Understanding Avoidant Restrictive Food Disorder
Understanding Avoidant/restrictive food intake disorder (ARFID) may not be a new problem, but it is the newest form of disordered eating to be recognized by healthcare professionals first acknowledged in 2013. Previously defined as a disorder exclusive to children and adolescents, the diagnostic criteria recently broadened the disorder to include adults who limit their eating and are affected by related physiological or psychological problems, but who do not fall under the definition of another eating disorder. ARFID is quite different from other eating disorders because weight and body shape are of little concern to these children and adolescents. More often than not patients who present at Massachusetts General Hospital (MGH) for ARFID are seeking to gain weight. However, ARFID may be a risk factor for later-onset eating disorders. Currently, little is known about effective treatments and interventions and the course of illness for individuals who develop ARFID.
For many parents, the hope is that their picky eater will just “grow out of it.” Fortunately, eating disorder treatment facilities, such as Behavioral Nutrition, have increased their awareness and resources to assist families in obtaining support and new methods of treatment (therapy and nutritional counseling) for ARFID. The range of severity can include some individuals with ARFID being so restrictive that the foods they are willing to eat fit on a single index card, while others may suddenly refuse to eat anything solid.
Individuals who meet the criteria for ARFID have developed some type of problem with eating (or for very young children, a problem with feeding). As a result of the eating problem, the person is not able to eat enough to get adequate calories or nutrition through their diet. There are many types of eating problems such as difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite, or being afraid to eat after a frightening episode of choking or vomiting.
Because the person with ARFID is likely not receiving adequate nutrition through their diet, they may end up losing weight. Or, younger kids with ARFID might not lose weight, but rather may not gain weight or grow as expected. This type of eating disorder can also significantly impair children and adolescents ability to socialize, mood and academic performance. Furthermore, ARIFD can have detrimental effects on school or work because of their food and eating rules/ limitations, which can cause them to avoid sharing meal-time during school or work lunches, not getting school-work done because of the time it takes to eat or even avoiding seeing friends or family at social events where food is present.
ARFID patients might benefit from nutritional supplements, such as Ensure, Pediasure or even require tube feeding, to receive adequate nutrition and calories.
MGH’s research team is trying to figure out what exactly triggers ARFID and better ways to treat it, focusing on three different, biological causes:
- Some kids are hypersensitive to taste, texture, and smell. For example, some foods — especially vegetables — can taste unusually bitter.
- Others describe a traumatic experience, like choking. These kids can become anxious about eating solid foods and avoid them.
- Some kids simply have a chronic lack of interest in food. They lose weight because they fail to eat.
- ARFID affects about 1.5% of adolescents, which is nearly the same as the 1.7% diagnosed with anorexia and twice that of the 0.8% dealing with bulimia.
- ARFID also appears to be more common in boys than girls.
Many children develop idiosyncratic patterns of food intake, sometimes referred to as picky eaters, or refusing to eat certain foods (i.e. vegetables, anything of a different color than white), but have no obvious clinical significance and therefore never receive the beneficial intervention. Therefore, a clear distinction must be made between these behaviors and clinically significant symptoms that could otherwise go un-identified or untreated. As ARFID is still a relatively new diagnostic category, there is little data available on its development, disease course, or prognosis. We do know that symptoms typically present in infancy or childhood, but they may also present or persist into adulthood. It is possible that some individuals with ARFID may go on to develop another eating disorder, therefore, seeking professional treatment is imperative. With research initiatives as well as the creation of a more inclusive diagnostic category for ARFID, those who suffer from this disorder can now receive care through specialized modalities, which can be especially powerful in deterring the development of a potentially life-threatening eating disorder.