What is ARFID?

ARFID is Avoidant and Restrictive Food Intake Disorder. It’s a relatively recent eating disorder addition to the DSM-V (the Diagnostic and Statistical Manual of Mental Disorders fifth edition), having been added in 2013.

ARFID is separate to any eating disorder like anorexia that is about fear of weight gain, or body dysmorphia. But exhibiting ARFID can still lead to decreased food intake, which can result in low weight gain and slow growth.

How many people have ARFID?

Some research indicates that up to 34% of all eating disorders in children could be ARFID. It is likely to be long term, beginning in early childhood and continuing for many years such as 4-11 years of age.

What is ARFID?

According to the criteria for diagnosis, there are 4 elements that must be met for ARFID.

  1. There must be an eating disorder that results in either large weight loss, nutritional deficiency, or reliance on supplements (such as oral formula or tube feeding). The reasons for this could be low appetite (skipping meals, eating little), avoidance of foods due to sensory aversion (not liking smell, taste or texture, often avoiding entire categories of foods like vegetables), or not wanting to eat foods due to fear of vomiting, choking or nausea.
  2. The avoidance or restrictive eating is not related to lack of food availability or cultural practices.
  3. The restrictive eating to is because of other eating disorders such as anorexia nervosa or bulimia nervosa. If there is no concern about body image or body weight then this criteria is met.
  4. There is not another condition that explains the symptoms e.g. a gastrointestinal disease.

As this is a relatively new diagnosis, there is not a large research base on it. However, there are some questionnaires that have been developed, such as the Eating Disturbances in Youth-Questionnaire (EDY-Q) that can be used to diagnose ARFID.

What do children with ARFID look like?

Children could

  • be underweight, have a higher weight or be of normal weight
  • be very “fussy” or restrictive about what foods they will eat, having a narrow selective of acceptable foods. This could include avoiding whole categories of foods e.g. fruit and vegetables.
  • have malnutrition, slow growth, or delays in puberty
  • also have ASD, ADHD or developmental delays.

A 2019 paper suggests key questions for determining a diagnosis in their Box 3.

How to treat ARFID?

It is a complex diagnosis, so multiple experts (in a multidisciplinary team) are generally required to work together. This might include psychologists, occupational therapists, dieticians, and speech pathologists.

Family-based therapy and cognitive behaviour therapy are generally considered effective approaches to changing eating behaviours. This involves the whole family working towards increasing acceptance of foods and could take 6-12 months.

This can include strategies to expose children to more foods, to desensitise any sensory aversions. It can also include regulation strategies, such as mindfulness, to help reduce fear related to foods. In addition, strategies such as gradual reintroduction of foods in a low-pressure environment can be part of treatment.

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