Have you been recently diagnosed with ARFID (Avoidant Restrictive Food Intake Disorder) or are you wondering if you may possibly suffer from ARFID?
Are you now wondering what the next steps should or could be?
What is ARFID really? What does treatment look like for ARFID? Can I work on ARFID treatment from home? Do I need a treatment team? Can I do this alone?
This is a lot of information to digest…so let's take it one step at a time.
This article will explain what ARFID is and what treatment options are best for you.
So let's jump in!
What is ARFID?
ARFID (Avoidant Restrictive Food Intake Disorder) is an eating disorder that can affect children and adults. People who suffer from ARFID tend to have a very small range of foods that they feel comfortable eating. It has been known to be called extreme picky eating or very selective eating (1).
Is ARFID a Mental Illness?
ARFID is a type of Eating Disorder and should be treated as such.
Diagnosis with DSM-5
ARFID is a newer eating disorder diagnosis that was added to the DSM-5 (which is a tool medical providers use to diagnose) in 2013. There have been recent adjustments to the diagnostic criteria including that weight is not a factor. A child or adult may be of “normal” weight but still only have a very selective amount of foods they feel comfortable eating and suffer possible nutrient deficiencies (2).
ARFID & ADHD
It is common to see an overlap of other disorders with ARFID, but not always. These could include ADHD (Attention Deficit Hyperactivity Disorder), OCD (Obsessive Compulsive Disorder), and Autistic Spectrum Disorders (3).
What causes ARFID?
There is no known cause for ARFID and there is nothing people can do to avoid or prevent themselves from suffering from ARFID. ARFID is not typically related to body image or intended weight loss like other eating disorders. Since there is no way to prevent ARFID, treatment is needed!
Three types of ARFID
ARFID can present itself in three different ways.
1. Sensory sensitivity
Example: Some food textures could be a reason certain foods are difficult to eat.
2. Lack of interest in eating
Example: There is just no drive or want to eat. Easy to forget to eat.
3. Fear of aversive consequences
Example: There is an intense fear of choking or vomiting.
People suffering from ARFID can present in one of these ways or multiple ways. For example, you could have no interest in eating foods and have an aversion to eating because of the fear of possibly choking. Another example: You may prefer to not eat crunchy foods because of the dislike in texture and fear of choking.
Can ARFID cause malnutrition?
YES!!! Think about it. If you are only eating a limited amount of or a lack of different kinds of foods . . . you are missing out on a lot of vitamins and minerals. The foods that individuals suffering from ARFID tend to struggle with most are fruits, veggies, and proteins.
Fruits and veggies can be more difficult because they are not as consistent with flavor or texture as some of our snack foods are. You know when you bite into a pretzel what to expect. With fruits and veggies it can vary. You never know what you are going to get with produce. One blueberry might be super sweet, and another in the same package, might be super tart!
Possible Nutrient Deficiencies
The following are some potential nutrient deficiencies that commonly occur with people suffering from ARFID and how the lack of them impacts your body (4).
How You May Be Feeling
Tired, weak, irritable, and severe deficiencies are called Scurvy (bruising, gum and dental issues and dry skin and hair). Vitamin C deficiency can result in anemia.
Kiwi, Peppers, Oranges, Mango, Broccoli, Spinach, Brussel Sprouts, Tomatoes
Tired, weak, and headache. Can also result in pale skin and cold hands and feet. Low iron results in lack of red blood cells in the body resulting in decreased oxygen to the body tissues.
Red meats, Liver, Spinach, Beans, and Fortified Cereals and Breads.
Tired, weak, joint pain, dry skin, dry eyes, possible night blindness, and a possible stunt in growth.
Beef Liver, Spinach, Sweet Potato, Pumpkin, Carrots, Cheese, Milk (fortified), and Cereals (fortified)
Tired, low energy, weakness, lightheaded, and even a possibility of shortness of breath and heart palpitations. This could also result in anemia.
Red meat, Fish, Eggs, Dairy products, Cereals (fortified)
Tired, fatigued, muscle weakness, bone pain, and can lead to loss of bone density causing an increased risk of osteoporosis
Dairy products (fortified) and Sunlight
Difficulty walking, weakness of limbs, and low energy.
Meat, Dairy products, Whole grains, Eggs, Seeds, and Beans
Tired, fatigued, headache, irritability, sores in the mouth
Edamame, lentils, Asparagus, Spinach and other Leafy Greens, Brussels Sprouts, and eggs
Increased bleeding and bruising, Heavy menstrual periods
Leafy Greens, Prunes, Kiwi, Broccoli, Avocado
There are other potential deficiencies and this is why we would suggest working with a doctor and dietitian to figure out your possible deficiencies.
Ways to Supplement
Since it is difficult to “just start eating” when you are suffering from ARFID, there are ways to buffer your diet while you are working through your treatment.
Supplements can come in the form of pills or drinks. It is very important to talk with your doctor before starting any supplements, as they could interfere with medication. Your doctor can also obtain labs to help in figuring out possible deficiencies. Working with a dietitian will help identify what you might be commonly missing from your diet.
Using supplements will allow you to continue eating the “safe” (we consider safe foods the common foods you feel comfortable eating) foods while working through treatment to bridge the nutrient gaps.
ARFID Treatment at Home
There are many things you can work on at home to help the progression of your recovery! However, when suffering from ARFID it is beneficial to work with a team (Dietitian, Therapist, Family Therapist, Medical Doctor, and Psychiatrist). When you are working on setting goals with your treatment team you can work on these goals at home.
It is also important to have as much support as you can. You do not need to do this alone. Recovering from an eating disorder is not an easy task! This is why there are different types of treatment to help you.
Types of Treatment
Depending on intensity of the treatment needed, the amount of time and frequency of visits will change. So let's go through and talk about the different types of treatment.
Outpatient treatment is when you see each person on your team every week or every few weeks. Typically this could look like seeing a therapist and dietitian weekly or every other week and seeing the medical provider and psychiatrist every 3-6 weeks. This would be the least intensive level of care and depending on your recovery path, you might have appointments spread out even further. It relies on doing the work at home with the guidance from your treatment providers.
Intensive Outpatient (IOP)
IOP is similar to outpatient but as the term implies, it is a bit more intensive. You would be seeing your normal team, as listed above, along with group therapy. Group therapy typically meets three days a week for three hours. Every treatment facility runs a little differently but they are similar providing nine hours of treatment time per week. In IOP, there is usually a snack or meal involved and groups teach you things like understanding your eating disorder and ways to challenge it.
Partial Hospitalization Program (PHP)
PHP is everything above and more. Treatment takes place daily for 6-12 hours (depending on the treatment center). All meals and all snacks are eaten on sight with your support team. During the day you participate in different therapy groups. Most facilities have a teacher to follow up on education needs. The amount of time spent in PHP is dependent on severity of the disorder, insurance allowance, and how well the treatment is progressing.
Residential is all of the above and you live on site. This treatment option allows 24 hour care if needed. Again, all meals and snacks are provided based on the meal plan your dietitian creates for you. Groups run most of the day with the addition of community time and individual journaling time.
Inpatient means hospital admission. Your medical provider admits you to the hospital for stabilization if blood work is dangerously off or possibly low heart rate, low blood pressure, or low weight. Inpatient care is needed if you are at risk for serious medical complications.
Next Steps for Treatment
The first step for recovery is talking to your doctor. Even if your primary care physician does not specialize in eating disorders, ideally they will know where to refer you and can get the process started with lab work and with an overall physical check up. If they have not heard of ARFID please have them look into it or to consult a nearby treatment program.
You may need to advocate for treatment. If you are not completely honest with your doctor they might not recognize the signs. For example if your weight is “normal” and labs turn out ok, but you feel awful everyday because of the few foods you are eating . . . make sure to speak up! Take someone with you for support to help you feel more comfortable talking to your doctor.
ARFID is an eating disorder that causes individuals to have a very select few foods they feel comfortable eating.
ARFID is not caused by anything and typically presents itself in three different ways: texture issues, lack of interest or fear of possible consequences when eating (choking, stomach pain, GI issues etc.)
ARFID can cause malnutrition due to the limited variety of foods. There are a multitude of possible nutrient deficiencies. Supplementation can occur after consulting with your doctor to help bridge the nutrient gaps during your recovery process.
ARFID treatment can start and continue at home, BUT we highly suggest obtaining a treatment team to help support you in the process. There are many types of treatments including outpatient, IOP, PHP, residential, and inpatient. Your treatment team can work with you on what treatment best meets your needs.
First step in the process is to talk to your doctor or if you have a therapist, bring it up at your next session! We also suggest visiting our ARFID site www.bridgethefoodgap.com for resources and to learn about our new ARFID workbook that will be released soon!
Visit NEDA (National Eating Disorders Association) for even more information and guidance.
Reviewed by: Dr. Valerie J Weesner