ARFID (Avoidant/Restrictive Food Intake Disorder) is not just “picky eating”. It is a multilayered eating disorder unrelated to fear of weight gain or body image disturbance. A person with ARFID will avoid food and/or restrict their intake due to one or more of the following reasons:
- Sensory sensitivities (Avoidant): particularly hypersensitivity to textures, tastes, or even visual aspects of food.
- Lack of interest (Restrictive): exhibit little interest in food due to low appetite or challenges with interoception i.e. ability to feel hunger cues.
- Fear of aversive consequences (Aversive): restriction of food linked to previous experiences of and/or fear of choking, vomiting, food poisoning, allergic reactions or gut discomfort.
- Mixed: characterized by having two or more of the above subtypes.
- ARFID Plus: characterized by having one or more of the above subtypes plus another eating disorder such as anorexia nervosa, bulimia nervosa or binge eating disorder.
Neurodivergent is a term used to describe individuals whose brains function in a way that is not considered typical, such as those who are autistic, ADHD, dyslexic, OCD, or have learning disabilities and other neurodevelopmental diagnoses. Long before a connection between ARFID and neurodivergence was made, clinicians and caregivers had noticed that many neurodivergent children had feeding difficulties or differences. Now we know there is a common occurrence between ARFID and neurodivergence, and why it is important to understand this relationship.
Why is there a common link between ARFID and neurodivergence?
Many traits seen in neurodivergence help explain the eating challenges commonly seen in ARFID.
Sensory processing differences
Neurodivergent people may experience hypersensitivity and sensory overload. This means some senses may be heightened to the extent that sensory input may feel uncomfortable or overwhelming. This includes the texture, taste, smell, and even appearance of food. This can result in a limited variety of accepted foods. These sensory processing differences can also be in relation to the eating environment itself. This on its own can be enough to trigger the disrupted eating behaviours of ARFID.
Routine and repetition
Neurodivergent individuals often prefer routines and predictability to feel safe and regulated in their world. This may present as reliance on “safe” foods which provide feelings of comfort and safety. Often, the foods that are consistent, predictable, and non-challenging are what you may know as “beige” foods. One example is potato crisps – these are predictable in taste, smell, and texture. Whereas fresh fruit or vegetables can be unpredictable in their flavour and texture depending on ripeness or season. This concept of rigidity is also implicated in eating disorders such as ARFID.
Hyperfixation cycles
Neurodivergent individuals may develop hyperfixations which can also relate to food. For example, a person may eat the same food or meal repeatedly. Hyperfixations can then end suddenly, leading the person to avoid the food or meal completely. This can result in a limited and decreasing range of accepted foods.
Difficulties with interoception
Interoception is the ability to sense what it is going on inside your body such as feelings of hunger or thirst. Neurodivergent people may experience challenges with interoception, therefore struggle to respond to body signals like hunger. This is often apparent in the lack of interest (Restrictive) subtype of ARFID.
Some other neurodivergent traits that can overlap with ARFID include:
- Black and white thinking style
- Being highly detail-focused
- Having co-occurring anxiety and/or depression
- Difficulties with emotional regulation
- Differences in experiences of hunger and fullness
- Dichotomous or rule-based thinking about food
Why is it important for clinicians working with ARFID to understand the link with neurodivergence?
Before being able to support someone with co-occurring ARFID and neurodivergence, one has to be aware that they commonly co-occur in the first place. Clinicians should then offer a neurodiversity-affirming approach. It is important to remember that neurodiversity means there is not only one “right” way to eat and the goal of achieving neurotypical eating norms may not be a good fit. Many people with ARFID can have their nutritional needs met, create a positive relationship with food and live fulfilling lives.
Providing a “one size fits all” approach is not neurodiversity-affirming and may cause distress in some individuals. For example, for people who are forced to eat foods that cause them intense distress, this can be highly traumatizing. In addition, when people learn to associate their “safe foods” with shame or being “incorrect”, it can make it extremely challenging for them to eat adequately or have a positive relationship with food. This is important to recognize as ARFID can co-occur with and/or lead to other restrictive eating disorders such as anorexia nervosa. There are several ways in which a neurodiversity-affirming approach can be implemented when working with individuals with both ARFID and neurodivergence. When freely chosen and carried out in a collaborate and affirming way, food exposure therapy may be beneficial for some individuals who are wanting to increase their food variety and decrease specific distress around certain foods.
The most important thing to know about ARFID and neurodivergence is that research on this connection is growing. While one type of treatment, for example CBT-AR, may be helpful for some people, for others, another intervention or treatment approach may be more effective. The key to treating ARFID with co-occurring neurodiversity is recognizing that one may affect the other, and individualise treatment so that it is neurodiversity-affirming to ensure no further harm or trauma is done.
At Dietwise, our team work in a neurodiversity-affirming way considering individual differences in social communication, sensory processing, interoception, emotional regulation and executive functioning. In ARFID treatment, we recognise that current treatment models with compliance-based behavioural interventions may cause harm by risking further sensory overwhelm, distress and trauma for some individuals. If you or someone you care about need support with ARFID, 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:
Accredited Practising Dietitian & Accredited Nutritionist