Beyond picky eating: Treating patients with ARFID

By Anastasia Climan, RDN, CD-N | Fact-checked by Barbara Bekiesz
Published August 21, 2023

Key Takeaways

  • ARFID is an avoidant restrictive food intake disorder where patients avoid certain foods because of sensory issues or aversions. 

  • Left untreated, ARFID can lead to physical signs of malnutrition or nutrient deficiencies.

  • Engaging a mental health professional to help treat underlying anxiety and related issues is essential for providing comprehensive care for your patients with ARFID.

Avoidant restrictive food intake disorder (ARFID) is an eating disorder currently recognized in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. People with ARFID restrict themselves from eating certain foods because of aversions to certain tastes, smells, or textures. They may also have a fear of choking or a general lack of interest in eating. 

Unlike what is typical with most other eating disorders, body weight isn’t a primary motivator for ARFID, according to the National Eating Disorders Association.[]

Nonetheless, this type of restrictive behavior can lead to malnutrition and reinforce underlying mental health problems. Here’s how you can help your patients.

What causes ARFID?

The causes of ARFID are not yet fully understood, but several factors may contribute to its development. It is known to co-occur with other mental health conditions, such as anxiety disorders, obsessive-compulsive disorder (OCD), and depression.[] Identifying and addressing these comorbidities is crucial to ensure comprehensive treatment and support for the individual.

Your patients may have a higher risk of ARFID if they have any of the following:

  • Early childhood feeding difficulties: Some children may have experienced feeding difficulties during infancy, leading to a long-lasting aversion to food.

  • Food-related conditions: Medical conditions, such as gastrointestinal disorders or food allergies, may contribute to food aversions.

  • History of anxiety or trauma: Past traumatic experiences related to eating, such as choking incidents, can lead to fear and avoidance.

  • Neurodevelopmental factors: ARFID is more common in individuals with autism spectrum disorders and other neurodevelopmental conditions.

  • Sensory sensitivities: Individuals with ARFID may have heightened sensory perceptions, making certain textures, tastes, or smells overwhelming.

Recognizing ARFID in patients can be challenging, as it may not always present with obvious physical symptoms like other eating disorders.

Physicians and healthcare professionals can look for certain red flags: Patients may exhibit nutritional deficiencies, resulting in weight loss or growth impairment. Fatigue, weakness, hair loss, and dental issues may also arise due to inadequate nutrition. However, these symptoms take time to develop.

"It’s always a good idea to check in on your patients’ mental health and eating habits."

Anastasia Climan, RDN, CD-N

A quick dietary questionnaire can help identify if any major food groups are being omitted from the diet. If you suspect your patient may be suffering from an eating disorder like ARFID, you can use the The Nine Item ARFID Screen to better assess their risk.[]

A day of eating with ARFID

A typical day of eating for someone with ARFID includes limited food choices and possibly repetitive meals that stick to familiar and “safe” foods.

For example, they may opt for a small selection of breakfast foods, such as plain toast or a specific cereal brand with milk, avoiding any condiments or fruits.

Lunchtime might consist of a sandwich with only one or two ingredients, such as deli meat and bread. They may prefer to eat alone or in a quiet environment. Simple foods like crackers or plain chips may be preferred snacks. A person with ARFID may also have a limited selection of foods for dinner, such as plain pasta with butter or a small serving of plain, well-cooked vegetables.

Long-term effects of ARFID

Untreated ARFID can have severe and lasting consequences on physical and mental health. Some potential long-term effects include:

  • Developmental delays: In children and adolescents, ARFID can hinder proper physical and cognitive development.

  • Gastrointestinal issues: Long-term avoidance of certain food groups may result in gastrointestinal problems and discomfort.

  • Nutritional deficiencies: Insufficient intake of essential nutrients can lead to stunted growth, a weakened immune system, osteoporosis, anemia, and increased susceptibility to illnesses.

  • Psychological effects: ARFID can lead to social isolation, low self-esteem, and anxiety around food-related situations/events.

  • Weight fluctuations: Individuals with ARFID may experience unintended weight loss or weight gain.

Identifying and intervening as early as possible can help minimize the consequences of ARFID on your patient’s mental and physical well-being.

How to help your patients

Once diagnosed, ARFID should be managed with a multidisciplinary approach, including medical, psychological, and nutritional interventions.

Tailor your treatment plan to each patient's specific needs, considering their age, nutritional deficiencies, medical history, and emotional well-being.

Referring patients to a registered dietitian, psychologist, or therapist experienced in treating eating disorders is essential for providing your patient comprehensive care.

A registered dietitian/nutritionist can help create a balanced and varied meal plan that accommodates the patient's food and food-related aversions and ensures adequate nutrition. Some patients may also benefit from nutritional supplements.

A mental health professional can help your patient with the process of being desensitized to their specific aversions through gradual exposure to feared foods in a controlled and supportive environment.

Mental health professionals can also help people with ARFID address any underlying anxiety or emotional issues related to food, through therapy sessions or cognitive behavioral therapy. 

When appropriate, engaging a patient’s family members to create a supportive environment at home can help reinforce positive changes. You may find it helpful to educate your patients and their families about ARFID, its potential consequences, and the importance of treatment. In addition, you may want to regularly monitor the patient's physical health and progress with mental health support.

What this means for you

Physicians can help identify eating disorders like ARFID with simple dietary and mental health screenings. With ARFID, a gradual reintroduction of diverse foods and support from dietitians and mental health professionals are essential. Providing referrals, resources, and ongoing monitoring can help patients avoid long-term complications related to ARFID.

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