Avoidant Restrictive Food Intake Disorder (ARFID)

What is it?

A new disorder in the DSM-5, avoidant/restrictive food intake disorder (ARFID) is characterized as an “eating or feeding disturbance” that leads to nutritional deficiency (APA, 2013). The lack of nutrition may lead to weight loss, use of a feeding tube, oral nutritional supplements, and/or interference with psychosocial functioning. This disorder is distinct from typical picky eating in toddlers. Reasons for the avoidance or restriction of food may be due to the sensory characteristics of food, such as “appearance, color, smell, texture, temperature, or taste” (APA, 2013). Additionally, some kids presenting with ARFID do not want to eat due to fears related to the outcomes associated with eating, often following experienced or witnessed traumatic events related to eating (e.g., choking, gagging, vomiting and/or constipation) and this is maintained by avoidance (Nicely, T., et. al., 2014). Nearly half of children with ARFID report a fear of vomiting, or emetophobia, and this disorder is more frequently diagnosed in boys. To be diagnosed with ARFID, there should be NO indication of body image disturbances or fear of weight gain, as these are indicators of other eating disorders.

Risk Factors

ARFID is most likely to be diagnosed in infancy or early childhood. It may then continue into adulthood (APA, 2013). Children diagnosed with anxiety, pervasive developmental, and learning disorders are at a higher risk of developing ARFID (Nicely, T., et. al., 2014). Additionally, children who do not outgrow typical picky eating behaviors may also be at risk for developing ARFID.

Symptoms

The symptoms of ARFID are also quite diverse. There can be dramatic weight loss, individuals may face constipation, abdominal pain, acid reflux, lethargy, or an excess of energy and menstrual irregularities (NEDA). Other symptoms include difficulties concentrating, dizziness, fainting, sleep problems, dry skin, hair thinning, muscle weakness, or impaired immune functioning. Overall, the lack of essential nutrients in the body can lead to significant health consequences in an individual with ARFID. It is important to discuss these concerns with a medical doctor so steps can be taken to supplement one’s diet in order to address these nutritional deficits.

Assessment

It is important to rule out other possible mental health concerns, and medical conditions. Other diagnoses that should be considered and ruled out include Obsessive Compulsive Disorder (OCD) and anxiety disorders. In addition to mental health concerns, it is also important to rule out possible medical conditions including gastrointestinal disease, food allergies or intolerances, and tumors (APA, 2013). It is important to accurately identify and treat psychiatric and/or medical conditions that may be impacting a child’s ability to eat.

Treatment

Depending on the types and severity of symptoms, treatment for ARFID can vary greatly. Treatment can range from inpatient treatment programs to outpatient therapy. At an outpatient center, the focus of treatment is on restructuring negative thoughts surrounding food consumption, systematically increasing the quantity of a variety of new foods until these foods become part of the child’s food repertoire. At home parents should make sure to model healthy eating and promote a regular pattern of family meals.

If your child is experiencing some of the symptoms outlined above, we recommend that you discuss your concerns with your child’s doctor and if possible, ask for a referral to see a Developmental Behavioral Pediatrician and a Feeding Expert. In our area we highly recommend the Developmental Behavioral Pediatrics Department as well as the Feeding Clinic at UofM. We also encourage that you make an appointment with a clinician at Sunfield Center who will be able to get you and your child started with treatment and resources to address your child’s restricted food intake.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., … & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49-52.

Grewal, S., Lieberman, M. (2016). Conditions and Diseases – Avoidant/restrictive food intake disorder: How to help your child at home. Retrieved from: http://www.aboutkidshealth.ca/En/HealthAZ/ConditionsandDiseases/BehaviouralandEmotionalProblems/Pages/arfid-how-to-help-child.aspx

Kennedy, G. A., Wick, M. R., & Keel, P. K. (2018). Eating disorders in children: is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment?. F1000Research, 7.

King, L. A., Urbach, J. R., & Stewart, K. E. (2015). Illness anxiety and avoidant/restrictive food intake disorder: cognitive-behavioral conceptualization and treatment. Eating behaviors, 19, 106-109.

NEDA. (n.d.) Avoidant Restrictive Food Intake Disorder (ARFID). NEDA: Feeding Hope.

Proschaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behaviour change. Am J Health Promot, 12, 38-48.

Nicely, T., Lane-Loney, S., Masciulli, E., Hollenbeak, C., & Ornstein, R. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders 2:21.