ARFID

Avoidant/Restrictive Food Intake Disorder (ARFID) is often dismissed as ‘picky eating’ and may go undiagnosed until there is a serious impact on health.  The fallout of ARFID can be significant, as not consuming enough energy and nutrients can halt or slow growth and development in children and result in nutrient deficiencies, low energy levels, fatigue, increased anxiety and low mood across all ages. It is different from other eating disorders such as anorexia nervosa as people living with ARFID do not have body, weight or shape concerns or an intense fear of weight gain.  

ARFID can be classified into three phenotypes including:

1. Sensory sensitivities e.g. texture, smell, taste, sight
2. Fear of aversive consequences e.g. fear of vomiting or choking, gut pain
3. Lack of interest in food and eating due to low appetite and/or differences in interoception

Those with ARFID can present with more than one phenotype. ARFID can also occur concurrently with other eating disorders, referred to as ARFID-Plus. The goals of treatment for ARFID will vary and will be determined by both the underlying cause for the avoidance/restriction of food as well as the goals of the parents or adult.

Red flags of ARFID can vary but some of the most common signs and symptoms include:

• Failure to gain weight or weight loss
• Development of nutritional deficiencies
• Very limited intake of certain types, textures or brands of foods
• Consistent loss of appetite or disinterest in food and eating
• Fears of choking, vomiting or food poisoning limiting food variety and intake
• Food intake and variety becoming progressively limited to ‘safe’ foods over time
• Increased dependence on oral nutritional supplements

How our dietitians can help with ARFID:

• Providing a safe, non-judgemental, neurodiversity-affirming space to talk openly and share your concerns/fears/anxiety about food and eating
• To achieve a more positive relationship with food and eating
• Psychoeducation on ARFID including neurobiology, interplay with neurodivergence (ASD, ADHD), and clarifying common misconceptions
• Psychoeducation on the role and importance of nutrition restoration on physical, social, and emotional wellbeing
• Providing medical nutrition therapy to achieve or maintain medical stability, reverse malnutrition, prevent refeeding syndrome, restore menstruation (if relevant) and resume growth and normal development if a child or adolescent
• In-depth nutritional analysis of current food intake to identify nutritional gaps and guide your personalised supplementation plan.
• Providing a personalised vitamin and mineral supplementation plan to correct and prevent deficiencies. This may include the use of liquids, chewables, powders, sprays, tablets, or drops depending on personal preference while considering sensory or fear-based sensitivities
• For children and adolescents, using an FBT-AR (Family Based Therapy for ARFID) approach, empowering caregivers to play an active role in refeeding and normalising eating behaviours
• Utilising a CBT-AR (Cognitive Behavioural Therapy for ARFID) approach to facilitate food exposure therapy, and an acceptance-based interoceptive exposure treatment for children
• Identifying and challenging fear foods using food chaining and fading techniques and creating a food hierarchy
• Using the Dietwise developed My Food Journey Flash Cards to guide treatment
• Discovering ways to manage and reduce anxiety during food challenges
• Taste testing of medical nutrition supplement drinks and scripts to purchase them at a reduced price if required
• Providing in-session meal support with the optional support of our Dietwise dogs Ella, Eddie and Reggie
• Increasing regularity of meals as well as adequacy and variety of foods eaten.
• Building your recovery team which may include all or some of the following – GP, Paediatrician, Psychiatrist, Psychologist, Occupational Therapist and Speech Pathologist
• Providing specific guidance on gold-standard GP medical monitoring to ensure medical safety and minimise risks during treatment
• Creating a relapse-prevention plan

Learn more about warning signs and health impacts of ARFID.