID (Avoidant Restrictive Food Intake Disorder)?
Avoidant restrictive food intake disorder (ARFID) is a feeding or eating disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs leading to one or more of the following:
- significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
- significant nutritional deficiency
- dependence on enteral feeding or oral nutritional supplements
- marked interference with psycho-social functioning
It is not the result of a lack of available food or an associated culturally sanctioned practice, explained by another medical or mental disorder, so that if you treat that, the eating problem will go away. It is not typically associated with any abnormalities in the way in which someone perceives their body weight or shape. It is not just picking eating or a lesser eating disorder.
Unfortunately the incidence and prevalence are relatively unknown since it is the newest eating disorder, only falling into this diagnostic category since May 2013. 1/5th report avoiding certain foods because of sensory issues, those with ARFID are more likely to be younger and male, with the mean onset age of 11 years old3, and recent studies estimate that it may impact as many as 2%-14% of children.
of new eating disorder cases report an ARFID diagnosis 4
of ARFID diagnoses report a fear of vomiting or choking 5
of children with ARFID have an anxiety disorder
of children with ARFID are neurodivergent 6
How is ARFID different from picky eating?
Although picky eaters have a decreased range of foods, individuals with ARFID have a restricted variety, typically less than twenty total, which doesn’t meet the basic nutrition expectation of incorporating at least ten foods from each food group. Along these lines, a picky eater typically eats more than one food from most food or texture groups, someone with ARFID refuses entire categories of food textures or nutrition groups (specifically proteins, fruits, and/or vegetables). Whereas picky eaters (and even typical eaters) may burn out on certain foods they eat frequently, those with ARFID tend to never re-acquire them, something called food jagging.
Sometimes malnutrition is so profound they require nasogastric tubes for supplemental nutrition.
Eating unusually large amounts of food over a short period of time (around 2 hours) AND feeling out of control or that one can’t stop eating.
Repeated engagement in behaviors in an attempt to lose weight/”undo” calories consumed. These behaviors can be in response to multiple types of feelings including guilt, shame, and embarrassment.
The most common is self-induced vomiting (could be with a finger, toothbrush, on one’s own or other object, or by inducing vomiting with ipecac).
- Excessive exercise
- Not using insulin as prescribed (withholding it or taking too much)
- Thyroid hormone misuse
Symptoms of ARFID
Individuals with ARFID typically present with a lack of interest in eating or food in general. Someone might find themselves avoiding foods based on textures, smells, or other sensory characteristics, while others may exhibit strong worry about the consequences of eating certain foods, such as vomiting, choking, or fear of an allergic reaction, all of which are often unrelated to their body image or weight.
Individuals with ARFID can experience all of the medical symptoms seen in individuals with anorexia nervosa. As restriction behaviors increase in frequency and/or intensity, individuals will experience weight loss that can be dangerous and may experience symptoms of the body slowing down related to the weight loss and restriction including;
- dry skin
- hair loss
- lanugo or fine hair development on the face to help with temperature regulation
- brittle nails
- low blood pressure (hypotension)
- low pulse (bradycardia)
- loss of or delayed onset of menstrual cycle or a lighter than normal cycle
- bone changes or loss (osteopenia or osteoporosis)
It can also lead to vitamin, mineral, and protein deficiencies, and in children and adolescents poor growth, delayed puberty.
4 Norris, M., Spettigue, W., & Katzman, D. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213-18. https://doi.org/10.2147/NDT.S82538
5 Nicely, T.A., Lane-Loney, S., Masciulli, E., Hollenbeak, C., & Ornstein, R.M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young individuals in day treatment for eating disorders. Journal of Eating Disorders, 2, 21. https://doi.org/10.1186/s40337-014-0021-3
6 Fisher, M., Rosen, D., Ornstein, R., Mammel, K., Katzman, D., Rome, E., Callahan, S.T., Malizio, J., Kearney, 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. https://doi.org/10.1016/j.jadohealth.2013.11.013