ARFID, What Is It and How Do You Address It?
Written by Elizabeth Grzan, MSW, LSW
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:
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:
These goals are addressed in four different stages. Individuals participating in CBT-AR will focus on:
Psychoeducation on ARFID and making early changes.
What treatment is not:
Trying to change personality
Making individuals eat very unusual foods
If you are interested in counseling for ARFID, call OakHeart at 630-570-0050 or 779-201-6440 or email us at Contact.OH@OakHeartCenter.com. 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.
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.