Welcome to the inaugural edition of Nutrition Stories, a series exploring hot topics in nutrition and dietetics. Our first guest is Josefina Figueredo, a graduate of the UF Didactic Program in Dietetics (DPD) in the Food Science and Human Nutrition program at The University of Florida. In this article, Josefina delves into the differences between picky eating and ARFID while offering hope for caregivers and loved ones of those suffering from ARFID.
Josefina: Eight-year-old Hannah saw mealtimes as times of anxiety and terror rather than as times of joy and nourishment. Her once-healthy appetite vanished, replaced by a terrible phobia of specific foods.
Her parents, Sarah and David initially had a tough time realizing the seriousness of Hannah’s illness. They did not know that she was acting out of deep-seated worries and anxieties; instead, they saw her unwillingness to try some foods as stubbornness. However, as Hannah’s list of acceptable foods grew shorter and her growth began to plateau, they knew they needed help.
What Sarah and David first dismissed as typical childhood pickiness revealed itself to be more intricate. Eventually, with professional guidance, they came to understand that Hannah’s condition, recently diagnosed as ARFID (avoidant/restrictive food intake disorder), was not something she could simply outgrow.
What is ARFID?
Through research, Hannah’s parents gained a better grasp of ARFID. This diagnosis includes eating behaviors marked by excessive pickiness, aversions to certain foods, and sensory sensitivity. These behaviors can lead to significant weight loss, nutritional deficiency, and dependence on enteral feeding or oral nutrition supplements. Unlike typical picky eating, which often occurs in childhood and resolves over time, ARFID persists beyond childhood and can affect individuals of any age.
Diagnosis of ARFID involves assessing an individual’s eating behaviors, nutritional status, and psychosocial functioning. Criteria for diagnosis include restrictive eating patterns, avoidance or restriction of certain foods, and significant impairment in physical, psychological, or social functioning.
Studies have revealed that the disorder can present in many ways, with different people feeling different degrees of sensory sensitivity, eating indifference, or fear of negative consequences. Additionally, they have found that estimates of the prevalence of ARFID among individuals seeking treatment for eating disorders range from 7.2% to 17.4%.¹
How is ARFID Diagnosed?
Since no approved diagnostic instruments have been created especially for ARFID, diagnosing and assessing the disorder is difficult. However, researchers have found hope in emerging tools like the Eating Disorder Assessment for DSM-5 (EDA-5) and the Pica, ARFID, and Rumination Disorder Interview (PARDI), which hold promise for improving identification and diagnosis.²
Symptoms of ARFID may present as extreme pickiness, refusal to eat certain foods or food groups, anxiety or fear related to eating, and avoidance of social situations involving food. This disorder can have severe consequences on both emotional and physical well-being, leading to malnutrition, growth delay (especially in children), social isolation, anxiety, depression, and impaired quality of life.3
The duration of ARFID can vary widely among individuals. Some may experience symptoms for a brief period, while others may struggle with the disorder for years. Early recognition and intervention are crucial for improving outcomes and preventing long-term complications.
Navigating Treatment for ARFID
With this newfound understanding, Sarah and David sought help for Hannah. They contacted a group of medical professionals skilled in treating ARFID, including therapists, dietitians, and doctors. Together, they set out to assist Hannah in overcoming her anxieties and nurturing a positive relationship with food.
As Hannah engaged in therapy sessions, she found a safe space to confront her fears and develop coping mechanisms under the guidance of her therapists. Concurrently, collaboration with dietitians helped address her nutritional deficits and create a tailored meal plan that gently introduced new foods while considering her comfort level.
Sharing this narrative of Hannah’s journey aims to provide more specific insights into ARFID treatment and highlight the importance of early recognition and intervention. Beyond appreciating the difficulties of the disorder, parents, educators, and healthcare professionals need to understand the multifaceted approach required in treating ARFID. This approach includes supporting individuals during therapy sessions, collaborating with dietitians to address nutritional needs, and advocating for appropriate resources within the community.
By raising awareness and understanding of ARFID, we can better support those affected by this complex disorder, offering a future free from the constraints of fear around food.
Differentiating ARFID from Picky Eating
Furthermore, understanding the distinction between ARFID and picky eating is crucial. While picky eating may be a phase children outgrow, ARFID persists and significantly impacts an individual’s emotional and physical well-being. By appreciating this difference, caregivers and professionals can provide more effective support and intervention strategies.
Research is now focusing on interventions such as cognitive-behavioral therapy (CBT), medication, and nutritional support as potential treatment options for ARFID. While the success stories of people like Hannah who have benefited from these therapies are encouraging, further study is necessary to fully understand which strategies work best for various ARFID presentations.4
Advocating for greater awareness and resources for ARFID within their communities is essential. Resources can provide support and understanding for individuals affected by the disorder, ensuring timely intervention and treatment. By fostering a supportive environment and understanding the complexities of ARFID, individuals like Hannah can receive the help they need to overcome their challenges and thrive.
A Message of Resilience for Friends and Family of Individuals with ARFID
While Hannah’s journey with ARFID continues, her progress is evident. With unwavering support, she confronts each day with bravery and perseverance. Although challenges persist, there is hope for recovery and healing. By raising awareness and understanding of ARFID, we can better support those affected by this complex disorder, offering a future free from the constraints of fear around food.
For families like Hannah’s, the journey to recovery from ARFID is undeniably long and challenging, but it is also filled with hope and resilience. By sharing Hannah’s story, the memorable message conveyed is one of perseverance, support, and the unwavering belief that with understanding, intervention, and support, individuals affected by ARFID can embark on a path toward recovery and reclaim their relationship with food.
If you suspect your child has eating issues beyond typical picky eating, seek professional help immediately. Consult a pediatrician or a specialist in eating disorders to get an accurate diagnosis and appropriate treatment. Early intervention can make a significant difference in your child’s recovery journey. Let’s work together to ensure no child faces ARFID alone.
References
- Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: A Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports. 2017;19(8). doi:https://doi.org/10.1007/s11920-017-0795-5
- Silvers E, Erlich K. Picky Eating or Something more? Differentiating ARFID from Typical Childhood Development. The Nurse Practitioner. 2023;48(12):16. doi:https://doi.org/10.1097/01.NPR.0000000000000119
- Picky Eating … or Eating Disorder? stanfordchildrens.org. Published December 2019. Accessed February 22, 2024. https://www.stanfordchildrens.org/en/topic/default?id=picky-eating-or-eating-disorder-88-p11049
- Białek-Dratwa A, Szymańska D, Grajek M, Krupa-Kotara K, Szczepańska E, Kowalski O. ARFID—Strategies for Dietary Management in Children. Nutrients. 2022;14(9):1739. doi:https://doi.org/10.3390/nu14091739
Header photo credit: UF/IFAS Photo by Tyler Jones
Looking for more posts sharing stories about nutrition hot topics? Check out the rest of the UF/FSHN Nutrition Stories Series!
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