ARFID: The new kid on the block? A dietitian perspective.

Having worked in the field of eating disorders for a few years, I would say that an individual diagnosed with Avoidant Restrictive Food Intake Disorder (ARFID) in the past were far and few between. Awareness of ARFID is now on the rise due to its inclusion in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which has led to greater awareness as there are more health care professionals upskilling in the area and there are more resources that are being created on ARFID. This is increasing public awareness and ultimately leading to earlier diagnosis and treatment interventions. 

Frequently, individuals with ARFID are classified as the picky/fussy eater. Mealtimes can be quite stressful with a parent frustrated with the fact that their child is not eating a variety of foods. Parents may find themselves cooking only certain meals in a very specific way or the individual themselves sitting with large amounts of anxiety, guilt, and frustration as to why “they just can’t eat”. Parents are often told by healthcare professionals to give it time, it’s just a phase and that their child would “outgrow” the phase. Due to the prolonged effect of restrictive eating, individuals are at a high risk of medical instability requiring an admission into hospital.   Ultimately, there is a constant struggle as the person living with ARFID wants to eat, wants to be able to increase their variety of foods and wants to gain weight.

ARFID broken down: 

According to the DSM 5, “Avoidant/Restrictive Food Intake Disorder is defined as: An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with 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 psychosocial functioning. 
• The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another mental disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
• The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
• The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.”

  Simply put, ARFID is defined by highly selective eating habits, disturbed feeding patterns or both, which could have a significant impact on nutrition and lead to energy and nutrient deficiencies.   In children, the impact of limited food intake may lead to failure to gain weight. Common eating and feeding challenges for an individual with ARFID include difficulty digesting food; heightened sensitivity to food that leads to the avoidance of specific types of food textures, colours, and smells or eating at an abnormally slow pace or having a general lack of appetite. Individuals can be quite “brand loyal”, where they prefer to keep to specific brands of food or packaged products as they know what to expect in terms of taste, texture, and smell of food.   

Symptoms of ARFID 

• Extreme pickiness in choosing food or limited variety of foods eaten. Tends to keep to foods that would be considered on the safe food list. 
• Anxiety when presented with fear/new foods or foods that are not included in the safe food list. 
• Weight loss and difficulty gaining weight in adults.
• Children may experience failure to gain adequate weight for their growth, development phase and age.   
• Dependence on oral nutritional supplements, and/or enteral feeding. 
• Avoidance of some foods, based on texture, colour, taste, smell, food groups, etc. 
• Frequent vomiting, choking, gagging during or after exposure to certain foods. 
• Difficulty chewing food. 
• Lack of appetite. 
• Considerable decrease in portion sizes of meals and snacks.
• Social isolation. 

Now that you know a bit more about ARFID, take the time to reflect if you or your child may be presenting with some of the signs and symptoms of ARFID and may require further support. Remember that the longer we have a person living with ARFID, the more we feed the anxiety that surrounds the eating experiences which leads to continuous decrease in variety and adequacy of meals thereby negatively impacting quality of life. Treatment of ARFID consists of an eating disorder informed team that includes a GP, psychiatrist, dietitian, and clinical psychologist.  As a dietitian who has been doing a lot of work in this area, I know that it can be a very overwhelming, scary and anxiety driven time to take on recovery. However, remain open to the process, get the relevant information from the team on what recovery will look like and do not close the door by saying that it will be too hard when you have not had the opportunity to try. 

I hope you have enjoyed this blog.

Reach out today to our Dietwise Care Coordinators to get started by contacting us on – 08 9388 2423 or reception@dietwise.net.au. You can even contact us through our website here. We are open 6 days per week for in-person and Telehealth appointments including both after-hours and Saturdays.

Written by:

Kirasha Maharaj

Accredited Practising Dietitian & Accredited Nutritionist