ARFID: Beyond Picky Eating

Understanding ARFID

Eating disorders are confusing for anyone to understand. There are many misconceptions around each diagnosis, with most people thinking that it is always due to poor body image, shape, size and weight. It is not commonly known that there is far more complexity underneath this, and some individuals have an eating disorder that does not stem from these concerns. A lesser-known eating disorder is Avoidant/Restrictive Food Intake Disorder (ARFID). Understanding ARFID is important as the risks as just as serious as other eating disorders.

Instead of focusing on body, weight and self, those with ARFID have an opposition and avoidance to eating, and an overall disinterest in food (1).

ARFID is more complex than just ‘picky eating’.

Commonly, this stems from one of the following:

A fear of choking/traumatic choking experience
Fear of contamination
Sensory discomfort and avoidance
Fear of vomiting
Little interest in food/eating (2)

Ultimately, this may lead to a state of malnourishment, weight loss and mental health implications, restricting your ability to function daily (3).

What causes ARFID?

Humans living with ARFID commonly have other mental health conditions, such as autism, obsessive compulsive disorder, anxiety disorders, or ADHD (4). The presence of these conditions increases the risk of developing ARFID.

The cause varies for each person, often based in anxiety surrounding negative consequences of eating particular foods.

Research has found that a combination of genetic, psychological and traumatic events can result in the development of ARFID (5).

How common is it?

ARFID is estimated to occur in 1 in every 300 Australians (7).

It is a relatively new diagnosis, introduced to the ‘feeding and eating disorder’ category in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), in 2013 (8).

Research is still growing, especially around how best to treat this disorder. As in all eating disorders, it is vital to take action early into the progression of the disorder, with early intervention and support giving the individual the best possible chance of recovery and a healthy, fulfilling life.

ARFID is most common in childhood and adolescence, and is more common in girls than boys (9). Despite being initially regarded as a childhood condition, it is now understood to also persist into adulthood for many.

Misconceptions

People with ARFID are often misunderstood, with healthcare professionals unaware of the complexities of the condition.

Unlike most eating disorders, ARFID does not stem from insecurity and anxiety related to one’s appearance.

People living with ARFID have an overall disinterest in their body image, more focused on the way that food makes them feel and the anxieties it presents.

ARFID is more than ‘picky eating’

It is a serious mental health condition that can greatly reduce someone’s quality of life. Understanding ARFID as well as the serious physical and psychological implications it can cause is important as it can leave someone in a state of severely poor health.

Contrary to popular belief, ARFID is not just a childhood condition. Not everyone will fully recover as a child. Many improve, and learn to live alongside the condition.

I [Tara] was always told ‘you will grow out of it’, ‘you are just a fussy eater’. My ARFID stemmed from the sensory overload I experience when I consume certain textures, flavours and colours of foods.

It is a strange condition to describe to people who don’t understand that eating disorders can exist beyond body image preoccupation.

How Do I Get Better?

If you, or anyone you know is living with ARFID the most important thing to remember is that treatment and recovery is always possible. The involvement of an Accredited Practising Dietitian (APD) is essential in helping you establish a sweeter relationship with food.

As someone with a lifetime struggle with ARFID, I have a unique understanding from my own perspective surrounding the condition. I am passionate about education of the illness to all – friends, family, treatment professionals, society as a whole.

I know how beneficial having a Dietitian on your treatment team is, as I worked with many over my life who helped me rebuild my relationship with food, and establish healthier eating behaviours. My relationship with food today is much better, and I credit this to the treatment I was so lucky to receive.

The Dietitian’s at Sweet Spot Health (6) are educated, informed and human-centred, and can help guide you on your path to healing and reclaiming the narrative of your life.

tara has a lived experience of ARFID eating disorder

What is the Most Effective Treatment?

As with all eating disorders, early intervention is crucial in providing the individual with the best chance of full recovery.

Treatment for ARFID involves identifying the reasoning and anxiety underlying the aversion to eating.

Determining what is perpetuating the cognitions and illness is the best way to take action and work towards change.

It is best to work with a medical professional (such as your GP), an Accredited Practising Dietitian (APD), and a Psychologist at a minimum. A multidisciplinary team can work cohesively to provide support and change that is sustainable to maintain.

Treatment may include cognitive behavioural therapy (CBT), exposure therapy, and regular medical assessment of physical health (10).

The implications of ARFID may cause weight loss, so weight restoration may be required in restoring your health.

There are ways to combat each trigger. A common cause of ARFID developing is a traumatic experience of choking, or fear of choking. A speech-language therapist can do a swallowing and feeding examination (11). This can help alleviate the fear of this choking, or provide strategies in feeding and eating to challenge this fear.

I Have A Loved One With ARFID – How Can I Help?

It is important to show care, understanding and patience with anyone suffering with an eating disorder.

Validation of how difficult living with ARFID is can help your loved one feel understood and listened to. Remembering, this condition is not a choice.

Seeking a professional treatment team, educating yourself, and showing unwavering support and love is what will lead to healing.

Working on the anxieties underpinning the condition can be confronting and distressing, so it is important to keep your loved one safe and supported in these moments.

Staying calm, avoiding blaming and rewarding progress can also help recovery. You may hold frustration toward them and the condition, but it is important to remember that eating disorders are not a choice.

If you think a loved one may be struggling with ARFID, try one of these conversation starters to help them to open up:

I’ve noticed you are getting increasingly selective with what you are eating. Do you want to tell me a little bit more about that?

I feel you have become preoccupied with food, avoiding certain foods you used to love. Is there anything you can tell me about that?

I am worried about how little you show interest in food, and avoiding eating with our family. Did you want to speak to someone about that?

I Have Been Diagnosed With ARFID – Where To From Here?

An eating disorder diagnosis is difficult to come to terms with.

But, treatment for ARFID can lead to lasting management and recovery from the condition.

I struggled immensely with ARFID through my childhood and adolescence, but with repeated exposure and support from loved ones, I have been able to open up and diversify my eating.

There are many educated medical professionals, able to provide support and understanding for you and your symptoms. Engaging with a multidisciplinary team is essential in ensuring you are being monitored and making progress towards recovery.

Recovery from ARFID is Possible, With Support

It is so helpful to begin opening up to friends and family around the thoughts you may be having. Working through these thoughts with someone else may help you rationalise them.

The team at Sweet Spot Health are educated, informed and human-centred. Their team of Dietitians can help you make steps towards challenging your thoughts and fears.

Maddi Parsons is the founder of Sweet Spot Health, an Accredited Practising Dietitian, and a Credentialed Eating Disorder Clinician. She has comprehensive experience with ARFID, and can work with you to take steps forward.

Reach out to book a strategy call with the Sweet Spot team today.

This blog post was co-written by our student intern Tara Finn. Tara is a 21 year old student, studying Nutrition and Dietetics (Honours). Having battled with an eating disorder for the majority of her life, she understands the complexity behind why the behaviours manifest and has learnt skills to overcome them. Tara is firmly in recovery and is passionate about helping others find their sweet spot with food. Learn more about Tara here.