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. ARFID is more commonly present in childhood and adolescence, however, it can occur in people of any age, gender, background, and sexual orientation. It is predicted to occur in 1 in 300 people in Australia. 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-based due to being sensitive to the taste, texture, temperature, smell, appearance of specific food and fluids
2. Trauma-related due to fear or phobia of aversive consequences such as fear of vomiting, gagging, choking, an allergic reaction, food poisoning/contamination or gastrointestinal discomfort
3. Lack of interest in food and eating due to poor/low appetite or difficulties in recognising hunger/fullness signals due to lowered interoceptive awareness

Those with ARFID can present with more than one phenotype. ARFID can also occur concurrently with other eating disorders, such as Anorexia Nervosa and is referred to as ARFID-Plus. People with anxiety, autism (ASD) and Attention Deficit /Hyperactive Disorder (ADHD) are more likely to develop ARFID.

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

• Failure to gain weight or significant weight loss
• Development of significant nutritional deficiencies
• Very limited intake of certain types, textures or brands of foods, often excluding whole food groups
• 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 enteral feeding or oral nutritional supplements
• Marked interference with psychosocial functioning such as being unable to eat out with family or friends, unable to eat at school or work

What is the treatment for ARFID?

ARFID is a relatively new diagnosis and the research is still growing around which treatments are effective.  As a result, there is no one standardised evidence-based treatment for ARFID. The goals of treatment for ARFID will vary and will be determined by both the underlying cause for the avoidance/restriction of food, co-occurring conditions such as neurodivergence as well as the goals of the individual.

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
• Psychoeducation on ARFID including neurobiology, interplay with neurodivergence (ASD and ADHD), and clarifying common misconceptions
• Psychoeducation on the role of nutrition restoration on physical, cognitive, social, and emotional wellbeing
• To achieve a more positive relationship with food and eating in a way that works for you
• 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 gaps
• Providing a personalised supplementation plan such as vitamins, minerals, protein, fibre to prevent deficiencies and correct deficits. This may include the use of liquids, chewables, powders, sprays, tablets, or drops depending on personal preference while considering sensory or fear-based sensitivities
• Taste testing of medical nutrition supplement drinks and scripts to purchase them at a reduced price
• Providing in-session meal support with the optional support of our Dietwise dogs Ella, Eddie and Reggie
• Using the Dietwise developed My Food Journey Flash Cards to assess food preferences and guide treatment
• Identifying sensory triggers and providing strategies to manage and reduce anxiety around food and eating
• 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 best practice GP medical monitoring to ensure medical safety and minimise risks during treatment if required
• Creating a relapse-prevention plan
• For children and adolescents, we may use an FBT-AR approach (Family Based Treatment for ARFID), empowering caregivers to play an active role in refeeding and normalising eating behaviours
• We may also utilise a CBT-AR approach (Cognitive Behavioural Therapy for ARFID) to facilitate food exposure therapy, and acceptance-based interoceptive exposures for children, if appropriate
• If appropriate, identifying and challenging fear foods using food chaining and fading techniques and creating a food hierarchy

A special note on neurodiversity-affirming care

Our experience is that compliance-based behavioural-based ED interventions such as CBT-E, CBT-AR and FBT are not neurodiversity-affirming and may not be a good fit for some people with autism and/or ADHD. In these cases, we challenge neuronormative beliefs, assumptions, norms, goals and expectations related to food, eating and body to prevent  trauma and harm. Our dietitians prioritise self-determination and incorporate a client-centred, compassionate, strengths-based approach to all aspects of our nutrition care.