What is Avoidant Restrictive Food Intake Disorder?

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder similar to anorexia in the sense that food intake is restricted and there is a general resistance to eating that results in significant nutritional deficiencies and extreme weight loss. Both conditions also affect your psychological and social well-being as well as your physical health.

The signs and symptoms of ARFID include extremely selective eating habits, limited food choices, eating only very small portions, difficulty chewing, swallowing and digesting certain foods. Children and adults with ARFID sometimes show a general disinterest in food and often need dietary supplements and sometimes external tube feeding to avoid nutrient deficiencies and maintain a normal weight.

ARFID affects mostly infants and young children but sometimes continues into (or even first shows up in) adulthood. Early studies suggest that up to 5% of children suffer from ARFID and the condition is thought to be as common as anorexia and bulimia. Unlike other eating disorders, ARFID is more likely to affect boys than girls. While those with ARFID are likely to have a coexisting anxiety disorder, they are less likely than those with other eating disorders to be depressed.

How is ARFID Different from Anorexia?

Unlike those with anorexia, who avoid many foods because of an excessive and obsessive fear of body fat and weight gain, those with ARFID avoid many foods because they fear choking or vomiting or they are disturbed by qualities such as the textures, smells or colors of certain foods. Children and adults with ARFID don’t worry about their body size or shape. ARFID is more like an extreme case of picky eating, and those who are affected generally have little appetite, are afraid to try new foods, and show great anxiety over the possibility of getting sick or dying from food poisoning or choking.

While the motivation for avoiding food may be different, the symptoms and health concerns of ARFID and anorexia are similar. However, since ARFID has only been recognized as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) since 2013, not a lot is known about its root causes or the appropriate treatment of symptoms. Very few studies of ARFID have been performed with children and adolescents, and even fewer with adults.

What Causes ARFID?

The exact cause of ARFID is unknown but, as is the case for all eating disorders, a variety of biological, neurological, genetic, environmental, and sociocultural factors are likely to be involved. The condition is more likely to affect children with a history of extreme picky eating or who don’t grow out of a stage of normal picky eating. Early trauma, including traumatic experiences with food, such as an episode of choking, can play a role. Those with attention-deficit issues, on the autism spectrum or with anxiety disorders or intellectual disabilities are also at higher than normal risk of developing ARFID.

How ARFID Effects Health and Well-Being

Toddlers and children with ARFID, who often display extreme picky eating habits from very early childhood, may have trouble transitioning from individual foods to mixed foods and often refuse to try new foods, limiting both their calorie and nutrient intake.

Malnutrition and gastrointestinal problems are common, as are developmental delays and stunted growth in children and weight loss in adults. Younger children may not lose weight, but they also do not gain the weight they need to grow and thrive. Lower than normal body weight for height puts children at risk for further medical problems.

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The health effects of ARFID, which are also signs of the condition, are similar to those of anorexia, and include sleeping problems, thinning hair, dry skin, muscle weakness, dizziness, feeling cold, menstrual irregularities in females, poor wound healing, slowed heart rate, anemia, and impaired immunity. Severe cases could lead to electrolyte imbalances and heart attack.

Where to Get Help and What to Expect

Although it is a serious and long-lasting condition, ARFID can be difficult to diagnose. Since very young children are often affected by the unique symptoms of ARFID, treatment generally begins with specialized pediatric care and family-based therapy to help ensure proper care. Without treatment, ARFID is likely to continue into adulthood. It is best to start with your primary care physician or your child’s pediatrician, who can provide referrals to both mental and physical health specialists as necessary.

Much more research and understanding of ARFID is necessary to provide guidance on the most appropriate and successful form of treatment. Although evidence is limited, cognitive behavioral therapy (CBT), which has been used to successfully treat other eating disorders, has been suggested as a potential treatment. CBT with children may take a slightly different form than with adults, incorporating various forms of play to deal with emotional issues and teaching skills to help the family manage their child’s condition. Individual case study reports indicate that other therapies used generally to treat eating disorders, such as family-based therapies, hospitalized re-feeding that may include tube feeding in severe cases and, in some cases, medication, all need further study but may be considered in treating ARFID in children and adults.

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Last Updated: Sep 4, 2019