Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder (ARFID) is a type of eating disorder in which people eat only within an extremely narrow repertoire of foods.

It is a serious mental health condition that causes the individual to restrict food intake by volume and/or variety.

ARFID is not a condition that is created by one’s conscience.

It is subconscious process that prohibits the person with the condition from eating certain foods to the point where they will refuse to eat anything and starve themselves if not given options of what their sub-conscience has deemed safe foods.

Food avoidance may be based on its appearance, smell, taste, texture, brand, presentation, fear of adverse consequences, lack of interest in food, or a past negative experience with food.

Associated findings: sensory sensitivity to tastes, textures and the appearance of foods, selective eating and fear of new foods, fear of certain foods causing pain and discomfort fear of vomiting and/or gagging caused by new or unsafe foods, 

low appetite or disinterest in food

gastrointestinal problems when eating unsafe foods,  feeling poisoned, autism spectrum disorder and anxiety disorders.

ARFID may lead to nutritional deficiencies, failure to thrive, or other negative health outcomes.

The fixation is not caused by a concern for body appearance or in an attempt to lose weight.

Patients with ARFID have an inability to eat certain foods. 

foods  may be limited to certain food types and even specific brands.

Some individuals will exclude whole food groups, such as fruit or vegetables, or refuse foods based on color. 

Some may have preferences for  very hot or very cold foods, very crunchy or hard-to-chew foods, or very soft foods, or avoid sauces.

Most people with ARFID will still maintain a healthy  body weight. 

individuals with the condition can experience physical gastrointestinal reactions to adverse foods such as retching, vomiting or gagging. 

Some have social avoidance due to their eating habits. 

Most people with ARFID would change their eating habits if they could.

Sub-categories for ARFID:

Sensory-based avoidance, where the individual refuses food intake based on smell, texture, color, brand, or presentation of food.

A lack of interest in consuming the food, or tolerating it nearby

Food being associated with fear-evoking stimuli

ARFID symptoms are usually found with symptoms of other disorders or with neurodivergence. 

Some form of feeding disorder is found in 80% of children that also have a developmental disability.

Children With ARFID often  exhibit symptoms of obsessive-compulsive disorder and autism. 

Although many people with ARFID have symptoms of these disorders, they usually do not qualify for a full diagnosis. 

Strict behavior patterns and difficulty adjusting to new things are common symptoms in patients that are on the autistic spectrum.

Children with some degree of autism spectrum disorder (ASD) have a higher degree of selective eating  and favored more energy dense foods such as nuts and whole grains. 

Eating a diet of energy dense foods could put these children at a greater risk for health problems such as obesity and other chronic diseases due to the high fat and low fiber content of energy dense foods. 

ASD, children are less likely to outgrow their selective eating behaviors,

Specific food avoidances could be caused by food phobias that cause great anxiety when a person is presented with new or feared foods. 

Most eating disorders are related to a fear of gaining weight., but 

Those with ARFID do not have this fear, but have psychological symptoms and anxiety that is similar.

ARFID fears may include emetophobia, the fear of vomiting, or a fear of choking.

Anorexia nervosa differs from ARFID because in ARFID the lack of food intake is not related to body image or weight concerns. 

Patients with ARFID were significantly younger (10.8 vs 14.1 yrs old) with an earlier onset of illness (6.2 vs 13.7 yrs old) and a longer evolution time (61.2 vs 8.4 months) than those with anorexia nervousa.

A greater proportion of the ARFID patients are male rather than female (60.6% vs 6.1%) in anorexia nervosa.

There may be a higher rate of ARFID in young boys than there is in young girls.

In a study conducted between 2008 and 2012, 22.5% of children aged 7–17 in day programs for eating disorder treatment were diagnosed with ARFID.

In a 2021 study ARFID also has a high comorbidity with ASD, with up to 17% of adults with ASD at risk of developing disordered eating, with modest evidence for heritability. 

Among children, one study revealed a 12.5% prevalence of ASD among those diagnosed with ARFID.

Other risk factors include sensory processing sensitivity, gastrointestinal disease and anxiety associated with eating.

Prevalence among children aged 4–7 is estimated to be 1.3%, and 3.7% in females aged 8–18.

The female cohort study also had a BMI of 7 lower points than the non-ARFID population.

Previously defined as a disorder exclusive to children and adolescents, the DSM-5  includes adults who limit their eating and are affected by related physiological or psychological problems.

The DSM-5 diagnostic criteria:

Disturbance in eating or feeding, as evidenced by one or more of:

Substantial weight loss, or, in children, absence of expected weight gain.

Nutritional deficiency

Dependence on a feeding tube or dietary supplements

Significant psychosocial interference

Disturbance not due to unavailability of food, or to observation of cultural norms

Disturbance not due to anorexia nervosa or bulimia nervosa, and no evidence of disturbance in experience of body shape or weight.

Disturbance not better explained by another medical condition or mental disorder.  

Children are often picky eaters, but this does not necessarily mean they meet the criteria for an ARFID diagnosis. 

Picky eating, which can exhibit symptoms similar to those of ARFID, can be observed in 13%-22% of children from ages 3–11

The prevalence of ARFID has range from 5% to 14% among pediatric inpatient eating disorder programs and as high as 22.5% in a pediatric eating disorder day treatment program.  

 Because of ARFID’s subconscious nature, means it cannot be combatted through bribery, reason nor shouting, threatening or coercing, and using such methods can lead to the condition or the anxieties associated with it worsening.

Eating or not eating certain foods is not a preference, but rather a necessity.

Some people with ARFID can also be scared of new experiences as a whole or novel situations where food is present.

ARFID can lessen and can eventually disappear without treatment. 

Those who struggle with ARFID may find it difficult to eat in a variety of settings such as at a friend’s house, in cafeterias, or at events. 

TheyPatients may also find it challenging to be around certain types of foods. 

Anxiety experienced can significantly limit their ability to engage in age-appropriate social settings and cause an increase in isolation. 

A picky eater is usually able to attend social activities with little to no distress regarding foods that will be present or the environment itself.

Picky eaters may not eat a food due to the smell or look of a food, they often can tolerate a variety of textures, smells, and visual presentations of food with some distress. 

With ARFID there is increased anxiety and inability to consume foods due to texture, taste, smell, visual presentation, without high distress or other symptoms such as gagging or spitting out food.

While a picky eater may also avoid a food due to a negative experience, those struggling with ARFID have an intense aversion to foods either due to the fear of choking or vomiting, witnessing someone choking or vomiting, or a real or perceived allergic reaction.

The avoidance of these foods can often be extreme in response to an aversive situation.

A lack of interest in food or eating can be a sign of ARFID.

Patients ARFID will say they are not hungry, do not think about food, and can even forget to eat because food is not a priority. 

Picky eaters do often feel hungry, are interested in eating the foods they enjoy, and do not have the same lack of interest in food and eating.

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