All eating disorders are characterized by an inability to properly feed oneself. Difficulties in eating, body image, and digestion are largely rooted in neurobiological and metabolic factors and complicated by sociocultural influences. Avoidant/Restrictive Food Intake Disorder (ARFID) was officially recognized in the DSM5 in 2013, although researchers had been studying it for several decades prior, so this is not a new illness.
ARFID is an eating disorder that typically develops in childhood. Often misunderstood as “picky eaters”, people with ARFID struggle with low interest in food and eating, oral and digestive sensitivities to textures and tastes, and fears of aversive consequences related to food. In an effort to manage these experiences, children often learn to restrict what and how they eat. Some kids with ARFID will only eat certain types of food or may rely entirely on foods of a certain colour or texture. The avoidance of eating a wider variety of foods leads to an inability to meet nutritional needs resulting in weight loss or lack of growth in children. In some cases, people depend on feeding tubes or supplements to get enough nutrition.
These symptoms are not just a phase that a child goes through, rather a longstanding pattern of engaging with food and eating that, if left untreated, persists into adulthood and leads to problems with weight/development, social functioning, and school/work performance. Due to highly restrictive nature of the eating, high anxiety, and visceral sensory issues, people with ARFID are at high risk of medical complications such as heart arrythmias, bradycardia (low heart rates), electrolyte imbalances, bone loss, and other damage to organs. The impact on the brain secondary to the lack of nutrition is well documented across eating disorders showing changes to grey and white matter, cognitive functioning, and greater reliance on emotional regions of the brain (e.g., limbic system). It is a vicious cycle – fear and discomfort with food – restricting intake to feel better/stay safe – worsening physical and cognitive symptoms – more avoidance of food.
People often confuse ARFID with anorexia nervosa as they share restrictive patterns of eating and weight loss/lack of expected growth in children. Unlike anorexia, however, people with ARFID do not demonstrate fears of weight gain or body image disturbance. The avoidant and restrictive eating is predominantly caused by:
- sensory disturbances (e.g., taste, texture, colour, smell, temperature, body sensations)
- fear of something bad happening (e.g,. choking, vomiting, worsening of a physical illness)
Awareness and early treatment are essential. More information about ARFID and eating disorders treatment can be found on our website: https://www.psychology-emotionregulation.ca/eating-disorders.
Our community partners at NEDIC have added two brief assessment measures that you can access here: NEDIC | ARFID Screen
In an our next post, we will discuss the latest advances for the treatment of ARFID.