While eating disorders like anorexia and bulimia get much of the attention, it is important to understand that other, less-known eating disorders impact huge swathes of people. One such disorder is Avoidant Restrictive Food Intake Disorder, commonly known as ARFID. ARFID is not just about being picky with food; it is a serious condition that can significantly disrupt your daily life. The good news is that there is hope. With professional treatment like that offered at Banbury Lodge, you can develop a healthier relationship with food and reclaim your life. This journey isn’t easy, but understanding ARFID is a critical first step.

What is ARFID?

ARFID is a relatively new term in the field of eating disorders. It was officially recognised in 2013, replacing what was previously known as “Selective Eating Disorder.” This change was more than just renaming; it marked a broader understanding of the condition.

Unlike anorexia or bulimia, ARFID doesn’t revolve around distress about body shape or weight gain. It’s characterised by highly selective eating habits, going beyond typical picky eating in severity. ARFID involves consistent avoidance of specific textures, colours, or smells and heightened anxiety about the consequences of eating, such as fear of choking. This pattern goes beyond preferences, often resulting in serious nutritional deficiencies and avoidance of food-related social situations.

ARFID is more commonly diagnosed in children and adolescents, but it can and does affect adults as well. It is a disorder that can easily go unnoticed or not be taken seriously, which can lead to escalation and prolonged suffering.

Different forms of ARFID

Understanding the different forms of ARFID is crucial for accurate diagnosis and effective treatment. Each type has its unique characteristics and symptoms.

Sensory-sensitive ARFID
This form of ARFID is where you have an aversion to certain food textures, colours or smells. It is not just a normal dislike or preference like most people have; these sensory attributes of food can trigger severe anxiety or discomfort.
Conditioned ARFID
Condition ARFID often develops after a negative experience with food, such as choking or vomiting. The fear of re-experiencing these events leads to avoidance of certain foods or eating in general.
Avoidant ARFID
The avoidance is due to a lack of interest in food or a general apathy towards eating. This can be particularly challenging to diagnose and treat as you may not even recognise or accept the severity of your condition.

Common ARFID symptoms

While symptoms can vary widely among individuals and types of ARFID, some common ones include:

  • Significant weight loss or failure to achieve expected weight gain in children
  • Serious nutritional deficiencies
  • Gastrointestinal issues
  • Dependence on nutritional supplements
  • Avoidance of social situations involving food
  • Extreme distress when presented with certain types or textures of food
  • Obsession or preoccupation with food and eating
  • Hindrances in growth and development

Different forms of ARFID

Understanding the causes of ARFID is essential for effective treatment and compassionate care. Like all eating disorders, ARFID is a complex medical condition influenced by a variety of factors, which include:

Biological factors
  • Genetic predisposition: Like other eating disorders, ARFID may be more common in individuals who have family members with similar or related conditions.
  • Personality traits: Certain innate personality traits, such as a heightened sensitivity to textures and tastes, may make you more likely to develop ARFID. These traits can make certain foods or eating experiences particularly challenging or distressing, which can ingrain avoidant behaviours.
Environmental factors
  • Cultural and societal influences: Cultural norms around eating, dietary practices, and food-related beliefs can influence the development of ARFID. For instance, highly restrictive or health-focused family environments may inadvertently contribute to the disorder.
  • Parenting styles and family dynamics: Family conflicts, stress and overly controlling or anxious parenting around food can also contribute to the development of ARFID. Children in such environments may develop food aversions or restrictive eating behaviours as a coping mechanism.
Past negative experiences with food
  • Food neophobia: A fear of trying new foods, often developing in early childhood, can evolve into ARFID. This fear can limit the variety of foods an individual is willing to eat, potentially leading to nutritional deficiencies.
  • Adverse reactions to foods: Allergic reactions, food intolerances, or gastrointestinal issues linked to certain foods can make eating a distressing experience, leading to avoidance.
  • Psychological trauma: Psychological trauma, especially when linked to eating or food, can significantly contribute to the development of ARFID. This can include extreme experiences like force-feeding or being punished for not eating.
Neurodevelopmental and psychological aspects
  • Autism spectrum disorders: People with autism spectrum disorders are more likely to develop ARFID, partly due to sensory sensitivities and a preference for routine, which can include limited food choices.
  • Anxiety disorders: Anxiety, particularly around eating or the consequences of eating, is a common feature in ARFID. This anxiety can be so severe that it overrides the basic need to eat or try new foods.
  • Other mental health disorders: Co-occurring mental health disorders like OCD or ADHD can also contribute to the development of ARFID. For instance, OCD-related fears about contamination can lead to avoidance of many foods.

Crucially, it is usually not just one single cause but a combination of these factors that leads to ARFID. For example, a child with a genetic predisposition to anxiety may develop ARFID after a traumatic choking incident, particularly if they are in a high-stress family environment.
Understanding these causes is crucial in crafting comprehensive ARFID treatment plans that address the symptoms and the underlying factors contributing to the disorder.

How is ARFID diagnosed?

Diagnosing ARFID requires a comprehensive, multi-faceted approach, often involving a team of healthcare professionals. This team may include your GP, a mental health professional and a dietitian. This process must be approached with compassion and sensitivity, as it can be a difficult and emotional experience for the individual and their family. ARFID diagnosis will often include:

ARFID DSM-V criteria review

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), provides specific criteria for diagnosing ARFID. These include:

  • Persistent failure to meet appropriate nutritional and/or energy needs, leading to significant weight loss (or failure to gain weight in children)
  • Nutritional deficiency
  • Dependence on oral nutritional supplements or tubal feeding
  • Significant interference with the ability to function socially

Physical assessment

A thorough physical examination is often necessary to assess the medical impacts of ARFID outlined in the DSM-V, such as weight loss, growth delays in children and signs of malnutrition.

Psychological assessment

Mental health professionals can also play a key role in diagnosing ARFID. They assess for coexisting conditions like anxiety or obsessive-compulsive disorder and help determine if the eating issues are related to body image concerns. They can also rule out similar conditions to ensure the right treatment is given.

Nutritional assessment

This involves evaluating your dietary intake, understanding your specific food aversions and assessing the nutritional implications of your eating habits.

Family input

For children and adolescents with ARFID, family input is particularly crucial. Parents or guardians can provide valuable insights into eating behaviours, childhood development and any potential family dynamics that may be contributing to the disorder.

What does ARFID treatment involve?

Treating ARFID is often a complex process, requiring a tailored approach that addresses the unique needs of each individual. UKAT’s Banbury Lodge offers a holistic approach to ARFID recovery, integrating various therapeutic modalities in our rehab treatment programme. These include:

  • One-to-one therapy: These personalised therapy sessions will help you understand and work through the underlying causes of your ARFID. It is a space to explore your relationship with food and develop healthier coping mechanisms.
  • Group therapy: Group sessions provide support and insights from peers facing similar challenges. This can be incredibly validating and help you overcome feelings of isolation.
  • Cognitive behavioural therapy (CBT) / dialectical behaviour therapy (DBT): These therapies are effective in changing harmful thought patterns and behaviours associated with ARFID. They teach skills for managing anxiety and emotional regulation, so eating is not used as a coping mechanism.
  • Family therapy: Involving family members is crucial, especially for younger individuals. Family therapy can help address family dynamics that may influence eating behaviours and provide support for your recovery journey.
  • Nutritional counselling: Our dietitian plays a key role in developing a balanced meal plan that accommodates your aversions, slowly introducing new foods while ensuring your nutritional needs are met.
  • Aftercare: Ongoing support is crucial for maintaining ARFID recovery. UKAT provides weekly group therapy sessions to create a consistent support system and help you stay on track long after you have left rehab treatment.
  • Begin the ARFID recovery journey today

    Starting the journey toward recovery from ARFID can feel daunting, but it’s a crucial step towards a healthier life full of opportunities. At Banbury Lodge, we are committed to providing compassionate, comprehensive care tailored to your unique needs. If you or a loved one is struggling with ARFID, we encourage you to contact us and begin the path to recovery today.

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    At what age does ARFID start?
    ARFID can start at any age, but it is most commonly identified in infancy or early childhood. Unlike some other eating disorders that typically emerge during adolescence or early adulthood, ARFID often begins when children are first introduced to solid foods. However, it is important to note that ARFID can also develop or persist into adulthood, particularly if not identified or treated early.
    Is ARFID dangerous?
    Yes, ARFID can be dangerous as it may lead to serious health consequences due to nutritional deficiencies. People with ARFID are at risk of not consuming enough calories or essential nutrients, which can result in weight loss, stunted growth, weakened immune function and other complications. In children, these deficiencies can impact development and overall health. In severe cases, ARFID may require medical interventions, such as tube feeding, to address nutritional shortfalls.