Avoidant Restrictive Food Intake Disorder
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Are you or is someone you know a picky eater?
Some extremely picky eaters may have aneating disorder, known as avoidant/restrictive food intake disorder (ARFID).
In most cases, picky eating does not interfere with weight status, growth, or daily functioning.
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However, people who experience consequences such as these as a result of extremely picky eating mayneed treatment.
ARFID is described by some asfood neophobia, where difficulty with novelty leads to a limited diet.
Parents often report that their children with ARFID had trouble transitioning to mixed foods from single baby foods.
They also often report they had a specific sensitivity to textures such as mushy or crunchy.
Most children are still able to meet their nutritional needs despite some pickiness.
In chapter 12 ofFamily Therapy for Adolescent Eating and Weight Disorders: New Applications,Dr.
Kathleen Kara Fitzpatrick and her colleagues explain the condition."
The condition can have serious consequences.
Individuals with ARFID do not eat enough to meet their energy and nutritional needs.
ARFID is not as well-known asanorexia nervosaorbulimia nervosa.
Individuals with ARFID usually have had restrictive eating all along.
A diagnosis of ARFID requires a thorough assessment.
Other medical reasons for the nutritional deficits need to be ruled out.
It is relatively more common inchildrenand young adolescents, and less common in older adolescents and adults.
Nonetheless, it does occur throughout the lifespan and affects all genders.
Onset is most often during childhood.
Most adults with ARFID seem to have had similar symptoms since childhood.
Fitzpatrick and colleagues note that ARFID patients are more frequently referred from gastroenterology than patients with other eating disorders.
They are also likely to have an anxiety disorder, but less likely to have depression.
They also commonly express more concerns around physical symptoms related to eating, such as an upset stomach.
Treatment
For patients and families, ARFID can be extremely challenging.
Families often get anxious when children are having difficulty eating and may get stuck in power struggles over food.
For older adolescents and adults, ARFID can impact relationships as eating with peers can become fraught.
Left untreated, ARFID will rarely resolve itself.
For children and adolescents with ARFID, evidence shows thatfamily-based treatmentcan be helpful.
Residential Treatment
At present, there are no evidence-based treatment guidelines for ARFID.
Thus, patients are encouraged to rotate presentations of preferred foods as well as gradually introduce new foods.
The average person typically requires several presentations before foods are no longer experienced as novel.
For people with ARFID, it is often fifty times before a food is no longer experienced as unfamiliar.
Treatment Example
One adult patient with ARFID ate no raw vegetables and no fruit.
His goals were to increase his ability to eat fruit and vegetables.
He ate carrots when they were in soup.
Then, he began to work on the peels of fresh carrots.
He also started to work on fruit.
He began with strawberry jelly on toast, which was something he was comfortable eating.
He next introduced strawberry jelly with seeds to get him used to some texture.
After that, he introduced macerated fresh strawberries (mixed with sugar to soften them).
Eventually, he began to eat very small pieces of fresh strawberries.
After that, other fruits and vegetables were gradually added in a similar fashion.
Merck Manual Professional Version.Avoidant/Restrictive Food Intake Disorder (ARFID).
New York: Routledge; 2015.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed.
Washington, DC; 2013.
2017;50(9):1067-1074. doi:10.1002/eat.22737
