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When It’s More Than “Picky Eating”: Avoidant/Restrictive Food Intake Disorder

By Carol Church, Writer, Family Album

Reviewed by Laura Acosta, MS, RD, CSSD, LD/N, Department of Food Science and Human Nutrition, University of Florida

Many children go through a phase or two of “picky eating” in their lives. While my own kids have generally been pretty open-minded, they’ve sometimes driven me crazy by being extremely particular as to (for instance) what type of apple or peanut butter they will eat. I’ve known other children who seem mostly to survive on chicken nuggets, pasta, pizza, and fruit. These situations can be frustrating for parents.

But for some children and teens, restricted eating habits become a more serious issue. While almost all of us have heard of eating disorders like anorexia nervosa and bulimia nervosa, there are other eating problems that can also be very concerning. One such issue is Avoidant/Restrictive Food Intake Disorder, or ARFID for short. This is a relatively new diagnosis that many doctors and parents may not have heard of.

ARFID: Definitions

What is ARFID? This is a diagnosis given to people who have serious problems with eating that prevent them from getting enough calories and/or a nutritionally complete diet. They may avoid most foods (even things like pizza or cake) due to issues with texture and tastes, or because of pain associated with eating. In other cases, they may lack a normal appetite, or eat so slowly that mealtimes become a real problem. Some people with ARFID have a severe fear of vomiting or choking (often linked to a specific past incident) that makes eating frightening for them. People with ARFID are often unable to eat normally in typical social settings, like a party, a family meal, or even a school cafeteria.

No Focus on Body Image or Size

Unlike people with anorexia and bulimia, those with ARFID do not have disturbed or problematic beliefs about their body shape and size. It is not their goal to lose weight. However, significant weight loss or a failure to grow as expected is typically a feature of ARFID. Some people with the problem may even need to be tube-fed or have to rely on oral nutritional supplements (such as Pediasure, Ensure, or Boost) to maintain their weight.

Approximately 30% of ARFID patients are male, making this disorder more common among boys and men than other eating disorders. ARFID is sometimes associated with developmental disabilities or other disorders like Autism Spectrum Disorder, attention deficit disorder, or obsessive-compulsive disorders. It’s important to note that to receive the ARFID diagnosis, other eating disorders and medical problems must be ruled out.

A New Diagnosis

Because ARFID is a relatively new diagnosis (it was recognized for the first time in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, released in 2013), it’s not yet fully clear what treatment methods are most effective. However, certain types of psychotherapy (such as cognitive behavioral therapy and exposure therapy) may help.

Concerns? Seek Help

If your child or teen has severely restricted eating patterns, is not growing and gaining weight normally, or has serious fears or anxiety related to eating, be sure to speak to a pediatrician. ARFID and other eating disorders are serious, and can be quite hazardous to your child’s health. The sooner the symptoms are brought to a doctor’s attention, the sooner a proper diagnosis can be made, and if necessary, treatment can be initiated.

Further Reading:

What is ARFID?

Avoidant/Restrictive Food Intake Disorder

References:

Fisher, M. M., et al. (2014). Characteristics of Avoidant/Restrictive Food Intake Disorder in
Children and Adolescents: A “New Disorder” in DSM-5. Journal of Adolescent Health, 55, 49-52. http://dx.doi.org/10.1016/j.jadohealth.2013.11.013 

Kenney, L., & Walsh, B. T. (2013). Avoidant/Restrictive Food Disorder. Retrieved from http://eatingdisordersreview.com/nl/nl_edr_24_3_1.html

The Center for Eating Disorders at Sheppard Pratt. (2013). What is ARFID? Retrieved from http://eatingdisorder.org/blog/2013/08/what-is-arfid/

Photo Credits: NOVKOV/iStock/Thinkstock