This article was written by Sarah IdakwoDietitian specializing in eating disorders at the Talking Dietetics Clinic.
Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new, but complex, type of eating disorder that was officially recognized in the DSM-V in 2013. Unlike traditional eating disorders , ARFID does not necessarily involve concerns about weight or body image. It is estimated that between 5 and 14% of children and adolescents suffering from an eating disorder may meet ARFID criteria.
The characteristics of ARFID
ARFID is characterized by a persistent failure to meet appropriate nutritional and/or energy needs, leading to one or more of the following:
- Substantial weight loss (or failure to achieve expected weight gain in children)*
- Significant nutritional deficiency
- Dependence on enteral feeding or oral nutritional supplements
- Marked interference with psychosocial functioning.
*It is important to note that you do not have to be underweight to meet the ARFID criteria. People with ARFID can have different body types.
The distinction between ARFID and picky eating
Any picky or avoidant eating is caused by the sensory aspects of food: how it looks, feels, smells, etc. It is important to note that picky eating, especially in young children, is quite common and is not the same as ARFID. Although many children exhibit likes and dislikes, particularly toward vegetables, this usually does not lead to serious nutritional problems. ARFID, however, involves more intense avoidance and restrictions that can lead to significant health problems.
Sensory sensitivities and food intake
Many children and adults with ARFID may have increased sensory sensitivities that affect their perception and acceptance of certain foods. These sensory responses are thought to have a genetic component and may be influenced by external factors, including anxiety levels and approaches taken by parents or caregivers to manage eating behaviors. Nonetheless, it is essential to recognize that parents are not responsible for a child’s diagnosis of ARFID, as this condition involves a complex interplay of factors beyond their control.
Identifying and Diagnosing ARFID
Due to the relatively recent recognition of ARFID, there is currently a shortage of properly trained healthcare professionals to diagnose and treat it. As a result, unfortunately, this can lead to misidentification, often confusing ARFID with extremely picky eating. Typically, pediatricians or clinical psychologists are the only healthcare professionals qualified to diagnose ARFID. However, dietitians with specific training in ARFID can play a crucial role in assessment and management, contributing to faster diagnosis and comprehensive nutritional care.
ARFID Presentation Templates
The ARFID presentation can be classified into three distinct models:
- Onset in early childhood: This tendency can appear as early as 18 months and persist into toddlers.
- Fluctuating resolution: Children may experience periods of better drinking followed by setbacks often triggered by stressful events.
- Late appearance: Some people have no early symptoms, with ARFID appearing around age 11, often in response to age-related anxiety. This late onset is more frequently reported in girls.
ARFID Assessment
Healthcare professionals use specific criteria to assess ARFID, including:
- A clearly limited range of foods accepted.
- Strong adherence to specific brands or flavors.
- Intense aversive reactions to new or specific foods.
- Sensory processing challenges that impact eating.
- Avoid social dining scenarios or places where food is present.
Professionals emphasize the importance of assessing the range of foods consumed rather than the quantity when diagnosing ARFID.
Conclusion
ARFID is a significant medical condition that requires professional intervention. Far from simply being a case of picky eating, it poses significant nutritional and psychological challenges that can profoundly affect an individual’s health and well-being. Early identification and intervention are crucial, and with the appropriate multidisciplinary support, people affected by ARFID can achieve a better quality of life and a healthier relationship with food. If you or someone you know is concerned about ARFID, seeking professional advice is a crucial step. As awareness and understanding of ARFID increases, so does the potential for success for people living with this disorder.
If you are looking for a dietitian to support you or a loved one with ARFID, you can find out about a free discovery call with one of our dietitians here.