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Answering Some Frequently Asked Questions About ARFID

Although there is no single cause of any eating disorder, most include distorted body image as a causative factor. Body dysmorphia is a common cause of well-known eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder. However, another less-known disorder is gaining more public knowledge, and unlike those others, it doesn’t list body image concerns as a typical cause. This disorder is known as Avoidant Restrictive Food Intake Disorder (ARFID), which was, in the past, was often referred to as Selective Eating Disorder (SED).

ARFID is one of the most recently listed eating disorder subtypes in the DSM-V and is commonly treated in eating disorder treatment centers.THE DSM (Diagnostic and Statistical Manual of Mental Disorders) is the American Psychiatric Association’s official manual for diagnosing mental health disorders, and it has gone through several editions. In the most recent edition, the fifth, ARFID was for the first time listed as its own disorder rather than being lumped in with other types in a category known as OSFED (Other Specified Feeding and Eating Disorder. A lot of parents with concerns have questions about this condition. Take a look at some of the common questions associated with ARFID, its symptoms, and its treatment.

What Are the Symptoms of ARFID?

ARFID is an eating disorder that affects children, adolescents, and adults, most commonly beginning during early adolescence. According to the DSM-V,here are the diagnostic criteria (be ready for some psychiatric jargon – don’t worry, we’ll clarify below):

  1. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
  2. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
  3. Significant nutritional deficiency.
  4. Marked interference with psychosocial functioning.
  5. The disturbance is not better explained by a lack of available food or by an associated culturally sanctioned practice.
  6. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
  7. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another mental disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

Basically, ARFID is a disorder wherein a person avoids eating certain foods or food groups to the point that it negatively affects their mental and physical health. Unlike anorexia nervosa, the individual does not avoid the foods because of a desire to lose weight, but rather out of a phobia or fear of those foods. This is often sparked by a bad experience with the food, like choking or food poisoning, often during childhood. It can be difficult for parents to tell the difference between picky eating and ARFID because of this.

The diagnostic criteria make it clearthat an ARFID diagnosis will not be made if the person is suffering from another eating disorder, especially anorexia nervosa, which has somewhat similar symptoms and carries many of the same health risks. It should also be made clear that ARFID is not a result of religious or cultural food restrictions, such as halal or kosher practices, or if the individual lives in a “food desert” and cannot get certain kinds of food.

How Common Is ARFID?

ARFID is less common than bulimia nervosa or anorexia nervosa, and being only recently added to the DSM as a standalone disorder, somewhat less well-known. Because of this, there are relatively few numbers to go by when trying to understand the prevalence of the disorder. In one study of individuals in treatment for eating disorders, about 14 percent met the diagnosing criteria for ARFID, according to the National Eating Disorder Association. The total incidence rate of all eating disorders is below 5 percent of adults, which sounds like a small number. However, in a nation of 350 million people like the United States, even a fraction of a percentage can reach millions of people.

It is suspected that ARFID is underdiagnosed because many people simply assume that their child is a picky eater. ARFOD Can have severe health consequences such as extreme weight loss, malnutrition, and disrupted growth in children. It also affects a person’s psychosocial functioning. In an advanced case, the individual will avoid certain types of food to a point that it causes them problems. However, ARFID is treatable.

Who Does ARFID Affect?

ARFID does affect both males and females, although it tends to happen more frequently in girls and women. LGBTQ individuals are also at higher risk, as with other types of eating disorders. In addition, younger children seem to be more at risk than older children, as the condition will oftentimes improve with age and maturity. About 20 percent of children with ARFID also have an autism spectrum disorder. Additionally, about 20 percent of children with ARFID avoid certain foods because of sensory issues.

Although it occurs more often in children and adolescents, adults are also susceptible to ARFID. It is known to be comorbid with mental health disorders like depression, particularly anxiety disorders and OCD. ARFID affects people of every ethnicity, geographical location, and socioeconomic status. As mentioned, a diagnosis of ARFID will not result from a person’s religious or cultural dietary choices, although treatment may be complicated by those rules of the person’s “fear food” is among those restrictions.

What Causes ARFID?

For many people with an eating disorder, the primary causes are related to body image distortions and a fear of gaining weight, or in the case of binge eating disorder, extreme hunger driven by dieting (which is also related to fear of gaining weight). However, ARFID is unlike other eating disorders because its typical triggering cause is something else entirely. Often, but not always, ARFID sufferers’ “fear foods are one that triggered a bad experience. For example, someone who choked on a piece of steak may avoid eating any meats. Sometimes the flavor or texture can progress from something unlikeable to compulsively avoided.

Some people are more at risk for developing the symptoms of ARFID. It is suspected that anxiety may be a major contributing factor to the disorder, and certain phobias also come into play. As with other eating disorders, a family history of the disorder can contribute to its development, provoking a “nature or nurture” debate among clinicians. Unlike anorexia nervosa or bulimia nervosa, media presentations of beauty or attractiveness are not usually contributing factors to the onset of ARFID.

How Is ARFID Treated?

Eating disorder treatment in general involves a combination of talk therapy, behavioral therapy, and nutritional education. Medical care is also prioritized when an individual has suffered excessive weight loss or related physical complications. Eating disorder supportfor ARFID typically involves cognitive behavioral therapy, group therapy, food and nutrition counseling, and family therapy. The recovery process is usually individually catered to the client, so every eating disorder recovery journey can be different in its specifics.

One therapeutic method used extensively in ARFID treatment is exposure therapy. This form of therapy involves gradually exposing the individual to the situation or object they fear, step by step allowing them to feel more comfortable around it. Exposure therapy is often used in treating phobias and social anxiety disorder and applies equally well to ARFID. An example of exposure therapy for a person with ARFID might be slowly introducing, for example, scallops in a taco with lots of other ingredients that hide the flavor in a person who won’t eat shellfish. Over time, they will become more acclimated to these foods and can incorporate them into a nutritionally balanced meal.

Treatment for ARFID From Rosewood

Rosewood Ranch is one of the nation’s leading eating disorder treatment centers with multiple locations in Wickenburg and Tempe, Arizona. If you or a loved one dealing with ARFID or another eating disorder, reach out to us to speak with one of our compassionate staff members about the programs we have available. ARFID recovery is possible; get started today.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.
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