ARFID
Is my child or young person a fussy eater like most kids his or her age, or should I be thinking of other explanations? I have summarised some information from the BEAT and RCPsych webpages on ARFID.
Avoidant / restrictive food intake disorder is an eating disorder that is as valid as anorexia, bulimia or binge eating disorder. It is characterised by avoidance or restriction of food intake in terms of overall amount, range of foods eaten, or both. It commonly presents in primary school children but can occur at any age; may affect the ability of the child to eat socially, and may necessitate nutritional supplementation.
“ARFID is also more common in autistic people. One reason for this is that autistic people can have sensory differences. This means that they experience their senses and sensations in a different way to people who aren’t autistic. This can make eating some types of food especially difficult. However, if an autistic person has challenges with eating, this doesn’t mean they definitely have ARFID.” (source: RCPsych link above)
Does it matter if the weight is normal or does the child’s or young person’s growth need to be affected? I think ARFID can be diagnosed if weight is normal, but requires a degree of suspicion from the point of view of the clinician. The child or young person may not be intentionally losing weight, but this may be a result of eliminating major food groups due to:
- sensory-based avoidance or restriction of intake
- concern about the consequences of eating
- low interest in eating
If the child or young person is underweight, it is important to seek help and treatment (talking therapies such as cognitive behavioural therapy, graduated exposure therapy and food chaining, alongside physical monitoring/ nutritional supplementation and dietetic input).
“Is ARFID different to anorexia and bulimia?
ARFID is different from anorexia nervosa, bulimia nervosa and related conditions; in ARFID, beliefs about weight and shape do not contribute to the avoidance or restriction of food intake. A diagnosis of ARFID would not be given at the same time as one of these other eating disorders, although it could precede or follow. A diagnosis of ARFID would also not be given if there is another clear reason for the eating difficulty, such as a medical condition that results in appetite loss or digestive difficulties. People with ARFID can lose weight and become very underweight, their weight may be in a “normal” range, or they may gain weight or have high weight (particularly if their diet is restricted to foods that are high in calories). ARFID can be present on its own, or it can co-occur with other conditions; those most commonly co-occurring with ARFID are anxiety disorders, autism, ADHD and a range of medical conditions. The eating difficulties someone with ARFID has, can have been present for a very long time, in some cases almost as long as they can remember. In other people, it might have a more recent onset.” (source: BEAT link above)
Further information
Beat, ARFID – Information on ARFID from the UK’s eating disorder charity.
National Centre for Eating Disorders, ARFID – Information on ARFID from an organisation that offers information to people living with eating disorders and professionals working with people with eating disorders
ARFID Awareness UK – A charity dedicated to raising awareness and furthering information about ARFID.
Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults, Jennifer J Thomas – This book is written by experts in ARFID, and looks at CBT and how it can be used to treat ARFID (source for this section: RCPsych link above)