Children are often picky with their food choices, but sometimes, those eating habits can go beyond pickiness and start affecting a child’s physical health. If a child’s eating patterns become increasingly restrictive and they begin to have symptoms like a lack of energy, failing to hit growth milestones, and refusing to eat anything beyond a few specific foods, they could have avoidant/restrictive food intake disorder, or ARFID.
What Is Avoidant/Restrictive Food Intake Disorder? Is ARFID an Eating Disorder?
Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that can occur throughout life—in infants, children, teens and adults, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which is published by the American Psychiatric Association. The disorder was originally diagnosed in infants and children as a feeding disorder, but the DSM-5 recognizes that it stretches beyond early childhood.
The disorder goes beyond picky eating or staying away from foods for reasons, such as nut allergies or lactose intolerance. The disorder can lead to severe malnutrition and impairment to a person’s health, even causing hospitalization if it’s untreated.
The avoidance of food can stem from incorrect information and beliefs about food intolerance and nutrition, sensory issues, severe food aversion, or other reasons.
For some, rigid beliefs about certain foods conflict with factual evidence about them that results in people with the disorder avoiding particular types of foods. Other people with ARFID may dislike the smell, taste, texture or temperature of certain types of foods. In addition, the disorder may be the result of a trauma that’s related to food, such as choking or painful throat spasms that are caused by dysphagia.
Is ARFID a Mental Disorder?
The answer to this is yes, technically ARFID is a mental disorder, but it can also be more complicated than that. ARFID is in the DSM-5 and is a diagnosable disorder that can affect mental health; however, it is not diagnostically the same as mood disorders.
With mood disorders, symptoms that arise are, for the most part, directly a result of the mood disorder, as with anxiety and depression. With ARFID, though, the symptoms are not directly caused by someone having ARFID, but are more a collection of behaviors that are identified as a restrictive eating disorder. The cause is instead the reasoning behind the restrictive eating, such as sensory issues, food aversion, anxiety, or other signs of internal distress around eating.
Put more simply, pinpointing why the restrictive eating is happening has less to do with the disorder itself and more to do with the other factors that are causing ARFID to occur.
ARFID is often comorbid with other mental disorders such as autism, anxiety, or even obsessive/compulsive disorder (OCD).
Is ARFID a Form of Autism?
No; ARFID is not a form of autism. However, ARFID is commonly co-occurring with autism, as mentioned above.
Autism is a neurodevelopmental disorder, and it can present challenges in terms of maintaining proper nutrition. People with autism that have more difficulty managing sensory issues can resort to only eating very specific “safe” foods and might struggle with food restrictions. This selective eating can quickly lead to a nutritional deficiency.
What Are Symptoms of ARFID?
According to the DSM-5, the diagnosis of ARFID includes the following criteria.
- There is no other distinct mental disorder or medical condition.
- Their eating habits can include a lack of interest in eating or food.
- Rigidity and refusing to eat foods because of their smell, taste, texture or appearance.
- Worry about the results of eating, though not due to concerns about weight or body image.
- The individual will continuously fail to meet his nutritional or caloric needs, which causes significant weight loss or the inability to gain any weight. In children, it may cause them not to meet their growth milestones.
- Deficiencies in micro-nutrients—a chemical element or substance that’s required in trace amounts to allow for the normal growth and development of a person—can result in the individual needing to be fed by enteral feeding, which is a method of feeding that uses the gastrointestinal tract to deliver part or all of a person’s caloric requirements by using a tube. Or, the individual may be given oral nutritional supplements.
- The disorder will usually cause an interruption around the individual’s social functioning, such as stress during meals with the family or not participating in social events that include food.
- It’s important to note that ARFID is not caused by a lack of food or a cultural practice, such as religious fasting or being restricted from eating particular foods. It’s also separated from both anorexia nervosa and bulimia nervosa, because there’s no perception of distorted body image.
Other symptoms and warning signs of ARFID can include a lack of energy and a dependence on supplements to get nutrients.
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How Do You Develop ARFID (Avoidant Restrictive Food Intake Disorder)?
There are many reasons one might develop a restrictive eating pattern such as ARFID. To meet the criteria for an ARFID diagnosis, one must have significant functional impairments due to food restrictions.
As for the reasoning for restrictive eating, restriction can happen for a number of reasons:
- Past food poisoning or strong food aversion
- Significant social anxiety around eating in social settings (with no focus on body image)
- Sensory issues/autism
- Traumatic experiences (asphyxiation, etc.)
- Catatonic depression causing someone not to eat
As stated above, these reasons must have nothing to do with weight/body image, urges to eat things that are not food, or lack of access to food.
Can ARFID (Avoidant/Restrictive Food Intake Disorder) Develop During Adolescence?
The development of ARFID is more common in children than in adults. The DSM-5 indicates that these symptoms tend to appear by the age of 10 and may continue into adulthood. However, ARFID can develop at any time, though it’s important to seek a diagnosis to make sure it isn’t a different eating disorder.
Some research states that boys may have a higher risk for the disorder than girls. According to the National Library of Medicine (NLM), ARFID is prevalent in between 40 and 60 percent of children with developmental disabilities.
What Is the Difference Between Anorexia Nervosa and Avoidant/Restrictive Food Intake Disorder?
While it involves food restriction like anorexia, ARFID’s underlying motives are unrelated to distorted body image, which is at the core of anorexia nervosa. Though they have similar symptoms, ARFID revolves around a rigidity in eating patterns and avoiding particular types of food, which results in an insufficient amount of calories.
The Impacts of Avoidant/Restrictive Food Intake Disorder
With the weight loss and nutritional deficiencies that can result from ARFID, many times family and friends can become frustrated with the individual with the disorder. In social settings, others may be offended when the individual refuses to accept food that’s been offered to them. This is particularly true in cultures where food is in short supply—or has been scarce in the history of the culture—and sharing food with others is considered an honorable gesture. The disorder can cause family tension in general.
Infants with ARFID may be finicky, fussy, and hard to comfort during feeding.
The relationship between the parents and child may contribute to the disorder in situations where food is given abruptly or even forcefully.
Other factors can include the disposition of the infant, such as staying away from different experiences. Avoiding food may be their way of expressing a hesitance to try foods that are new to them.
It’s important to note that many children develop different eating patterns at some time in their lives, such as stubbornly refusing to eat vegetables for a while or opting for only chicken nuggets or fish sticks for dinner. For most children, those patterns usually subside on their own without the need for intervention. Individuals with ARFID have consistent or continually worsening problems with their food intake.
What Are the Risk Factors of ARFID?
The DSM-5 lists a variety of disorders which may trigger ARFID, including:
- Anxiety disorders
- Autism spectrum disorder
- Obsessive/compulsive disorder
- Attention-deficit/hyperactivity disorder
- Eating disorders are familial illnesses. Traits like temperament predispose people toward developing a disorder that may be passed from generation to generation.
- Anxiety within the family.
- Higher rates of feeding disturbances in children who have mothers with eating disorders.
- History of gastrointestinal conditions, such as gastroesophageal reflux disease.
- Incidents of choking or vomiting food can be a precipitator, including traumatic events
- Cultural pressures to eat pure and healthy foods that emphasize food processing, sourcing, packing, and environmental impact can be an influence on food beliefs, as well as intake.
Treatment for Avoidant/Restrictive Food Intake Disorder
Since ARFID does not quite describe a mental state in the same way as other disorders, it’s important to investigate the reasoning behind ARFID for each individual person and case in order to effectively treat it.
It’s also best to use a team-based approach for treatment, since ARFID can affect one’s physical health just as much (if not more) than one’s mental health. This means that patients will need more than just a mental health provider; a nutritionist, dietitian, primary care provider, and therapist may be needed to holistically treat ARFID’s mental and physical impacts.
In terms of therapeutic approaches, cognitive behavioral therapy (CBT) is often used to challenge the rigid beliefs individuals have surrounding food, as well as the fear of choking. The therapist can provide information about nutrition, especially if the food avoidance is based on false beliefs or fears.