An Introductory Guide to ARFID

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This article was written by Sarah Idakwo, Eating Disorder Specialist Dietitian in the Dietetically Speaking Clinic.


Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new, yet complex type of eating disorder that was formally recognized in the DSM-V in 2013. Unlike traditional eating disorders, ARFID doesn’t necessarily involve concerns about weight or body image. It is believed that between 5-14% of children and adolescents with an eating disorder may meet the criteria of ARFID.

The Characteristics of ARFID

ARFID is characterized by a persistent failure to meet appropriate nutritional and/or energy needs, leading to one or more of the following:

  • Substantial weight loss (or failure to achieve expected weight gain in children) *
  • Significant nutritional deficiency
  • Dependence on enteral feeding or oral nutritional supplements
  • Marked interference with psychosocial functioning.

*It’s important to note that you don’t necessarily have to be under weight to meet the criteria for ARFID. People with ARFID can present with various body types.

The Distinction Between ARFID and Fussy Eating

All fussy or avoidant eating is caused by sensory aspects of food — the way it looks, feel, smells and so on. It’s important to note that fussy eating, especially in children during their toddler years, is quite common and not the same as ARFID. While many children exhibit preferences and aversions, particularly to vegetables, this typically doesn’t lead to serious nutritional issues. ARFID, however, involves more intense avoidance and restrictions that can lead to significant health problems.

Sensory Sensitivities and Food Intake

Many children and adults with ARFID may exhibit heightened sensory sensitivities that affect their perception and acceptance of certain foods. These sensory responses are believed to have a genetic component and can be influenced by external factors, including anxiety levels and the approaches taken by parents or caregivers to manage eating behaviours. Nevertheless, It’s essential to acknowledge that parents are not to blame for a child’s ARFID diagnosis, as the condition involves a complex interplay of factors beyond their control.

Identifying and Diagnosing ARFID

Due to the relatively new recognition of ARFID, there is a shortage of healthcare professionals who are adequately trained to diagnose and treat it at present. As a result, unfortunately, this can lead to misidentification, often confusing ARFID with extreme picky eating. Typically, paediatricians or clinical psychologists are the only health care professionals qualified to diagnose ARFID, however dietitians with specific training in ARFID can play a crucial in assessment and management, aiding in faster diagnosis and comprehensive nutritional care.

Patterns of ARFID Presentation

The presentation of ARFID can be categorized into three distinct patterns:

  1. Early childhood onset: This pattern may emerge as early as 18 months and persist into the toddler years.
  2. Fluctuating-resolving: Children may experience periods of improved intake followed by setbacks often triggered by stressful events.
  3. Late onset: Some individuals show no early symptoms, with ARFID emerging around the age of 11, often in response to age-related anxiety. This late onset is reported more frequently among girls.

Assessing ARFID

Healthcare professionals utilize specific criteria to assess ARFID, which include:

  • A markedly limited range of accepted foods.
  • Strong adherence to specific brands or flavours.
  • Intense aversive reactions to new or certain foods.
  • Sensory processing challenges that impact eating.
  • Avoidance of social eating scenarios or places where food is present.

Professionals emphasize the importance of evaluating the range of foods consumed rather than the quantity when diagnosing ARFID.

Conclusion

ARFID is a significant medical condition that necessitates professional intervention. Far from merely being a case of picky eating, it poses substantial nutritional and psychological challenges that can profoundly affect an individual’s health and well-being. Early identification and intervention are crucial, and with the right multidisciplinary support, those affected by ARFID can achieve a better quality of life and a healthier relationship with food. If ARFID is a concern for you or someone you know, seeking professional guidance is a critical step. As awareness and understanding of ARFID grow, so does the potential for successful outcomes for those living with this disorder.

If you are looking for a dietitian to support you or a loved one with ARFID you can enquire about a free discovery call with one of our dietitians here.



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