What is Avoidant Restrictive Food Intake Disorder?

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder that is characterised by a pattern of eating that avoids certain foods or food groups entirely. Typically, a person with ARFID will be avoiding or restricting their dietary intake for many reasons including: 

• sensory-based avoidance – Someone with ARFID might be very sensitive to the taste, texture, smell, or appearance of certain types of food.  This can lead to restriction of dietary intake.  
• concern about the consequences of eating. There may have been a distressing experience with food, such as choking or vomiting, or there could be significant pain on eating e.g. abdominal pain. This can cause the individual to develop feelings of fear and anxiety around food or eating, and lead to them to avoiding certain foods or textures. As a result, some people might restrict their diet to only a few foods which feel safe. 
• Low interest in eating.  For some people, eating might not be enjoyable and can feel like a chore resulting in them struggling to eat enough. In some cases, the individual may not recognise that they are hungry in the way that others would, or they may generally have a poor appetite. They may not have the usual cues for hunger or thirst. 

A person with ARFID may have one or more of these difficulties. The restricted intake of food is also associated with one or more of the following: 

• Significant weight loss (or failure to achieve expected weight gain/ faltering growth in children). However, a person with ARFID can also present as a healthy weight or overweight. 
• Nutritional deficiency – due to insufficient amounts of food or variety in the diet 
• Dependence on feeding via a tube or on taking oral nutritional supplement drinks to maintain health 
• Interference with psychosocial functioning – a negative impact on psychological wellbeing which impacts social situations e.g. school, work, or when with friends 

In ARFID, beliefs about body image e.g. weight or shape, do not contribute to food avoidance or restriction. A person with ARFID does not restrict their diet to lose weight or change their body shape. 

Who is most susceptible? 

ARFID is most common in young people aged 4-14 years, however it can affect all ages of children and adults. There is a greater prevalence in boys and in those with Autism or ADHD. Many adolescents with ARFID may have a co-existing anxiety disorder. 

Diagnosis 

Diagnosis involves a multidisciplinary assessment. This is likely to include a Psychologist or Psychiatrist and a Dietitian. A Speech and Language Therapist or Occupational Therapist may also be involved in the assessment depending on presenting difficulties. 

Treatment / therapy options for ARFID 

Treatment for ARFID is usually best tailored to the needs of the individual, based on the nature of the difficulties the person is experiencing and what is maintaining these. For example, a person who is avoiding food due to a fear of choking may follow a slightly different style of treatment to someone who is limiting their diet due to texture/smells/taste of food. ARFID treatment will always begin with the individual and his or her treatment team setting goals surrounding eating.  

Treatment for ARFID may include: 

Graded Exposure – This involves learning positive coping skills for overcoming the fear and anxiety surrounding food. New foods are introduced into the diet using a food chaining approach which breaks down eating into accepting, smelling, touching, tasting and eating the new food.  

Cognitive Behavioural Therapy for ARFID – This treatment typically involves 4 stages. It aims to educate and support individuals to tackle fear foods, set goals and make manageable changes which can be maintained. 

Often treatment will involve work with more than one therapist. A Psychologist may use a CBT approach whilst an Occupational Therapist may use strategies to manage sensory difficulties.  

A dietitian can provide support to: 

• Assess diet for nutritional adequacy 
• Provide advice to correct any nutritional deficiencies  
• Achieve a healthy weight/growth trajectory  
• Eat a larger range of foods  
• Reduce anxiety surrounding eating 
• Be comfortable eating in front of others

Recovery 

It is possible to recover from ARFID, even if a person has been living with the illness for several years. Recovery can be challenging, however, with the right team and support, recovery is possible.