What is ARFRID? (Avoidant/Restrictive Food Intake Disorder)
Avoidant restrictive food intake disorder, more commonly known as ARFID, is a condition characterised by the person avoiding certain foods or types of food or a restricted intake in terms of the amount eaten, or both.
A person avoids and/or restricts their intake for varied reasons.
Some of the most common presentations are the following:
They may have had a traumatic / distressing experience with food, such as choking or vomiting, or experiencing stomach pain or upset. This can cause the person to develop feelings of fear and anxiety around eating or food and can lead to them to avoiding certain foods or textures. Some people may experience more general worries about eating that they find hard to put into words and restrict their intake to what they regard as ‘safe’ foods. Significant levels of fear or worry can lead to avoidance based on concern about the consequences of eating.
They might be very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature or will only eat ‘safe’ food from their perspective and experience.
In some cases, the person may not recognise that they are hungry in the way that others would, or they may have a poor appetite. For them, eating might seem a chore or challenge and not something that is enjoyed, resulting in them struggling to eat enough.
ARFID is sometimes described as an ‘umbrella’ term – it includes a range of different types of difficulty. Nevertheless, all people who develop ARFID share the central feature of the presence of avoidance or restriction of food intake in terms of overall amount, range of foods eaten, or both.
Other key aspects of ARFID are that it can have a negative impact on the person’s physical health and as well as on their psychological wellbeing. When a person does not take in enough energy (calories), they are likely to lose weight. Children and young people may fail to gain weight as expected and their growth may be affected, with a slowing in height increase. When a person does not have an adequate diet because they are only able to eat a narrow range of foods, they may not get essential nutrients needed for their health, development, and ability to function on a day-to-day basis. For some people, serious weight loss or nutritional deficiencies may develop, which need treatment. In people whose food intake is limited, nutritional supplements may be prescribed. In some cases, a period of tube feeding may be recommended if physical risk is judged to be high.
Being limited in terms of what they can eat often causes people to experience significant difficulties at home, at school or college, at work and when with friends. Their mood and day-to-day functioning can be negatively affected. Many people with ARFID find it difficult to go out or to go on holiday, and their eating difficulties may make social occasions difficult to manage. They may find it difficult to make new friends or establish close relationships as social eating occasions are often part of this process.
According to the DSM-5, ARFID is diagnosed when:
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
Significant nutritional deficiency.
Dependence on enteral feeding or oral nutritional supplements.
Marked interference with psychosocial functioning.
The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
The eating disturbance does not occur exclusively during anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Treatment for ARFID is usually best tailored to the needs of the individual. Most often, treatment can be delivered in an outpatient setting. Treatment commonly involves a multi-disciplinary approach such as Hypnotherapy, cognitive behavioural therapy, anxiety management and exposure. Sometimes, medication may be suggested, most often to help with anxiety. The person’s physical health should also be monitored and managed, for instance by their GP or a physician or paediatrician. Treatment may also involve nutritional management through support from a dietician and help with sensory problems.
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