Avoidant Restrictive Food Intake Disorder (ARFID)


    What is ARFID?

    Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5 as an eating or feeding disorder characterised by a persistent and disturbed pattern of feeding or eating that leads to a failure to meet nutritional/energy needs. ARFID was previously referred to as 'Selective Eating Disorder', or 'Sensory Eating Disorder'.

    ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.

    Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss.

    While picky eating and ARFID may have certain similarities, ARFID is differentiated by the level of physical and mental distress that eating causes. Someone with ARFID may have difficulty chewing or swallowing, and can even gag or choke in response to eating something that gives them high levels of anxiety. The anxiety can also cause them to avoid any social eating situation, such as school lunches or attending birthday parties.

    How is ARFID diagnosed?

    For ARFID to be diagnosed, children must exhibit the following criteria for an extended period of time and across various settings.

    This fear of eating may be direct - where the person feels nauseous or experiences abdominal pain when eating so they restrict food to avoid these symptoms - or indirect - where the person worries that they might vomit or have an allergic reaction if they eat.

    Longstanding low appetite, early satiety and indifference to food may present at any stage of childhood or adolescence. By the child reaches puberty there are concerns around their weight and growth. In these cases, patients’ appetites do not increase sufficiently to meet the increased energy needs of puberty, resulting in a fall off their growth curve.

    Children in this category struggle primarily with food variety; they are often extremely selective (picky) regarding the food that they eat and have refused certain foods since early childhood. This is often linked to sensory hypersensitivity that results in profound rigidity involving food e.g. a child only eating foods of a certain colour or texture.

    In many cases, the rigidity extends to the manner in which food is served e.g. different foods on a plate cannot touch and/or certain food needing to be cut up in equal pieces, as well as the details related to the food preparation (e.g. pasta must be boiled for exactly 11 minutes, culminating in children only accepting the same (limited number) of foods, prepared in the exact same manner, and served in the exact same way.



    Is it just fussy or picky eating or is it ARFID?

    Although picky eating is common in children, and in most cases improves with age without the need for any intervention, this is not the case for children with this subtype of ARFID.

    • It can be difficult to distinguish between picky eating and ARFID, particularly in children.
    • Taking the approach of telling a child to ‘eat the food, or go to bed hungry’ may work with picky eaters but would never work for anyone with ARFID.
    • ARFID sufferers aren’t just being stubborn, they’re often fearful of specific food colours, textures, tastes or smells.
    • Forcing someone with ARFID to eat what’s in front of them may cause them to vomit, leading to a traumatic experience, which is likely to worsen the problem.
    • Early research suggests that Autistic children are more likely to be in this category of ARFID.

    How is ARFID treated?

    Treatment for ARFID is usually best tailored to the needs of the individual and will almost always require a multidisciplinary team approach (including dietitians, doctors or paediatricians, psychologists and occupational therapists) and will be based on the specific nature of the difficulties the person is experiencing and what is considered to be maintaining these.

    Most often, treatment can be delivered in an outpatient setting and commonly involves evidence-based treatments such as family-based treatment (for young people), cognitive behavioural therapy, behavioural interventions such as exposure work, and anxiety management training.