According to the fifth edition of the Diagnostic and Statistical Manual (DSM 5 TR), avoidant/restrictive food intake disorder (ARFID) is a pattern of limited eating in regards to the variety of food or volume of food. Most individuals with ARFID attribute their limited variety or volume to one of the following: a lack of interest in eating or food (low hunger/lack of enjoyment of eating), avoiding food due to their sensory characteristics (sensory sensitivity), or avoiding food consumption due to a feared adverse consequence of eating (choking, vomiting). 

However, it's important to remember that ARFID is more than just being a picky eater or skipping a meal here and there. For an individual to qualify for an ARFID diagnosis, the eating pattern must be associated with important medical or psychosocial consequences. 
Common medical consequences may be:

• Significant weight loss
• Slow-than-expected growth 
• Nutritional deficiencies
• Dependence on tube feeding
• Reliance on energy-dense supplements
• Common psychosocial consequences may be:
• Difficulty participating in social events
• Family tension during meals
• Crying episodes and feelings of anxiety related to food consumption

Of note, a main difference between ARFID and other eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder, is that the concern of gaining or losing weight is not experienced in ARFID. As mentioned before, individuals with ARFID may notice weight loss, but the function of their limiting behavior in variety or volume of food is not to manipulate their body shape or size. Frequently, individuals with ARFID express distress over their weight loss and may even express concern about others' comments on their weight loss. Individuals with Anorexia Nervosa, for instance, are more excited to look thin and have a hard time accepting being at a healthy weight. 

Three conceptual identifications of ARFID: 

As mentioned, those who struggle with ARFID have three conceptual identifications (sensory, lack of interest, and fear of adverse consequences). Below I will share more in-depth about what these identifications look like for individuals of ARFID. 

Sensory, also known as Avoidant:
These individuals are avoidant of food in relation to their sensory processing. These people may experience a sensitivity to the texture, smell, or appearance of food. Likewise, people who avoid foods based on their sensory processing may also avoid them due to overstimulation reactions. I often share with my clients that they are the supertasters of the world. Once a person with ARFID has a negative sensory experience with a specific food, they will often discontinue consumption of that food and foods with similar sensory properties. Lastly, new foods may also be difficult to try for fear of the uncomfortable sensory processing experience. ARFID is maintained via avoidance.  

Lack of Interest, also known as Restrictive: 
People who are restrictive of food intake due to a lack of interest or lack of strong hunger cues fall into this category. These people may struggle to find food pleasurable, meaning they have little to no reward for eating. Often people with ARFID who lack interest in food may become distracted during meals. This can be particularly hard for children or teenagers in school that have a limited amount of time to eat their lunch. 
 
Fear of Adverse Consequences, also known as Aversive:
People who are aversive to food due to fears of negative consequences, such as choking, vomiting, pain, nausea, etc., will avoid foods that trigger those fear-based beliefs altogether. It is not uncommon for this type of ARFID to develop after a traumatic experience, such as an incident of choking or throwing up food. It appears that the individual has a fear response that grows into overestimating the probability that they will choke or vomit again. 

A Cognitive Behavioral Treatment Approach: 

Cognitive-Behavioral Therapy for ARFID (CBT-AR) is a treatment approach often used for individuals struggling with ARFID. There are four main treatment goals used in CBT-AR:

• Achieve or maintain a healthy weight
• Correct any nutritional deficiencies
• Eat foods from each of the five basic food groups (fruit, vegetable, protein, dairy, grain)
• Feel more comfortable eating in social situations

These goals are addressed in four different stages. Individuals participating in CBT-AR will focus on:

Psychoeducation on ARFID and making early changes.

• Individuals will keep records to identify what maintains symptoms. If individuals are underweight, they will increase the volume of preferred foods and make early changes to their approach of various foods.

Treatment Planning and continuing early changes

• Individuals will work with their therapist collaboratively to set goals to address their fears while increasing the volume and variety of food consumption.  

Facing their fears and identifying maintaining factors

• Individuals will utilize exposure-based interventions to new or feared foods. They will start with small amounts and slowly work to incorporate more significant amounts. During this stage, individuals may need to chain to a goal, fade a food in, switch up how the food is consumed, or deconstruct the food. 

Relapse Prevention

• Clients will develop a personalized relapse prevention plan to utilize different skills to help prevent relapse and continue using them independently.

What treatment is not:
Trying to change personality
Making individuals eat very unusual foods
Forced eating

If you are interested in counseling for ARFID, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

American Psychiatric Association Publishing. (2022). Avoidant/Restrictive Food Intake Disorder. Diagnostic and statistical manual of mental disorders: DSM-5-TR (pp. 376–381).
Thomas, J. J., & Eddy, K. (2019). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder children, adolescents, and adults. Cambridge University Press. 

Imagine this scenario. You have to be up early the next day. You head to bed, lie down, and when your head hits the pillow, you feel wide awake. Or, you’re sleeping soundly and then suddenly you wake up, look at the clock and see that it is 3:30am. Anxiety and worries about not falling back to sleep start kicking in. Once this occurs, it can be incredibly difficult to get back to sleep. Grounding exercises can be very useful for calming anxiety and promoting sleepiness.

A grounding technique refers to a coping strategy that helps an individual refocus on the present moment. It is often used to help people who struggle with issues such as anxiety, PTSD, and panic attacks. The 5-4-3-2-1 technique is a grounding exercise in which an individual is guided to use their 5 senses to focus on the present moment. For example, a person may be asked to do the following:

Identify 5 things you can see, 4 things you can touch or feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. Or you can take one slow breath in and slowly exhale. Although this exercise seems simple enough, it usually takes practice before an individual starts noticing the benefits.

The 5-4-3-2-1 technique can also be very useful for improving sleep quality. I often work with clients to identify specific ways to calm their senses before bedtime. This strategy can also be used for someone who frequently awakens. Here are some examples of how this technique is used.

Sight- Dark rooms or rooms that have soft, warm light can promote more restful sleep. I advise clients not to look at their clock once they are in bed. It can often trigger intrusive thoughts about not sleeping.

Sound: Some people prefer complete silence when they sleep. If this is the case, I encourage them to be still and focus on the silence in the room. Others find the silence unsettling or perhaps they are bothered by noises in their environment. Using a sound machine or tuning into the sound of a fan can be helpful.

Smell: Having a calming smell such as a lavender, vanilla, or jasmine can be useful. If this smell is reserved for bed time, your brain may begin to associate that smell with sleepiness.

Touch: Research suggests that keeping your room somewhere between 60- and 72-degrees Fahrenheit promotes the most restful sleep (Goodarzi, 2021). In addition, it can be helpful to focus on the weight of your body on the mattress, how your head feels resting on the pillow, the softness of your sheets, and the heaviness of your eyelids.

Taste: Certain foods and drinks have been found to promote sleep (Breus, 2023). Large meals should be avoided before bedtime. Nuts such as almonds and walnuts contain melatonin, which is a sleep-regulating hormone. Pumpkin seeds contain zinc and magnesium and are also a source of tryptophan. Warm milk contains tryptophan which can help induce sleep (Breus, 2023). A small cup of hot tea without caffeine can help produce a warm-soothing feeling. When used as a nightly ritual, it can signal to your brain that it is time for bed.

When the 5-4-3-2-1 strategy is practiced regularly it can help your brain to start reassociating calmness and relaxation with bedtime. This is just one of many effective strategies for promoting restful sleep. If you are struggling with insomnia, reach out to us at Oakheart.

References:
Breus, M. (2023, February 10). The best foods for sleep. The sleep doctor. https://thesleepdoctor.com/nutrition/the-best-foods-for-sleep/
Goodarzi, N. (2021, September 28). This sensory grounding technique is a calming way to get ready for bed. Sleep.com. https://www.sleep.com/sleep-health/54321-grounding-technique

The 5 senses approach to a better night’s sleep. (2019, January). Threads. By Garnet Hill. https://www.garnethill.com/threadsbygarnethill/2019/01/08/the-5-senses-approach-to-a-better-nights-sleep

​If you are interested in counseling for insomnia, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

I heard once that the Chinese character for the word “change” was a combination of two other symbols: chaos and opportunity. I’m not sure if it is correct or not but in theory, it makes sense. With all the new changes going on every day, it is almost impossible to not think about how our lives have been impacted and what that means for our futures both personally and professionally. We can most certainly choose to focus on all that continues to not go in our favor…let’s face it, that’s pretty easy to do in the world today. But what would happen if we could find a way to embrace change? 

Did you know that “resistance to change” ranks as number four in a list of the most common career-limiting habits? When I read that…I immediately was reminded of how change is indeed a combination of chaos and opportunity. Those who are resistant, I feel, are only looking at one side of the equation. They are forgetting about the opportunity and focusing only on the chaos. Makes perfect sense as to why we would tend to resist change then…right?

If you think about it…change really is the only constant in life and nowhere is that more true than in our everyday lives. The pandemic alone forced us to be adaptable and learn new ways of accomplishing tasks and responsibilities on nearly a daily basis! Change is absolutely unavoidable, so resistance eventually becomes pointless. In order to be successful, we have to be willing to embrace change even when the outcome is still unknown. I don’t know about you, but for me, the unknown can be very scary. So, how do we move towards learning to understand and accept change?

Building Awareness & Recognize When You’re Resisting

For myself, a great first step is simply to recognize when change is happening and how I am reacting. If I am resistant, then I need to spend some time figuring out what’s beneath the resistance. Maybe it’s fear? Ask yourself why you are pushing back when everything around you is moving forward? It could just be that you have a lot of unanswered questions which can leave you feeling out of control. Remember…knowledge is power…seek answers!

Look for the Opportunity

Remember that change = chaos + opportunity. It’s a two-part equation. What potential exists within the change? This is exactly where your opportunity to shine lies! Embrace it!

Remove the Drama

An overnight, sudden change is much harder to handle than a gradual shift. Resist the urge to be negative and create more drama. When you see change coming your direction then be proactive. Do what you can to ease the transition, minimize the chaos, and enhance the opportunity.

Release Emotional Attachments

Do your best to let go of the feelings associated with the old way of doing things. It’s true…we find comfort in routine. Being comfortable often relates more to our emotions than to being rational. Remember that you’re endlessly adaptable and that growth almost always comes with discomfort. If you expect discomfort, like slowing down slightly before a familiar bump in the road, it won't send you flying when you hit it. Learn to simply go with the flow and see where the wave takes you!

Personally and professionally, I have experienced more change in the past several months than I ever imagined possible. I have definitely spent more time than not resisting the changes! But it always seems to come back to…where do I really want to focus my energy? How do I truly want the chaos in life to impact my everyday life? Is it chaos and unbearable or is it opportunity and just a little uncomfortable?

Sometimes, we simply need to adjust our perspective. Imagine sitting in a movie theater and watching a movie and then all of a sudden the movie stopped and all the lights went out. You may not see anything for a few seconds but gradually you start seeing the objects around you. This is because your eyes begin to accept the change and adjust to the darkness. Sometimes, it just takes time!

How do you feel about all the transitions in the world today? Chances are that if you wait for the motivation to feel better about all the changes...it’s never going to come! Especially since, motivation typically follows behavior. As we see ourselves doing things, we feel more confident that we can. So, don't just sit there, do something, but do something small…don’t overwhelm yourself. Take the big goal…obtaining a college degree, gaining financial stability, strengthening meaningful relationships, or improving physical health…and take it one moment, one step, one day at a time. Then, build up from there!

The best things in life come out of change, oftentimes, even the changes that are unwanted. We don't have to embrace change by diving into those cold choppy waters headfirst, but if we can start by just dipping our toes in, one foot at a time, before we know it, we'll be well on our way to arriving at our new destination riding on the wave!

Take care and take action!

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

A very common and natural response following any significant traumatic event and is one of the primary diagnostic criteria for posttraumatic stress disorder (PTSD) is hyperarousal, also known as hypervigilance. Biological changes in your mind and body which are initiated by a traumatic event instinctively remain alert to any additional potential threats to your wellbeing…both real or imagined. This is known as hypervigilance and can be an outcome of the anxiety experienced as part of Acute Stress Disorder or Posttraumatic Stress Disorder. The feelings of hypervigilance fluctuate and are often triggered by certain people or specific situations. Being in this constant state of heightened alert, tension, and “on guard” feeling for any hidden dangers is both stressful and exhausting to maintain over a prolonged period of time. During a time of heightened hypervigilance or when triggered, many trauma survivors experience intense bursts of energy or a drive to keep "doing something". It is not uncommon to discover that this energy is subconsciously aimed at managing the distress, anger, and pain resulting from a traumatic experience.

A few recurrent symptoms of hypervigilance may include sleeplessness, anxiety, panic attacks, and obsessive or obsessive-compulsive thoughts as well as behaviors. It is important to learn how to recognize hypervigilance, to channel that energy into constructive activities, and ultimately to find a way to peacefully rest and relax.

Understanding Hypervigilance

As mentioned earlier, hypervigilance is one of the diagnostic criteria for PTSD. Hypervigilance is watchfulness or checking one's surroundings that is over and above what is normal or reasonable. Hypervigilance takes many forms. It is what makes some of us always choose an aisle seat or one where our back is to a wall. It's what makes some of us carry defensive weapons such as guns, knives, mace or pepper spray, a police whistle or a cell phone set to 911. It makes some of us cross the street to avoid suspicious people. Some of us have alarm systems, multiple locks, window locks, high fences, guard dogs, etc. Another form of hypervigilance is studying people very carefully in an attempt to look deeply into their soul to determine exactly what they are made of. Hypervigilance is included in the cluster of symptoms referred to as "increased arousal". This cluster also includes difficulty sleeping, irritability or outbursts of anger, difficulty concentrating, and exaggerated startle response.

This increased arousal stems directly from trauma and the form it takes is shaped directly by the nature of the trauma. If one has difficulty sleeping, it may be because they are afraid to go to sleep or stay asleep for fear of an attack of some sort while unable to fight or avoid it. If irritable, it may be to warn people to keep their distance or to not behave in ways that might trigger the trauma survivor. If one finds it challenging to concentrate, it may be because they are too busy trying to monitor all inputs from possible dangers. If one startles easily, it may be because they learned to jump quickly to get out of harm's way. And if one is hypervigilant, it is probably because they saw their environment as having multiple and unpredictable dangers that warrant a state of constant alert. In fact, much of the time, our hypervigilance helps to keep us safe.

However, the "hyper" in hypervigilance suggests that one does more than is normal or reasonable. It is too much because it is an inconvenience or an encumbrance. While it is probably true that those diagnosed with PTSD are indeed safer because of all the precautions constantly taken, it is probably also true that hypervigilance gets in the way and can be an annoyance. It may be that one deprives themselves of going certain places and participating in certain events. For example, a person won't go to an event because they cannot get an aisle seat, or because they don't know what kind of people are going to be there. Sometimes, just seeing other people looking at you will automatically create thoughts of they are judging me or have the potential to be hostile toward me. Sometimes, a person will avoid eating certain foods due to a fear of being poisoned or made ill. These are just a few examples but there are actually a number of other ways in which hypervigilance can become an inconvenience.

Desired Outcome

In order to regain control following a traumatic event and decrease the intensity of hyperarousal, one will need to gain an increased understanding of the sources of their hypervigilance, acknowledge its advantages and disadvantages, accept the presence of hypervigilance in their lives, and increase their ability to manage unwanted thoughts and behaviors that are driven by their hypervigilant state.

Questions to Consider

1. When, where, and how have you been hypervigilant?
2. How have you reacted to your own hypervigilance as well as the hypervigilance of others? 
3. When do you feel that hypervigilance is a problem and when do you feel that it is a motivator? 
4. What have you done to try to manage unwanted hypervigilance? What has worked or not worked? 
5. Take notice of how you tend to respond to hypervigilance with more insight and awareness.

If you are interested in counseling for trauma or PTSD, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

So, I challenge you to start planting the garden of your life. Be in the moment and look around at what you are truly accomplishing each and every day. Then, weed it, if need be, water it, and let nature do its thing. I trust you'll have a bountiful harvest before you know it! How awesome is that?

Take notice, move into action, and live like you matter! But most importantly, keep smiling!!

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.