Written by: Julia Chivu
Edited by: Holly Paik
Avoidant/restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike other eating disorders, ARFID is not associated with concerns about body image, appearance, or weight gain. This disorder is also not caused by cultural or religious practices, food scarcity, or mental disorders (Coglan and Otasowie, 2019).
Rather, individuals with ARFID exhibit a lack of interest in eating and tend to avoid food. More specifically, they avoid foods based on textures, smells, and specific tastes. Some people with ARFID are afraid of the consequences of eating such as choking, gastrointestinal reflux, choking, and food poisoning. As a result, these individuals may limit their food choices. This restricted food intake can contribute to health issues, including delayed puberty, low bone density, and lethargy that is caused by iron deficiency (Seetharaman and Fields, 2020). Unfortunately, these behaviors often result in significant weight loss and nutritional deficiencies. Some people require external feeding or nutrition supplements and in some cases, reliance on nutritional formula or feeding tubes may be necessary. Additionally, these behaviors can lead to stunted growth and challenges with psychosocial functioning. For example, individuals with ARFID may face difficulty eating around others or avoid eating in certain locations (Coglan and Otasowie, 2019).
Currently, there is limited data regarding the prevalence of ARFID. Clinical reports show 5% to 14% incidence in pediatric eating disorder programs. Other studies show that prevalence ranged from 1.5% to 23% in North American eating disorder programs for children and adolescents. In addition, children are most commonly affected by this disorder. Infants may express distress, agitation while being fed, and lethargy, making it easier to diagnose this condition in infancy rather than in children or adolescents. As individuals age, the symptoms become more generalized and pose a challenge for diagnosis. Additionally, this eating disorder affects both males and females equally, yet physicians often have difficulty with accurate diagnoses. It can be challenging to differentiate between ARFID and childhood anorexia. Many physicians also perceive the symptoms of a child’s eating habits simply as a developmental phase that the child will most likely grow out of (Coglan and Otasowie, 2019). Comorbidities such as Autism, anxiety disorders, neurodiversity, and gastrointestinal symptoms are also associated with ARFID (Watts et al., 2023).
Little is known about the long term outcomes of this disorder. It is believed that ARFID is a risk factor for potential psychiatric problems and can lead to malnutrition. Some studies have demonstrated that patients with ARFID are at risk for heart issues, loss of their menstrual cycles, vitamin deficiencies, and even spinal cord degeneration. Furthermore, those children who have been hospitalized due to the severity of their symptoms usually require longer stays to stabilize their nutritional status (Thomas et al., 2017).
Although there are no specialized treatment options or nationwide agreements on how to treat ARFID, there are many treatment options that can be implemented. Support is available via child and adolescent mental health service programs, along with pediatric and specialist eating disorder services. Systematic desensitization, a behavioral process commonly used for phobias and anxiety disorders, is also a potential treatment option seeing as it allows the patients to be exposed and play with new foods so they can get comfortable. Paradigms of operant conditioning, which focuses on the usage of reinforcement and punishment to modify behaviors, can also be applied as a treatment option to reward the consumption of target food. Additionally, case reports have shown that cognitive behavioral therapy and family based therapy are useful in addressing ARFID (Thomas et al., 2017). Ultimately, the lack of standardized treatment highlights the need to develop more targeted and effective ARFID treatment methods. Furthermore, increased awareness and understanding of this disorder among healthcare professionals is necessary to better detect and assist those with ARFID.
References:
Coglan, L., & Otasowie, J. (2019, February 11). Avoidant/restrictive food intake disorder: What do we know so far?: Bjpsych Advances. Cambridge Core. https://www.cambridge.org/core/journals/bjpsych-advances/article/
Dustman. (2013, February 11). Resist. Flickr. https://www.flickr.com/photos/28603429@N06/8464573634
Seetharaman, S., & Fields, E. L. (2020, December). Avoidant/restrictive food intake disorder. Pediatrics in review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185640/
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017, August). Avoidant/Restrictive Food Intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current psychiatry reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281436/
Watts, R., Archibald, T., Hembry, P., Howard, M., Kelly, C., Loomes, R., Markham, L., Moss, H., Munuve, A., Oros, A., Siddall, A., Rhind, C., Uddin, M., Ahmad, Z., Bryant-Waugh, R., & Hübel, C. (2023, September). The clinical presentation of avoidant restrictive food intake disorder in children and adolescents is largely independent of sex, autism spectrum disorder and anxiety traits. The Lancet. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00367-X/fulltext
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