ARFID in Adulthood
Avoidant-Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder that was relatively recently added to the DSM (Diagnostic and Statistical Manual for Mental Disorders). While it has only been acknowledged for a little over a decade, ARFID has been around for much longer.
What is ARFID?
ARFID is a pattern of eating that limits the variety and/or quantity of food eaten to the extent that it greatly impacts one’s health and/or psychosocial functioning. There are three main subtypes of ARFID:
-Fear of Adverse Consequences: Typically, this occurs when there has been a traumatic event while eating, such as choking, vomiting, or having a severe allergic reaction. Food may then be limited out of an abundance of caution to avoid another frightening or uncomfortable experience.
-Sensory Sensitivities: With this subtype, an individual may limit food based on difficulty or aversion to texture, taste, smell, etc.
-Lack of Interest: Folks in this category tend to have limited hunger cues or have less enjoyment out of the eating process—to the extent where their health is greatly impacted.
Those with ARFID can have one or more subtypes present and experience one or more of the following:
-Weight loss or falling out of a growth curve
-Nutrient deficiencies
-Dependence on supplements for nutrition
-Distress around social situations in which safe or preferred foods are not available
- Overwhelm, anxiety, disgust, or terror at mealtimes
Body image is not a driving factor for ARFID; however, those who are struggling with ARFID may still experience distress or discomfort regarding the size or shape of their body.
It is important to note that most people, at some point in their lives, experience sensory sensitivities, adverse experiences, or disinterest when it comes to food and eating. Kids are often a common group of people in this category, as almost any parent will have stories to share about their kid’s picky eating.
However, this is much more than picky eating and it is not limited to young children. ARFID is a serious eating disorder that needs specialized and compassionate treatment by a team of professionals to address medical, nutritional, and psychological components.
How is ARFID treated?
The predominant treatment for ARFID is a form of Cognitive Behavioral Therapy called CBT-AR. CBT-AR is a strategic approach to providing psychoeducation, exposure work, family support, and relapse prevention strategies to increase food flexibility and overall wellbeing. When getting treatment for ARFID, it may be appropriate to meet with the following treatment providers:
-Therapist to help with exposure work and the psychological components that maintain the food avoidance
-Registered Dietitian to help with exposure work and address nutritional needs
-Primary Care Physician to monitor vitals and lab work and address health concerns
-Psychiatrist to address medication management if needed
-Occupational Therapist or Speech Language Pathologist to address feeding difficulties such as swallowing, if needed
Considerations and Limitations: Frustrations of an ED Therapist
Because focus on treating ARFID has barely spanned a decade, there are quite a few things that need to be changed to improve quality of care. While this is not an exhaustive list, it’s a start.
1. Most ARFID treatment has centered around children, and like I mentioned earlier, ARFID can affect people of all ages. This comes as a considerable disadvantage to adults struggling, as they not only feel under-represented in literature and treatment, but CBT-AR tends to focus on family support, which will inevitably look different for an adult.
2. Treatment for ARFID has not always been trauma-informed or neuro-affirming, but it absolutely needs to be. I firmly believe that when we create safety with our clients, consider how they want life to look like (rather than what someone else thinks it should look like), and integrate flexibility in exposure work, we are providing both compassionate and effective care.
3. Treatment for ARFID often ignores body image concerns. I’ve heard some clients tell me that their previous provider told them they must not have ARFID because they have body image issues. We live in a society where hating our bodies is normalized and beauty ideals are unattainable. Most people will struggle with body image in their lifetime. However, the key difference with ARFID is that the body image issues do not lead to restriction of food intake.
4. There is still such limited research on ARFID and effective treatment. My hope is that in the very near future, we continue to see shifts in the way we compassionately and skillfully show up for those struggling with ARFID.
If you or someone you know may be struggling with ARFID, I encourage you to reach out and schedule a free 15 minute consult call today.