ARFID Case Examples
Selena is an eight-year-old girl whom others define as a “picky eater.” She has sensory issues around eating any foods that aren’t completely solid. She also avoids anything cooked or warm. Her diet consists primarily of chips, cereal, and occasionally, raw vegetables. Because of her limited food intake, Selena is underweight and not as tall as predicted by her initial growth curve. Recently, her bloodwork has demonstrated some nutritional deficiencies.
Madden is a 27-year-old man who had a healthy relationship with food until he choked on a piece of fish a year ago. He panicked during his episode and became fearful of eating fish, as well as other foods, which he believes might cause him to choke again. This fear has limited what, how, and when he eats. He finds himself avoiding restaurants and will attend social events but won’t eat at these occasions. Madden has lost a significant amount of weight as a result of his dietary changes.
About ARFID
What do Selena and Madden have in common? Both are diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID). According to the DSM-5-TR, the following criteria must be met for an ARFID diagnosis:
- Feeding disturbance as manifested by persistent failure to eat adequately with significant failure to gain weight or significant loss of weight over at least 1 month.
- The disturbance is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).
- The disturbance is not better accounted for by another mental disorder (e.g., Rumination Disorder) or by lack of available food.
It’s important to note that ARFID goes beyond picky eating to include a collection of symptoms that significantly impact someone’s functioning. Thankfully for those who struggle, ARFID has become more widely known, researched, and treated in the last 10 years. While historically, we’ve focused on the more well-known eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder), ARFID has now claimed an important seat at the table. Because of our greater awareness of this presentation, many more people have come forward as struggling with the diagnosis. With this comes reduced stigma and greater understanding of the condition. The following sections detail what our professional community has uncovered about ARFID over the years.
Symptoms: While eating disorders in general are often driven by what we call over-valuation of weight and shape (i.e., a drive to lose weight or change one’s body shape), ARFID is driven by other causes. There are three primary ARFID subtypes:
Low interest in eating: Characterized by low appetite or disinterest in food, resulting in insufficient intake
Sensory sensitivity: Avoidance of select foods based on texture, taste, or other sensory properties
Fear of aversive consequences: Resulting from traumatic or anxiety-related experiences with food (e.g., vomiting, choking), leading to eating fears/avoidance of certain foods
As you might guess, Selena’s case involves sensory sensitivity, while Madden’s symptoms are driven by a fear of aversive consequences. It’s also possible that an individual with ARFID can have multiple subtypes. What each presentation has in common is that they result in a failure to nourish the body, causing weight loss and/or nutritional deficiencies that significantly impact a person’s well-being.
ARFID Treatment
Addressing ARFID can involve multiple professionals, from therapists to dietitians to speech-language pathologists. Some common approaches include:
Cognitive behavioral therapy for ARFID (CBT-AR): Targets the thoughts and feelings resulting in food restriction, focusing on increasing food intake and/or variety
Exposure therapy/desensitization: Introduces gradual exposure to feared foods to reduce related anxieties
Family-Based Treatment (FBT): Empowers parents of children and adolescents to facilitate increased eating and reduce mealtime anxiety
Nutrition therapy: Creates meal plans or offers additional food choices to ensure nutritional needs are met
Oral motor therapy: Strengthens chewing- and swallowing-related muscles, often supported by speech-language pathologists
Medical interventions: Medical management of severe presentations; use of psychiatric medications to manage the anxiety associated with eating
In general, ARFID interventions involve exposure to increased amounts and/or varieties of food, with increasing levels of challenge over time. The goal is to introduce or reintroduce foods so that the individual has access to a wider range of options that allow for better health and a fuller life. In more severe cases, these approaches might be insufficient. Treatment may require more significant interventions, such as intensive outpatient treatment, partial hospitalization, residential treatment, or inpatient hospital stays.
If you or someone you know is struggling with ARFID, please know that help is available. Despite the increased awareness of ARFID among eating disorder professionals, these diagnoses are sometimes missed, as providers can dismiss someone after ruling out other eating disorder behaviors. It is important to seek out support from someone who has specific experience and training with ARFID. With the right help, it’s possible to recover from ARFID, improving your nutritional status, reducing food-related anxiety, and developing a more diverse eating repertoire. Because food plays such a critical role in our social lives and psychologies, ARFID treatment can help sufferers live more balanced, enriched and meaningful lives.