Avoidant Restrictive Food Intake Disorder (ARFID)

By Enise Kaya Urcan, MPharm, MS Candidate in Human Nutrition  

Avoidant/restrictive food intake disorder (ARFID) is an eating disturbance resulting in a persistent failure to meet appropriate nutritional and energy needs or both. ARFID is a selective eating disorder with similarities to anorexia regarding the limitations in the amount and/or types of food consumed. However, unlike anorexia, people with ARFID are not concerned with body image (NEDA, 2021). ARFID may develop during childhood and continue into adulthood (Thomas et al., 2017). Due to similarity with the symptoms, it may be confused with picky eating. One way to differentiate them is that picky eating usually resolves in time, exposing the same food with a positive attitude and eating together as a family (Zucker & Hughes, 2020). However, with ARFID, the symptoms progress, and individuals may experience weight loss, malnutrition, developmental and behavioral issues (Norris et al., 2016).  

The Signs and Symptoms of ARFID  

The symptoms can be explained in two categories: behavioral/psychological and physical (Brigham et al., 2018).  

Behavioral and psychological symptoms may include:  

• Fears of choking or vomiting 
• Sensory sensitivity 
• Lack of interest in food 
• Prefers to eat only certain textures and limited food- children with extreme picky eating are more likely to develop ARFID.

Physical signs may include:  

• Significant weight loss 
• Abnormal laboratory findings (anemia, low hormone, and nutrient levels, slow heart rate) 
• Lack of menstrual period in women 
• Dry and brittle nails and hair 
• Muscle weakness 
• Frequent constipation and abdominal pain 
• Cold, mottled hands and feet or swelling of feet 
• Poor wound healing

ARFID was previously known as selective eating disorder (SED), and it was recently introduced in the diagnostic and statistical manual of mental disorders (DSM–5). Some of the causes of ARFID are genetic susceptibility, environmental influences such as observing restrictive behavior in the family or friends, sociocultural factors such as food beliefs, and cultural pressures to eat pure and healthy food (Feillet et al., 2019).  

How is ARFID treated?  

Eating Recovery Centers are the best places to seek treatment for ARFID. These facilities have a multidisciplinary approach where therapists, dietitians, psychologists work together. The nutrition case process contains four main steps: nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation.   

Please refer to the National Eating Disorder website for more information about AFRID.

References:

1. Brigham, K., Manzo, L., Eddy, K., & Thomas, J. (2018). Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. Current Pediatrics Reports, 6(2), 107-113. doi: 10.1007/s40124-018-0162-y
2. Feillet, F., Bocquet, A., Briend, A., Chouraqui, J., Darmaun, D., & Frelut, M. et al. (2019). Nutritional risks of ARFID (avoidant restrictive food intake disorders) and related behavior. Archives De Pédiatrie, 26(7), 437-441. https://doi.org/10.1016/j.arcped.2019.08.005
3. International OCD Foundation | The Relationship Between Eating Disorders and OCD Part of the Spectrum. International OCD Foundation. (2021). Retrieved 23 November 2021, from https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/.
4. NEDA. (2018, February 22). Avoidant restrictive food intake disorder (ARFID). National Eating Disorders Association. Retrieved November 23, 2021, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid.
5. Norris, M., Spettigue, W., & Katzman, D. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease And Treatment, 213. https://doi.org/10.2147/ndt.s82538
6. Thomas, J., Lawson, E., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. (2017). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports, 19(8). https://doi.org/10.1007/s11920-017-0795-5
7. Zucker, N., & Hughes, S. (2020). The Persistence of Picky Eating: Opportunities to Improve Our Strategies and Messaging. Pediatrics, 145(6), e20200893. https://doi.org/10.1542/peds.2020-0893

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