What is Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder

Overview

ARFID is an eating or feeding disorder characterised by a persistent and disturbed pattern of eating that leads to a failure to meet nutritional/energy needs (DSM-5). The main diagnostic feature of ARFID is avoidance or restriction of food that results in one or more of the following consequences:

• significant weight loss
• significant nutritional deficiency
• dependency on enteral feeding or oral
  supplements
• marked interference with psychosocial functioning

Individuals with ARFID restrict or avoid food intake due to one or more of the following:

• sensory characteristics of food:
  concerns about the texture, taste,
  appearance or smell of food
• aversive consequences of eating:
  concern of choking, gagging or
  vomiting
• lack of interest or low appetite for
  food or eating

It is the presence of one, or more, of these above factors that make the individual find food and eating unsafe, fearful or distressing, resulting in food restriction or avoidance.

ARFID is different to Anorexia and Bulimia Nervosa as individuals with ARFID do not typically fear weight gain or worry about how they look, although they often worry about being too thin or being underweight and unhealthy in their appearance.

What are the signs of ARFID?

• Sensory sensitivity to certain aspects of foods
• Lack of interest in eating or food
• Fear of consequences associated with eating or food
• Limited accepted foods
• Limited variety of accepted foods
• Avoidance of food following a negative feeding experience
• Unwilling or distressed trying new foods
• Lack of appetite and difficulty identifying hunger and satiety cues
• Periods of only eating one food or food group for extended periods of time, followed by refusal to eat
• Avoidance/ distress at social activities involving food and eating
• History of medical conditions impacting feeding experience, appetite, growth and enjoyment of food/eating
• Feeling prematurely full while eating

What are the causes of ARFID?

Most commonly, ARFID develops in infancy and early childhood and can persist into adulthood. However, ARFID may develop after an aversive traumatic eating experience at any point across the lifespan, without any early childhood history of avoidance or retraction of food.

There is not one cause of ARFID, and it can be unclear as to why some people develop ARFID. It does appear that a combination of temperamental, environmental, medical and biological factors contributes to the development of ARFID, with all individual cases having a unique combination of factors.

People with ARFID often also have anxiety. People with Autism Spectrum Disorder (ASD) and Attention Deficit /Hyperactive Disorder (ADHD) are more likely to develop ARFID.

How is ARFID treated?

At present there is no one standardised evidence-based treatment for ARFID.

Emerging research indicates preliminary findings for a positive outcome applying Cognitive Behavioural Therapy - ARFID (CBT-AR) and Family Based Therapy (FBT) - Unified Protocols or modified FBT.

Treatment components of these treatments include:

• parental supervision to ensure weight restoration
• correction of nutritional deficiencies
• reducing mealtime stress and anxiety
• exposure techniques to increase variety of foods

Treatment should target the factors that maintain ARFID and a treating team including a combination of medical, dietetics, speech pathology and psychology may be helpful to address and manage both the physical health and psychosocial aspects of the condition.

Where do I go if I have concerns?

General Practitioners (GP's) are often the first contact for those experiencing ARFID symptoms. The GP will begin the collection of information about symptoms, including arranging blood tests if needed and providing medical monitoring of symptoms.

The GP may then refer to a Psychologist for diagnosis and psychotherapeutic treatment, a Dietitian for a nutritional assessment, a Speech Pathologist for a swallow or feeding safety assessment, and/or an Occupational Therapist for a sensory assessment. The information gathered from these assessments will guide the treatment and formation of the treating team.