We all experience being picky with our food from time to time. We all have different and specific tastes. This can extend to textures and smells and the look of food. We can all think of a food that makes us want to vomit at the sight or thought of it. For adults with ARFID, it is more than that.
For many adults, this is an everyday occurrence. It is much more than picky eating or selective eating. Food aversion is a strong dislike for certain foods and there is a fear to try new foods.
ARFID, Avoidant Restrictive Food Intake Disorder is classified as an eating disorder in the DSM 5. It is a serious eating disorder that can lead to malnutrition and other health problems. Understanding ARFID is an important step in identifying and treating the disorder.
Known as selective eating disorder. According to the DSM 5, there are three profiles; Sensory sensitivity, meaning you are sensitive to tastes, smells and textures. Fear of aversive consequences, meaning a fear of choking on food or vomiting. A lack of interest in food or eating.
It is characterised by an apparent lack of interest in eating foods or eating certain foods. It is present when no other medical condition can explain it and is not because of a lack of food. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which you view your body weight or shape.
Symptoms of ARFID
The only people who can give a diagnosis of ARFID will be a clinical psychologist or an eating disorder specialist. If you think you may have an eating disorder, your doctor, or a health specialist with the NHS could be a good place to start.
ARFID symptoms in adults are:
- You have a diet that is limited to only a handful of foods. It might include hiding the food.
- Avoiding whole food groups or textures, such as vegetables or slimy food.
- You avoid social events where food is present as much as possible.
- More sensitive to aspects of some foods, such as temperature.
- You gag or retch at the smell or sight of a certain food. You have a strong dislike for a particular food.
- You have difficulty being in the presence of another person eating a certain type of food that you dislike.
- Need to take supplements to meet your nutritional needs
- A lack of interest in eating and you may miss meals altogether.
- Struggle to stay and/or eat at a table during family mealtimes.
To have an ARFID diagnosis there also has to be present:
Your eating pattern is not explained by a lack of available food.
Your eating pattern is not better explained by another mental disorder or a medical condition.
Other Neuropsychiatric disease and treatment
Studies have noted another mental disorder that presents with ARFID, this tends to be OCD, ADHD, bi-polar and depressive disorder.
There are also similarities in the eating patterns between people presenting autism spectrum conditions and arfid. This might include sensory sensitivity, high anxiety around food or a lack of interest around food.
Causes of Arfid in adults
It is not known what causes ARFID in adults. ARFID is more commonly found in children and adolescents. Children with ARFID may have experienced sensory sensitivity and your parents may not have understood your eating preferences.
As a baby, there may have been distressing experiences such as choking or vomiting after eating certain foods. There may have been traumatic experiences around meal times or food times that the child has associated with a fear of food.
This may have continued into adulthood and your eating behaviours have never changed.
Another study suggests that ARFID is hereditary. The study is suggesting that ARFID is heritable up to 89%, which is higher than autism (79-84%) and ADHD (76-89%).
I have seen adults develop a sudden food aversion, due to trauma and or have been through a traumatic/ stressful time and their eating has been affected. Adults could find it hard to change their pattern of avoidance of food and may not know where it has come from as ARFID affects adults in different ways. Some adults develop ARFID years after the trauma has occurred. Some find that the amount of food they eat has declined and others develop what is seen as picky eating. Adults with ARFID might avoid eating in front of others and socialising with food.
Food can be an anaesthetic and can also be the one thing that you can control if you feel out of control with other aspects of your life. This will be happening on an unconscious level.
ARFID vs disordered eating
ARFID is different to other restrictive eating disorders in that:
ARFID isn’t affected by a person’s beliefs about the size and shape of their body.
Someone with ARFID doesn’t restrict their food intake for the specific purpose of losing weight.
ARFID doesn’t feature some of the other behaviours that can be associated with anorexia, bulimia, or OSFED, such as over-exercising.
Disordered eating does not cut out entire food groups.
With disordered eating, your pattern of eating is irregular. You may eat too much at times and diet on other occasions. These are still restrictive eating habits.
Someone who is a serial dieter may not be suffering from ARFID as they are cutting back on the quantity of food, and swapping unhealthy food to healthier options.
The difference between ARFID and anorexia around eating is that anorexia does not display a dislike or fear for a particular food. People avoid eating altogether. They simply avoid the food. ARFID is similar to anorexia in that there could be nutritional deficiencies and low weight, although ARFID is not driven by a desire to be thin.
At the moment, there is no evidence-based treatment for ARFID. Evidence-based, meaning not enough studies have been done on various treatments or not enough research has been done on one particular treatment. This is because ARFID is a relatively new eating disorder in the DSM5. However, please do not let that deter you and feel that it is hopeless, far from it. ARFID is treatable and many people with ARFID have recovered from it.
Some of the different treatments for adults available are:
CBT (Cognitive behavioural therapy) Ths is a form of psychotherapy that helps you to become aware of your eating patterns. You become aware of your thoughts and behaviours and you turn the negative non-helpful thoughts into positive ones. You also become aware of your behaviours so you can change and manage them better. They will explore your sensory processing process so you can become aware of your reactions to different foods.
This includes counselling, psychotherapy. It involves talking about your issues. The therapist listens, reflects back and helps you to see the cause of your eating disorder. Many times people with eating disorders have experienced some kind of trauma or had an upsetting time in their childhood.
The emotions may have been suppressed and the only outlet for your emotions is to control your food. The therapist helps you process these suppressed emotions.
A therapist will look at the whole picture when looking at your eating disorder treatment.
People with ARFID may be suffering from nutritional deficiency, so seeing a dietician or nutritional therapist can help guide you towards healthier foods that you feel capable of eating.
Medical Doctor (G.P.)
It is advised that you see and discuss your issues with your medical doctor. They could provide you with extra resources and help that you may not be aware of. Because ARFID involves food restriction, your health could be at risk. ARFID can be fatal. Your doctor could be very helpful so they will be a key member of their treatment team.
ARFID is treatable
The goals of therapy could include getting you to eat a wider range of foods, helping you to become comfortable with more textures and tastes and food. Increasing your interest in food and decreasing any anxiety about food. They could get you comfortable eating with others.
The therapist could help you with what is known as the opposite of aversion therapy, where you are introduced to situations and food slowly and you become comfortable with them.
Treating adults with ARFID, may not necessarily focus on food, it may be effective to work on the cause of the eating disorder if ARFID started in adulthood. It is aimed at eating recovery.