This post was written by Jessica Steinbach, MPH, RD.
Avoidant Restrictive Food Intake Disorder or ARFID is a diagnosable eating disorder that was added to the DSM-5 in 2013. But what is ARFID? Let’s dig a little deeper into this eating disorder!
ARFID is commonly (not always) diagnosed earlier in life than other eating disorders as it will often develop in early childhood and present as extreme “picky eating.” ARFID must be diagnosed before diagnosis of a co-occurring eating disorder. The diagnostic order of eating disorders is present for a variety of reasons. One reason that ARFID cannot be diagnosed after the onset of anorexia nervosa is that ARFID (per the DSM-5) develops in the absence of body image issues. Though “official” diagnosis is often biased and limiting, the courses of treatment for anorexia, binge eating disorder, and other eating disorders may vary drastically from the treatment of ARFID, making it ideal to treat the disordered behaviors separately when appropriate.
How do I know if I have ARFID?
Due to the complexity of diagnosing ARFID, and the lack of education and awareness about this eating disorder, it may be difficult to decide if screening is needed. Here are some hallmarks of ARFID:
- Texture aversion aka not enjoying a specific texture (crunchy, creamy, mushy, etc.)
- Crying, gagging, or choking during meal times beyond what is typically expected for children or if this continues into adulthood
- Desire to eat the same foods for every meal
- Very low dietary variety
- Fear of reaction to specific foods (ex: fear of vomiting after eating something specific)
- Only eating specific brands of food or foods of specific colors
These food behaviors are often present without distress related to body image, need for control, or other distinguishing features of anorexia nervosa (this is not always the case if the two EDs are co-occurring).
How is ARFID treated?
The course of treatment for ARFID is dependent on a variety of factors and like all forms of treatment, is very individualized. Some common treatment techniques are:
Food exposures with a registered dietitian or therapist who specializes in ARFID are very useful in introducing foods in a safe environment. Early in the food exposure process, it is important to go slow. This can start with looking at the food, picking it up, smelling or licking it before moving towards taking a bite of the food. Going slow and setting the expectation that this may be a slow process is very important for minimizing anxiety and potential harm.
Disguising or linking food
After trying the “challenge” food and feeling comfortable moving forward in the introduction process, disguising the food or linking it with a “safe” food can be effective tools. This may look like eating carrots blended into pasta sauce or eating a blueberry muffin rather than blueberries on their own. Autonomy and pacing are very important during the ARFID treatment process. You can develop a personalized treatment process with your registered dietitian.
Creating a calming environment
ARFID is often accompanied by sensory process issues. Creating an eating environment that reduces overstimulation may help with making mealtimes less overwhelming! Consider dimming the lights, wearing noise canceling headphones, buying plates/utensils that are a calming color, wrapping yourself in a blanket, etc.
Understanding your limits
Sometimes with ARFID you will never tolerate a certain food, texture, taste, smell, etc. and that is OK! If your dietary variety is significantly limited and introducing new foods is not an option, working with healthcare professionals to add supplements to address where deficiencies may be present is very important. Consider seeking support from physicians, dietitians, and other healthcare professionals who have an in-depth understanding of ARFID.
ARFID, like all eating disorders, can be complex and challenging to navigate on your own. Eating disorder treatment should always be highly individualized and move at a pace that feels safe and comfortable for you. If you are struggling with ARFID, and feel that you may need more support, reach out to work with Jessica!
Additionally, here are some other providers who also specialize in ARFID and do great work in the field: