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More than picky eating—7 things to know about ARFID

Julie K. Lesser, MD

Most parents can attest to the difficulty of getting kids to try new foods. Picky eating is nothing new, but what happens when it involves many foods, never goes away, or gets worse?  

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder involving an extreme avoidance or low intake of food. Dr. Julie Lesser, MD, child and adolescent psychiatrist at Rogers–Minneapolis, shares seven facts that you should know about ARFID.  

1. ARFID is different than picky eating.

While picky eating and ARFID may have certain similarities, ARFID is differentiated by the level of physical and mental distress that eating causes. Someone with ARFID may have difficulty chewing or swallowing, and can even gag or choke in response to eating something that gives them high levels of anxiety. The anxiety can also cause them to avoid any social eating situation, such as a school lunch or birthday party. 

With ARFID, foods may be avoided based on physical characteristics such as texture, smell, and appearance, or based on past negative experiences like choking or vomiting. ARFID is a new addition to DSM-5, the official list of psychiatric diagnoses. Before this addition, it was classified under feeding disorder of infancy or early childhood, or eating disorder not otherwise specified.

2. ARFID can cause serious health issues. 

One of the most common results of ARFID is significant weight loss, or failure to gain weight and grow, for those who should be in a growth spurt. Significant levels of nutritional deficiency may require higher levels of care for medical stabilization. 

3. ARFID patients are not concerned with weight loss or body image.

Even though weight loss is a frequent sign of ARFID, it’s important to note that this isn’t the reason for avoiding food. The lack of a preoccupation with body image or a fear of gaining weight is one way that ARFID differentiates itself from other eating disorders, such as anorexia nervosa and bulimia nervosa. Despite this, the consequences of ARFID may be just as severe. 

4. ARFID may occur in people of all ages and genders.

While ARFID is more often diagnosed in children and adolescents, it may occur in adults. This might include those who went untreated as children and have a long pattern of selective eating based on sensory concerns or feelings of disgust with new foods. While some eating disorders are more often found in females, ARFID is much closer to an even split or possibly even more common in males than females.

5. Many people with ARFID have co-occurring conditions.

It is common for people who are diagnosed with ARFID to have co-existing anxiety, mood disorder, or other condition, such as autism spectrum disorder. If a medical condition that impacts appetite or eating is present, the degree of food avoidance must go beyond what would be expected for the medical condition to be classified as ARFID.

6. ARFID has psychological and physical warning signs.

Psychological signs can include:

  • Fears of choking or vomiting
  • Lack of interest in food or appetite
  • Picky eating that becomes worse
  • Limiting food intake to particular textures 
  • Complaints of upset stomach or feeling full around mealtimes

Physical signs can include: 

  • Stomach cramps and other gastrointestinal complaints
  • Cold intolerance
  • Menstrual irregularities
  • Difficulty concentrating
  • Dizziness or fainting
  • Sleep-related issues
  • Fatigue 

7. Treatment for ARFID is effective.

Despite ARFID being a recent addition to DSM-5, there are already effective treatment practices in place. One such treatment method, cognitive behavioral therapy with a specific focus on exposure and response prevention has been shown to help patients learn coping skills for long-term recovery.

 

Julie K. Lesser, MD, is a board-certified child, adolescent and adult psychiatrist with the intensive outpatient and partial hospitalization programs at Rogers Behavioral Health–Minneapolis. Dr. Lesser is certified in family-based treatment for eating disorders and in the child and adolescent unified protocol for emotional disorders. In addition, she completed intensive training in interpersonal therapy, dialectical behavior therapy and cognitive behavioral therapy-enhanced for eating disorders. She has a special interest in treatment development for Avoidant/restrictive food intake disorder (ARFID).