Although many eating disorders are relatively well-known outside the medical and psychiatric community, such as anorexia nervosa, bulimia nervosa, and binge eating disorder, there is one form of eating disorder that’s still relatively unknown: ARFID. Avoidant Restrictive Food Intake Disorder (ARFID), which is sometimes also referred to as Selective Eating Disorder (SED), is one of the most recently listed forms of eating disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorder 5), the official list of mental health disorders.
People with ARFID avoid certain types of food to an extreme level. The specific types they won’t eat differ from person to person. Everyone has particular tastes and food they don’t like; what differentiates ARFID from disliking a certain food or food group is the distress it causes the person when that food is present. They might gag or choke on the food, find it impossible to put in in their mouth, or experience anxiety or panic attacks when the food is presented to them.
ARFID or SED is still to this day often confused with “picky eating,” and while there are some similarities, ARFID is a potentially dangerous mental health disorder that can have strong negative effects on a person’s health and lifestyle. The person may lose significant weight, especially if their food phobia is a staple food group. ARFID can also cause social anxiety and stress that can interfere with a person’s social life and relationships. For children, who do experience ARFID, this can make school lunches and snack times terrifying experiences.
Because so few people are familiar with this disorder, we’ve put together some frequently asked questions about ARFID. If you’re concerned that someone you love, or yourself, might be showing the signs and symptoms of ARFID, check out these tidbits of information:
How Common Is ARFID?
ARFID is aless studied disorder than bulimia nervosa or anorexia nervosa, so there are relatively few statistics to reference when trying to understand the prevalence of the disorder. In one study of patients attending an eating disorder recovery center, about 14 percent of them met the diagnosing criteria for ARFID, according to the National Eating Disorder Association. This translates to less than one percent of the total population. Although that sounds like a small number, one percent of Americans is millions of people.
Partially because ARFID is not as well-known as other types of eating disorders, and partially because it’s confused with simple picky eating, ARFID is most likely widely under reported and under diagnosed. Also contributing to the under diagnosis of ARFID is the fact that many children and adolescents are very picky or selective about what they eat, and their parents just write that off as normal childhood behavior.
Who Does ARFID Affect?
Most eating disorders, such as anorexia nervosa and bulimia nervosa, tend to affect cisgender women and transgender people more commonly than cisgender men. That being said, all eating disorders affect people of all genders. Unusually for an eating disorder, ARFID affects men and boys as much if not more than females.
Most eating disorders first present themselves in late adolescence and early adulthood (ages 16 – 22), but ARFID is also unusual in that it affects children as well. In addition, younger children seem to be more at risk than older children. Although the child may eventually outgrow ARFID, it’s essential not to take that risk if they are displaying clear signs of ARFID as it may affect their growth and cause other developmental problems.
ARFID is a common co-occurring disorder, meaning it happens at the same time as another psychological or medical ailment. About 20 percent of children with ARFID also have an autism spectrum disorder. These co-occurring disorders usually require treatment in synch with eating disorder treatment programs.
What Causes ARFID?
One of the main causative factors of most eating disorders is a fear of gaining weight and a sense of dissatisfaction with one’s body (known as body dysmorphia). However, ARFID behaviors aren’t spurred on by a fear of gaining weight or attempts to lose weight. To be sure, those fears can be present in a person with ARFID; it’s possible for someone to have anorexia nervosa, avoiding caloric intake to an extreme level, AND also avoid certain food entirely with the symptoms of ARFID (as an example).
It is suspected that anxiety may be a major contributing factor to the disorder, and certain phobias also come into play. For instance, many people who avoid eating certain foods because they are afraid of choking or vomiting, or because of perceived fears that the food might make them sick. In some cases, the disordered eating behaviors appear similar to some anxiety disorders such as OCD. In these situations, the person may refuse to eat foods if they touch on the plate, or if they are not cut into same-sized pieces. These are just examples, as the selectiveness can be based on almost any criteria, no matter how arbitrary it might seem.
What Kinds of Treatment Are Available for ARFID?
When a person enters an eating disorder treatment center following a diagnosis of ARFID by their doctor or psychiatrist, there are usually several levels of therapeutic care available. Less severe cases and people stepping down from intensive care might enroll in an outpatient or day treatment program. For more intense cases or those requiring medical or psychiatric support, a residential program might be more appropriate
No matter the type of program, typical treatment methods for ARFID involve cognitive behavioral therapy, group therapy, food and nutrition counseling, and family therapy. Supplemental nutritional training can be provided by nutritionists and dieticians, allowing the patient to not only retrain their eating habits to include the previously avoided food but to build ongoing meal planning skills to restore their nutritional balance. Many programs also include a mindful movement component including yoga and low-impact exercise programs, which counteract excessive exercise behaviors.
ARFID is completely treatable, but as with any mental health disorder, the sooner treatment begins, the better. If you see that “picky eating” is affecting your health and lifestyle, or that of a loved one, reach out to a mental health professional or eating disorder treatment center. Recovery is possible – so get started today.