ARFID explained - Article on boostneurodiversity.com

Understanding ARFID (Avoidant/Restrictive Food Intake Disorder): Symptoms, Types, and Treatment

Following up on my last article on food avoidance, after 6 years of confusion, we finally got a proper diagnosis for our son so I thought I would write about this.

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Avoidant Restrictive Food Intake Disorder

ARFID is a set of eating disorders that is characterized by an individual’s avoidance or restriction of food intake. It was officially recognized as a mental health disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) in 2013. In the past, individuals with ARFID were often misdiagnosed with other eating disorders, such as anorexia or bulimia. It wasn’t until research and clinical studies were conducted that ARFID was recognized as its unique disorder.
One of the first known studies on ARFID was published in 2007 by Dr Jennifer Thomas, who identified a group of individuals who were picky eaters but did not meet the criteria for anorexia or bulimia. From there, the concept of ARFID began to take shape, and it was included in the DSM-5 as a stand-alone disorder.
It has become more recognized in recent years, with increased awareness and education on the disorder. It is estimated that it affects up to 5% of the population, with higher prevalence rates among children and individuals with developmental disorders.
The recognition of ARFID as a unique disorder has allowed for more accurate diagnoses and treatment options for those who struggle with it. As with any mental health disorder, early identification and intervention are important for successful treatment outcomes.

People with ARFID often have an aversion to certain textures, colours, or smells of food, which can make eating difficult and uncomfortable.
Unlike other eating disorders, ARFID is not related to body image or weight concerns. It is primarily a problem of not getting enough nutrients to maintain a healthy body weight or function.
ARFID can develop at any age, but it is most commonly seen in children and adolescents. It can have a significant impact on their physical health, growth, and development. It can also cause social isolation and mental health issues such as anxiety, depression, and obsessive-compulsive disorder.
If you or someone you know is struggling with ARFID, it is important to seek help from a qualified healthcare provider or mental health professional. Treatment for ARFID often includes a combination of therapy, nutrition counselling, and medication management. Early intervention can lead to better outcomes and improve overall quality of life.

Types

As the name suggests, individuals with ARFID have a difficult time eating a variety of foods or consuming the necessary amount of calories for growth and development.
Several types of ARFID can occur, each with its own set of symptoms and characteristics. These types include:

  1. Sensory – Linked to sensory sensitivities, such as sensitivity to the texture, taste, or smell of foods. Individuals with this type of ARFID may struggle to eat certain types of food due to their sensory perceptions.
  2. Digestive – Linked to digestive issues, such as gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), or gastroparesis. These individuals may struggle to eat certain types of foods due to discomfort or pain caused by their digestive issues.
  3. Medical – Linked to a medical condition, such as celiac disease or food allergies. These individuals may avoid certain types of foods due to an allergic reaction or adverse health effects caused by consuming these foods.
  4. Lack of interest in food – Linked to a general lack of interest in food or eating. Individuals with this type of ARFID may have no appetite or may struggle to feel hungry, leading to a restricted diet.
  5. Perceptual – Linked to distorted or irrational beliefs about food, such as a fear of choking or fear of contamination. Individuals with this type of ARFID may avoid certain types of food due to their perceived dangers or risks.
    It’s important to note that individuals with ARFID may experience symptoms from multiple types, or their symptoms may change over time. Seeking professional help is essential for proper diagnosis and treatment.

ARFID – Sensory Associated with Autism

One of the subtypes of ARFID is the sensory type, which is closely associated with autism. Sensory issues are common in individuals with autism, and they can greatly impact their eating habits. Those with sensory type ARFID have an aversion to certain textures, colours, smells, and even sounds when it comes to food. This aversion can cause anxiety, nausea, and even vomiting, making it challenging to try new foods or eat a variety of foods.
It is not uncommon for these individuals to have a restricted diet, consisting of only a few preferred foods. For example, they may only eat foods that are soft or pureed, avoiding anything with a crunchy or chewy texture. Alternatively, they may only eat foods that are beige or white, avoiding anything that is brightly coloured or has multiple colours.
Sensory-type ARFID can lead to nutritional deficiencies and impact overall health. Therefore, it is important to seek professional help from a healthcare provider or registered dietitian who has experience with this subtype. They can offer strategies to help introduce new foods and slowly expand the variety of foods consumed. They may also recommend supplements or fortified foods to ensure adequate nutrient intake.
It is important to note that sensory type ARFID is not a choice or behaviour. It is a real medical condition that requires proper understanding and treatment. With the right approach, those with sensory type ARFID can learn to manage their aversions and enjoy a varied, balanced diet.

References:

  • “Avoidant/Restrictive Food Intake Disorder: A Guide for Parents and Professionals” by Jennifer Thomas and Kamryn Eddy
  • “Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders” by Katja Rowell and Jenny McGlothlin
  • “When Your Child Has an Eating Disorder: A Step-by-Step Workbook for Parents and Other Caregivers” by Abigail H. Natenshon
  • “Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating Challenges!” by Lori Ernsperger and Tania Stegen-Hanson
  • “Treating Eating Problems of Children with Autism Spectrum Disorders and Developmental Disabilities: Interventions for Professionals and Parents” by Keith E. Williams
  • “Selective Eating Disorders in Children and Adolescents” by Nancy Zucker and Kristen Merkle
  • “The ARFID Adolescent: Strategies and Support for Avoidant/Restrictive Food Intake Disorder” by Emily K. Sandoz
  • “Understanding Eating Disorders: An Integrative Approach” by Simona Giordano
  • “Feeding and Eating Disorders in Childhood” by Bryan Lask and Rachel Bryant-Waugh

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