What Is ARFID? ARFID Treatment for Children, Teens & Adults
There’s a reason you may never have heard of avoidant restrictive food intake disorder (ARFID), where an individual avoids eating specific foods, restricts the amount of food they eat or avoids eating altogether.
Often mislabeled or waved off as “picky eating,” ARFID was just added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) — a manual that helps providers make mental health diagnoses — in 2013. Because of its relative newness and due to surrounding myths, ARFID symptoms and diagnosis can feel isolating at times. If you or your loved one are struggling with any of the symptoms below — or have questions about the diagnosis or treatment options — we’re here to help.
What makes ARFID unique?
Many people associate eating disorders with concern about weight and body image. While that’s true in some cases, ARFID is an eating disorder with unique diagnostic criteria.
While ARFID symptoms like food restriction and avoidance sound like symptoms of anorexia nervosa (AN), the two diagnoses are different. Notably, people with ARFID are not motivated by weight loss or thinness. However, due to their restrictive eating habits, people with ARFID may be at very low body weights or suffer from malnutrition, which can produce some of the same physical characteristics as AN. As a result, there is a chance that ARFID might be misdiagnosed or diagnosed later than would be ideal.
Knowing the warning signs and symptoms of ARFID is an important first step in seeking care for this type of eating disorder.
More than picky eating: ARFID signs and symptoms
There are different types of ARFID, just as there are different types of other eating disorders. The types of ARFID include avoidant, aversive, restrictive, adult ARFID and ARFID “plus.”
ARFID often first presents itself as “picky eating” — but it is much more than that. How do you know the difference? If a child is a nonproblematic picky eater and eats something they dislike, they might reject that type of food for a little while. Totally normal! After a while, the child will most likely circle back and be willing to try that food again.
However, “if a child develops a pattern of ‘I don't like something and I'll never have it again,’ and then ‘I don't like the next thing, and I'll never have it again,’” that is a sign that they are developing atypically, according to Ovidio Bermudez, MD, FAAP, CEDS, senior medical director of child and adolescent services and chief clinical education officer at Eating Recovery Center in “Mental Note,” a podcast from ERC Pathlight.
In addition to the appearance of picky eating, ARFID symptoms include the following:
- Lack of interest in food
- Avoidance of certain foods due to texture or consistency
- Refusal to try new foods
- Requirement that food be prepared a specific way
- Fear of eating due to concern about possible allergic reactions, choking or vomiting
Do you think you or your loved one might have ARFID?
Take this ARFID quiz to find out.
ARFID in children and teens
ARFID is most common in childhood and early adolescence. While the true prevalence of ARFID remains to be studied, preliminary research indicates that boys may have a higher risk than girls and that as many as 5% of children are affected. Children who show symptoms of ARFID might avoid certain foods out of fear of texture, smell or appearance. They also might develop a fear that a certain food would cause them to feel sick or choke. In addition to the fear of food, children who experience ARFID may also display some fasting behaviors.
ARFID in adults
Adults with ARFID often have inflexible eating patterns, which can leave them labeled as extremely “picky” with regard to food selection.
There is a clear distinction between food preferences, which everyone has, and inflexible eating behaviors found in people diagnosed with ARFID. These inflexible behaviors include the following:
- Refusal to try different foods or new types of food
- Requiring extremely specific preparation of food choices
- Sensitivity to the sensory perception of a food, whether physical or emotional
Another common symptom of ARFID in adults is fear-based food restriction. Individuals who experience distress about certain foods can have an emotional or physical reaction due to thoughts of an allergic reaction, choking or vomiting. Because of this fear, they may avoid certain foods and/or textures, depleting the individual of nutritional value. Fear-based food restriction can also result in low body weight and increased anxiety around food.
Treatment for ARFID
The most important step toward getting treatment for ARFID is having an accurate diagnosis. Within an ARFID diagnosis there are different types — such as restrictive ARFID or avoidant ARFID — and there is not a “one size fits all” treatment approach for each. To ensure an accurate diagnosis, “you want to be an informed consumer and ensure the diagnosis is verified by clinicians with experience, usually multidisciplinary,” Dr. Bermudez says. “If your pediatrician suspects a case of, say, restrictive ARFID, they should make a referral to a therapist and dietitian with the clinical expertise to get a consensus.” Only then should treatment begin.
Depending on the diagnosis, treatment may include some or all of the following interventions, following a comprehensive assessment:
- Medical and psychiatric stabilization
- Nutritional rehabilitation and weight restoration
- Family/caregiver involvement
- A multidisciplinary treatment team approach (medical, psychosocial, nutritional)
- Collaboration with referring providers
Wondering how to treat ARFID?
The treatment approach at ERC is unique for each individual. ARFID treatment addresses and includes the following:
- The patient's developmental history and stage of development
- Internal and external motivators as well as goals and values
- Family dynamics and family involvement
- Multidisciplinary treatment team alignment
- Seamless treatment team communication
- Collaboration with referring providers
A unique component of ARFID treatment at ERC — as well as all our treatments for eating disorders and mood, anxiety and trauma-related disorders — is continuous education of patients and caregivers alike about the patient's diagnosis, interventions, treatment expectations and treatment goals. We support the patient and family members from assessment to discharge — and beyond.
Get help today
If you believe you or your loved one may have ARFID, we’re here to support you on your recovery journey. Give us a call at 866-622-5914 so we can discuss the symptoms you are observing and explore your treatment options.
Eating Recovery Center is the nation's only health care system dedicated to the treatment of ARFID at all levels of care, including inpatient treatment, residential treatment, partial hospitalization treatment and intensive outpatient treatment.