Avoidant/Restrictive Food Intake Disorder (ARFID), oftentimes characterized as “extreme picky eating,” is an eating disorder impacting thousands of individuals, particularly children. There are three main types of ARFID:
- Lack of interest: people with this type of ARFID have a genuine lack of interest in eating and food. They also get full quickly.
- Sensory Avoidance: people with sensory avoidance have issues with food tastes, textures, temperature and smells.
- Fear of Aversive Consequences; people with a fear of illness, choking, nausea and allergies related to food.
What are the effects of ARFID?
Because ARFID leads to avoidance of certain foods and food groups, it can impact the body and brain in many ways. Below are some effects of ARFID, which may or may not be present in people diagnosed with this eating disorder.
Over time, avoidant/restrictive food intake disorder can cause malnutrition. Malnutrition is linked to many health issues, such as impacts on hormones and development caused by nutrient deficiencies. This can cause problems in bone health, and for women, amenorrhea (loss of a menstrual period). You can learn more about the health impacts of malnutrition by reading our blog.
Chronic stress from under-eating increases cortisol levels, which may increase the risk of anxiety and depression. Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.
Some people with ARFID might avoid eating with others to hide their symptoms. This can feel lonely and isolating, because they believe others won’t understand their experience. Children might avoid social situations involving food and eating. This can include parties, special occasions and almost any social setting. Since school involves social eating, many children suffer academically due to stresses and anxiety related to lunch time or snack time. Children might avoid extra-curricular activities where eating is a regular part of the club, organization, team or other entity.
Adults will likely continue many of their social habits from childhood. This might include seeking to avoid social eating, avoiding group participation in organizations. Adults might be limited in their career trajectory due to awkward or uncomfortable socialization. This is especially true since many people with ARFID have never gotten comfortable with socializing due to activity avoidance to spare themselves social eating discomfort and anxiety.
How is ARFID treated?
CBT – ARFID
Cognitive Behavioral Therapy, or CBT, is a psychological treatment that uses the connection between thoughts, feelings and physical sensations to address maladaptive behaviors in a less overwhelming way. There is a specific type of CBT for ARFID (CBT-ARFID) that is widely used by dietitians and therapists. The goals of CBT-ARFID are to achieve a healthy weight, correct nutritional deficiencies, eat foods from the basic food groups and feel more comfortable eating in social situations. CBT-ARFID uses several sessions to go through stages such as learning about the disease, making early changes, setting big goals, facing their fears and preventing relapse.
Exposure therapy involves “exposing” the person to their perceived fear, in this case, food that provokes anxiety, using smells, imagery, and mental visualization. Usually, dietitians will work on a hierarchy of fear foods from the least fearful to most anxiety provoking. Over time the dietitian will expose the person to the idea, smell, texture, sight and eventually the taste of the feared food until the person is no longer anxious around that specific food. It should be noted that not all fear foods will be exposed, and the dietitian works in collaboration with the individual to help them move towards foods that they would like to incorporate into their life.
Food chaining is one strategy that can help people try new foods or fear foods. The goal is to create “chains” or links between foods that they already eat and new foods that would support their growth health and goals The food is prepared in a way that is least overwhelming and stressful, and then moves gradually towards the food in its most challenging form. For example, if the fear food is blueberries, a person could start with a blueberry muffin, and gradually move to blueberry juice, blueberry yogurt and eventually to blueberries themselves.
Coping with ARFID can be a lonely and isolating experience, but there are many tools and professionals available to help one in their journey towards recovery, whatever that may look like for each person.An interdisciplinary team can involve a registered dietitian, occupational therapist, speech language therapist, psychologist and/or psychiatrist. At Sööma, our dietitians specialize in using the treatment methods above to help clients with ARFID. Reach out to us for more information or to learn how we can help!
By: Elsa Chu, Registered Dietitian
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