ARFID – when Picky eating becomes life threatening

I’m sure we all know at least one person who is very picky about food, I know people who don’t like fruit, garlic, whole grains, nuts and seeds, etc. For example, we often see in young children that they tend to be “picky” when it comes to food choices. That’s not a bad thing in general – we all have foods we prefer and foods we wouldn´t necessarily need. However, some EXTREMELY picky eaters may also suffer from an eating disorder – the Avoidant/Restrictive Food Intake Disorder also called: ARFID 

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"normal" picky Eater vs. ARFID

Certainly, there is at least one food that you absolutely cannot stand. You can hunt me, for example, with Brussels sprouts, pure milk chocolate, savoy cabbage, dumplings and butter made from cow’s milk products. Simply because I either don’t like the taste, the texture or the look. That alone is not a problem and can be part of “normal eating habits”.

Picky eating habits are very common in childhood. For example, around the beginning of school, kids begin to become pickier and tend to prefer carbohydrates – because these promote growth. However, most outgrow their sensitivity. Appetite and flexibility increase with puberty and food choices become wider.

Those affected by ARFID often show the first signs in infancy. For example, they have difficulty switching to mixed foods, don’t want to try anything new and are particularly sensitive to “crunchy” and “mushy” things. However, children usually still manage to meet their nutritional needs.

According to the DSM-IV, the diagnostic criteria for ARFID are as follows:

  • A diet and/or food restriction that is not explained by a lack of food, a culturally sanctioned practice, or another medical issue.
  • The food or diet restriction cannot be directly attributed to body-dysmorphia or weight control.
  • At least one of the following symptoms can be observed:
    • significant weight loss (or lack of expected weight gain in adolescents)
    • Significant nutrient deficiency
    • Dependence on tube feeding or oral nutritional supplements
    • Difficulties in daily life due to fear, shame, and inconvenience
  • the disorder does not occur in the context of anorexia or bulimia and there are no struggles with their body image at the onset of the disorder
ARFID

signs and symptoms of ARFID

  • weight loss
  • the body is tucked under layers of clothing to hide weight loss—or to keep themselves warm
  • Constipation, abdominal pain, cold intolerance, lethargy and fatigue
  • Repeated expressions of indigestion, bloating, … around meals
  • Restriction of certain foods and/or limitation of quantities
  • Restriction to certain textures of food
  • pronounced fear of vomiting or choking
  • Lack of appetite or interest in food
  • more and more foods are being avoided
  • physical warning signs such as anaemia, dry skin and nails, muscle weakness, weakened immune system, dizziness, missing period

who is at higher risk?

So now that we’ve cleared up the difference between normal picky eating and the eating disorder, let’s look at who is particularly vulnerable to developing ARFID. The disorder is more common in children and adolescents – but it can also occur in adulthood. The disorder appears to affect a larger proportion of men than in anorexia and bulimia.

  • people on the autism spectrum
  • sufferers with ADHD
  • Children who cannot outgrow their picky eating habits
  • children with anxiety disorders
  • People who are afraid of choking or vomiting
  • people that are affected by complaints in the gastrointestinal tract

types of ARFID

  1. Avoiding due to negative or fear-based experience such as vomiting, nausea, choking, pain, or swallowing
  2. Aversive – due to sensory traits, such as through a sensory processing disorder
  3. Restrictive eating behaviours due to little interest in food. Affected people are picky, distractible and forget to eat.
  4. The mixed type includes functions that are avoiding, stopping, and restricting.
  5. ARFID Plus refers to people who were initially able to identify with one of the ARFID types, but who develop characteristics of anorexia over the course of time. For example, weight and shape concerns, negative body image, and/or avoidance of high-calorie foods.

treatment

The consequences of ARFID can have a negative impact on health and growth in the long term. Depending on the severity of malnutrition and malnutrition, tube feeding should be considered to stabilize vital signs.

Cognitive-behavioural therapy should be used to treat the psychological problems associated with ARFID, such as anxiety. A nutritionist can help create a balanced diet plan and help you gradually face the foods you avoid (exposure).

At ARFID, the goal is often to get the person back to a reasonably healthy and balanced diet, even if that may mean they will never eat the “rainbow” or love or enjoy food like other peers.

7 ARFID - when Picky eating becomes life threatening
ARFID | Rumination Disorder
ARFID | Pica
ARFID | Diabulimia

Thank you for reading this far! Feel free to write me feedback here or via Instagram – I look forward to hearing from you! ♥

Resources

WHAT IS ARFID? | ARFID Awareness UK

Zimmerman J, Fisher M. Avoidant/Restrictive Food Intake Disorder (ARFID). Curr Probl Pediatr Adolesc Health Care. 2017 Apr;47(4):95-103. doi: 10.1016/j.cppeds.2017.02.005. PMID: 28532967.

Table 22, DSM-IV to DSM-5 Avoidant/Restrictive Food Intake Disorder Comparison – DSM-5 Changes – NCBI Bookshelf (nih.gov)

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