What Is ARFID (Avoidant / Restrictive Food Intake Disorder)?

Were you a picky eater as a child? Many people, especially children, have food preferences. For example, maybe you never got over your hatred for broccoli. However, ARFID, or avoidant restrictive food intake disorder, is when picky eating becomes severe and harmful. People who have ARFID don’t eat enough, to the point where it causes severe weight loss and serious health complications.

ARFID shares some similarities with another eating disorder, anorexia nervosa. But unlike people with anorexia, people with ARFID aren’t avoiding food because of body image issues. They have other reasons for not wanting to eat, including a fear of vomiting or simply not liking the experience of eating.

ARFID is a serious disease, and can cause severe health consequences if left untreated. But there are effective treatments that are helpful for people with ARFID. If you or your child have ARFID, there is hope for recovery.

What Are the Symptoms of ARFID (Avoidant/Restrictive Food Intake Disorder)?

ARFID is a new diagnosis that’s only been officially recognized since the last edition of the Diagnostic Statistical Manual, or DSM-V. Because of this, we still don’t know much about its causes or treatment, but experts have narrowed down its symptoms.

Diagnostic criteria of ARFID

According to the DSM-V, you must have the following symptoms to meet the criteria for a diagnosis of ARFID:

• A problem with eating that leads to an inability to take in enough food that’s necessary for nutrients or energy
• Lack of interest in or avoidance of food because of:
  • The smell, taste, appearance, or texture of food
  • Worries or fears about the possible consequences of eating, like vomiting or choking
• One or more of the following symptoms:
  • Significant weight loss (for children, this might mean not meeting weight and/or growth milestones)
  • Deficiency in important nutrients
  • Dependence on a feeding tube or nutritional supplements to get enough nutrients or calories
  • Problems with psychosocial functioning, like interfering with relationships
• The avoidance isn’t because of a lack of food or cultural practices like fasting
• The avoidance isn’t due to another eating disorder like anorexia or bulimia; there is no change to body image and the person doesn’t have any concerns about body shape/size
• The avoidance isn’t better explained by another mental health disorder

ARFID differs from most other eating disorders, like anorexia or bulimia, in an important way. People with other eating disorders tend to restrict or change their eating because of their body image. The disorder causes them to be unhappy with their body size, and their eating disorder is tied to their body image.

People with ARFID have no concerns about body image. For them, the need to avoid or restrict food is because of completely different reasons.

Other signs and symptoms of ARFID

Because ARFID leads to significant weight loss, it shares some physical warning signs with anorexia. On top of weight loss (or lack of growth for children), some of the other physical signs of ARFID include:

• Not having an appetite (or saying you don’t have an appetite) for no known reason
• Always feeling cold
• Problems with menstruation (like skipping periods)
• Abnormal bloodwork results (like anemia or low hormone levels)
• Dizziness and fainting
• Stomach cramps that can’t be explained by any other reason
• Dry skin and brittle nails
• Hair loss
• Muscle weakness
• Slow wound healing
• Damaged immune system
• Problems with sleeping
• Cold and/or swollen feet

These physical signs and symptoms happen because people with ARFID aren’t getting the caloric or nutritional intake they need. In other words, they aren’t eating enough, and this can severely damage their health.

Other behavioral signs that someone has ARFID include:

• Dressing in layers or wearing clothing that’s too large, either to hide weight loss or to keep warm
• Only eating foods of certain textures (like only eating soft foods and refusing to eat anything crunchy)
• Picky eating that gets worse and worse (fewer and fewer foods are “acceptable”)
• Difficulty concentrating
• Suddenly refusing to eat foods that they used to eat
• Having an intense fear of vomiting or choking
• Needing to prepare their foods in a very specific way
• Eating very slowly

Causes and Risk Factors of ARFID

Like other eating disorders, ARFID doesn’t have one known cause. Anyone can get ARFID, but researchers have found factors that may put certain people at a higher risk. However, because ARFID is such a new diagnosis, we don’t yet have all the information we need to be able to say for sure what increases the risk of ARFID.

Here’s what researchers think, so far, may contribute to ARFID:

Developmental disorders

The rate of ARFID is higher in people with developmental and/or intellectual disabilities than people without them. ^[1] Children with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder have higher rates of ARFID. Some studies have found that around 20% of children with autism spectrum disorder also have ARFID. ^[2] This may be because children with these disabilities are more likely to have sensory sensitivities. They may avoid foods that have certain textures or tastes.

Family history

People who have family members with eating disorders are more likely to develop one themselves. There may be a genetic component to this. It’s also possible that a person develops ARFID after observing a family member’s eating habits as a child. Parental pressure to eat is associated with picky eating, which might later develop into ARFID (although we need more research to say for sure).

Age

Although ARFID can and does occur in adults, it seems to be more common in children based on available information. If you were a severely picky eater or had ARFID as a child, you may be at higher risk of having ARFID as an adult.

Life events

Sometimes, people develop ARFID because of a triggering event. For example, if you’ve experienced the traumatic event of dangerously choking, then you might develop ARFID from that.

Other psychological and physical conditions

People with ARFID tend to have higher rates of co-occurring anxiety disorders or obsessive-compulsive disorder. Up to 50% of children with ARFID also have an anxiety disorder. ^[3] Some people with ARFID also have other physical conditions, like gastroesophageal reflux disease (GERD), that may be related to ARFID.

Health Risks and Consequences of ARFID

ARFID is much more serious than being a picky eater. It is a serious mental health condition, and when it’s left untreated, it can become severe and cause serious health problems. These consequences can eventually lead to death.

Here are some of the most common health consequences and medical complications of ARFID.

Malnutrition

People with ARFID don’t eat enough to get the nutrients that they need. Some become dependent on nutritional supplements or tube feeding. Others may start suffering from malnutrition, especially if they don’t get treatment. Children and adults with ARFID can have deficiencies in important vitamins and nutrients like vitamins A, C, and D. Malnutrition is dangerous, especially in children.

Low heart rate

ARFID can cause bradycardia, or when someone’s heart rate becomes dangerously slow. Bradycardia can cause other symptoms like dizziness, fainting, and heart failure. ARFID is less likely than anorexia to cause bradycardia.

Bone weakness and/or osteoporosis

Low bone porosity (which causes weak, brittle bones) and osteoporosis are common health complications with any eating disorder that causes weight loss, including ARFID. This may be due to deficiencies in certain minerals like calcium and vitamin D. Osteoporosis is a particularly dangerous health consequence of ARFID because it can last for years after the weight has been gained back.

Poor relationships

ARFID can severely harm interpersonal relationships. This disorder can make mealtimes a stressful event, both for the person living with ARFID as well as the people around them. This is especially true when the person with ARFID is a child; the parents may become frustrated with the refusal to eat. But adults with ARFID can have difficult relationships too; their avoidance of certain foods can strain social situations.

Stunted growth for children

Children, especially, need nutrients and caloric energy to grow and thrive. Children with ARFID often don’t meet their milestones or fail to gain enough weight. This can interfere with their overall growth and development.

Stomach problems

People with ARFID often present with gastrointestinal problems like stomach pain. In one study, 33 out of 2231 children referred to several different gastroenterology clinics (for gastrointestinal complaints) were diagnosed with ARFID. Severe weight loss that can come along with ARFID can lead to health conditions like gastroparesis and diarrhea.

Iron deficiency

When you don’t eat a complete diet, your body doesn’t get the nutrients it needs. One common complication of ARFID is iron deficiency or anemia. Untreated anemia can lead to an irregular heart rhythm and even heart failure. ^[4]

Electrolyte imbalances

Electrolyte imbalances may be one of the most dangerous complications of ARFID, because they can cause death without warning. An electrolyte imbalance can lead to symptoms like fatigue, confusion, and dizziness. When the imbalance is severe, it can lead to coma, seizures, and even death. Some research has suggested that electrolyte imbalances are even more common in ARFID than they are in anorexia. ^[5]

Along with these health consequences, ARFID also appears together with many other psychiatric disorders (called comorbidities). It’s impossible to say, at this point, whether ARFID causes these disorders or if these disorders increase your risk of ARFID.

Some of the most common comorbidities with ARFID include:

• Autism spectrum disorder
• Anxiety disorders
• Obsessive-compulsive disorder
• Attention-deficit hyperactivity disorder
• Conduct disorders
• Trauma-related disorders
• Other neurodevelopmental disorders

Treatment for ARFID

ARFID is a unique eating disorder that may become severe and even deadly if left untreated. There is effective treatment available for both children and adults with ARFID. It’s important to connect to treatment as soon as possible if you notice signs of ARFID to prevent serious health complications.

Early intervention is important in the treatment of ARFID, but this disorder goes undiagnosed in many young children. You may have developed symptoms of ARFID as an adult, or you simply might not have gotten the treatment you needed as a child.

Since ARFID is such a newly recognized condition, there still isn’t much research on what treatments are the most effective. There are no evidence-based treatments available yet for ARFID. That doesn’t mean recovery from ARFID isn’t possible; it just means the diagnosis is so new that researchers haven’t yet conducted any randomized controlled trials to be able to say for sure which treatments work best for ARFID.

But there are many promising treatments out there. There is a lot of research that’s been done on the treatment of anorexia, and since ARFID and anorexia share many symptoms, it’s possible that evidence-based treatments for anorexia may also be effective for ARFID.

Some of the most promising treatments so far for ARFID include:

Hospitalization

If ARFID symptoms are severe, hospitalization might be required. If you’re suffering from serious health complications like malnutrition, severe weight loss, or electrolyte imbalance due to ARFID, it’s critical that you receive medical care right away.

Hospitalization might not be a long-term treatment solution for ARFID. Even if medical complications get treated, if you return to avoiding food as soon as you’re home, you’re likely to end up back in the hospital.

But making sure that your ARFID symptoms don’t cause any serious health complications is often the priority. For example, if you’re malnourished, you may need to receive calories and nutrients through a tube so that your body can continue to function. This is often the first step of treatment for severe cases because behavioral treatments may require that you are medically stable.

Residential treatment

In some cases, residential treatment may be beneficial after, or in place of, hospitalization. Residential treatment centers for eating disorders like ARFID can offer you a place where you’re surrounded by professional and peer support as you recover. It can be difficult to make the necessary behavior changes to recover from ARFID (like eating even when you don’t want to), and residential treatment can give you the extra support you may need.

The Center • A Place for HOPE’s treatment center for eating disorders (including ARFID) is located in the town of Edmonds, with a beautiful view of the Puget Sound and only 20 minutes away from downtown Seattle. Each resident lives in their own condominium-style apartment with private patios and full kitchens. Our residential treatment center offers you a serene place to find recovery from ARFID.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy, or CBT, is a type of psychotherapy that is very effective for other eating disorders like anorexia. Treatment providers have used it successfully for ARFID. There is a specific type of CBT that was specifically designed for ARFID treatment, called CBT-AR, that is especially promising.

CBT-AR is based on the idea that some people have a biological predisposition to having food sensitivities. These may be sensory sensitivities (like not liking certain textures or tastes) or anxiety and fear around food. CBT-AR helps people challenge these sensitivities by working to reduce negative thoughts, feelings, and irrational predictions about eating.

For example, someone who has a fear of vomiting may have the thought, “If I eat this piece of bread, I will choke on it and throw up.”

CBT-AR can help that person to notice and change that thought. The goal of treatment for ARFID is to reduce anxiety, and restore joy, in the experience of eating.

Its creators say that this treatment is appropriate for anyone with ARFID over the age of 10 who is medically stable. CBT-AR can be delivered in both inpatient and outpatient settings.

Medications

There hasn’t been much research done on the benefits of medications for ARFID. Some smaller studies have found that certain medications may be helpful for weight gain for people who have lost significant weight due to ARFID.

Family-based treatment

For children and adolescents with ARFID, family-based treatment or parent training may be helpful and even necessary. Parents need to be responsible for feeding, especially with younger children. It’s important that parents are trained in what, and how, to feed their children with ARFID.

Get Help for Avoidant/Restrictive Food Intake Disorder (ARFID) at The Center • A Place of HOPE

If you’re ready to start healing from ARFID and find joy in food again, our team at The Center • A Place of HOPE is waiting to hear from you. We have over three decades of experience helping people like you recover from disordered eating, and our team truly cares about helping you heal your relationship with food. Our residential treatment program for eating disorders accepts many different insurance plans, and financing is also available.

There are specialized programs for women, men, and teens at our program. All of our programs are whole-person based, which means that we see you as a complete human being, not just an eating disorder patient.

To learn more about our admissions process and how you can start your treatment journey with us, get in touch with us today.

[1] https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid
[2] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8221394/
[3] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6281436/#R5
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569049/
[5] https://www.acute.org/avoidantrestrictive-food-intake-disorder-arfid-its-medical-complications-and-their-treatment