What are the 3 types of ARFID in Adults
ARFID, Avoidant-restrictive food intake disorder, is a relatively new eating disorder. Introduced into the DSMV in 2013. Many people may not be aware that what they have is an eating disorder. Because it is rare, it is estimated that only 0.3% of the population have ARFID. A person might think that they are just a picky eater, or they had a poor experience with food in their childhood. In this post, we are exploring the 3 types of ARFID in adults.
What is ARFID?
(ARFID)Avoidant-restrictive food intake disorder also known as selective eating disorder is an eating disorder where a person avoids eating specific foods or whole types of food. It is far more than just “picky eating,”
Long term, food avoidance could lead to adverse consequences such as a failure to meet your nutritional needs. This could result in symptoms such as dry hair, brittle nails and a decrease in weight.
There are 3 types of ARFID which we will go into further detail, Avoidant, Restrictive, and Aversive.
Avoidant-restrictive food intake disorder is listed as an eating disorder in the DSMV, which is the Diagnostic and Statistical Manual of Mental DisordersDSM-5, being the fifth version. This is what mental health practitioners refer to as a diagnostic tool.
To be diagnosed with ARFID, you have to meet the full criteria and be diagnosed by a psychiatrist. However you may not meet the full criteria, but that does not mean that you not experiencing some of the common symptoms such as food avoidance, a disinterest in food or extreme pickiness.
What I see with adults with Avoidant-restrictive food intake disorder is that there is a genuine desire to be able to eat a wider variety of foods and to improve their nutritional intake. Most would love a better relationship towards food.
So how and where do you begin to heal? It’s hard to do it on your own, especially if you have other psychiatric comorbidities and have suffered from sensory issues as a child.
Imagine your worst food that you hate, mushrooms are usually quite high up there. Someone then says you must eat them because they are good for you. The thought of eating them is making you recoil in disgust. So how are you supposed to get yourself to eat the food that disgusts you.
This is why many with avoidant-restrictive food intake disorder will stick to their acceptable foods, which may well be crunchy hard foods. It feels safe and eating does not produce anxiety disorders.
ARFID is Not
Avoidant-restrictive food intake disorder is not about weight loss, nor is restrictive eating done on purpose. Usually, a person with ARFID may have concerns about body weight but body image is not the primary concern as it may be with other eating disorders.
The restriction of food is also not due to cultural practice or because of a lack of food available.
ARFID is not to be confused with Anorexia Nervosa. The symptoms are very different. With Anorexia Nervosa your weight and control of food is the focus. You can eat most foods, there is no fear, sensory issue or pickiness. All foods are restricted for a purpose.
Further Reading – How to manage your emotions without food
Genetic causes of ARFID
Studies suggest that ARFID is highly heritable. The genetic component is the same as people with neuropsychiatric disorders, such as Autism and ADHD.
Those with Autism spectrum disorder and other comorbidities in children are more than likely to have sensory issues. So have difficulty when introduced to a variety of foods as a child. Many parents will attest to the meltdowns or food refusal based on colours, smell and feel of the foods.
Social & cultural causes of ARFID
Social and cultural causes of ARFID can be a contributing factor, but not an alone cause. Expecting yourself to eat certain foods or dishes in front of people is a lot of pressure and can leave you with negative consequences on your psychosocial functioning. Being expected to eat in social settings can cause any anxiety disorders to get worse and eating ends up being stressful.
People learn socially to eat in a guarded way. It is challenging to eat in a restaurant with severe food selectivity. This leads the person to feel judged, like they have to explain their condition, and to not enjoy what could be pleasant interactions.
Out of the 3 types of ARFID, socially factors could affect the fear of negative consequences more because it can be very apparent when you have issues with eating and it is in front of people.
Psychological causes of ARFID
People with Avoidant-restrictive food intake disorder are more than likely to have been diagnosed with other mental disorders, such as ADHD and or Autism spectrum Disorder.
With ADHD you can struggle with concentration and impulse activity. Studies have also shown that with ADHD you are more than likely to suffer from an eating disorder or some type, such as Binge Eating Disorder.
People with Autism spectrum Disorder experience over-sensitivity around objects but can be under-sensitive with the proprioceptive sense. The body awareness sense.
For example, a person who has been diagnosed with ASD might find common symptoms of eating are overly sensitive to slimy food such as mushrooms, but will be fine with a biscuit because of its hard crunchy texture.
The 3 types of ARFID
- Sensory avoidant. You avoid types of food due to sensory issues such as textures, tastes and smell.
- Lack of Interest. You feel indifferent about food. It does not excite you or give you satisfaction.
- Fear of negative consequences. You fear choking, vomiting, nausea or pain upon swollowing.
Here are the 3 types of ARFID in more detail.
1. Sensory ARFID or Avoidant
Sensory ARFID is characterised by a sense of disgust at the taste, textures, smell, or feel of food. A typical disgust is the thought of eating mushrooms and the thought of the slimy nature feels people leaving disgusted.
People with autism are particularly affected by this type of restrictive eating due to sensory features such as over-sensitivity issues.
People with no understanding of avoidant-restrictive food intake disorder may think this is picky eating.
Many people will have a list of acceptable foods. This will more likely be familiar food in taste and texture. They may have a strong preference for certain food textures, such as smooth or crunchy, and an aversion to others, such as slimy or mushy.
Severe food selectivity can also be prevalent with look and smell as well as texture. For example, cake that is broken up on a plate. Food that is touching one another.
The smell could be overpowering, such as certain meats or strong vegetables.
It can be hard to build a positive relationship with food, when you feel so much disgust towards it. However through it is possible. One common treatment is systematic desensitization where you slowly get used to a food.
Further Reading
How to overcome meat aversion in adulthood
2. Lack of interest ARFID/ Selective Eating ARFID
A person with a Lack of interest/ selective eating ARFID, also known as “food neophobia,” can show up as having little to no interest in eating or having limited food preferences. It is not that they dislike food, they just don’t seem to have the hunger cues that tell them to eat and food does not excite them. They feel indifferent about it and hence they can get so distracted doing things that they forget to eat.
This type is also called restrictive ARFID, although all types are restrictive in nature.
Many people grow up with a limited variety of food. As a child you would have been introduced to new foods but would have preferred to only eat familiar food. This felt safe.
Because the brain did not learn to experience different tastes, textures and smells, the brain wants you to stick to what is safe and familiar food. These dietary restrictions can lead over time to nutritional deficiences and or a decrease in weight.
Supplements can be added to a diet to enable a person to meet their nutritional needs and to be a healthy weight.
Lack of interest ARFID/ selective Eating ARFID is not the same as Anorexia Nervosa. Anorexics purposefully control their restriction of food intake. Their goal is to control caloric intake and some have a fear of weight gain. Another symptom is body image distortion, where they would believe they are bigger than they are. Striving for weight loss is common here, whereas that is absent with people with avoidant-restrictive food intake disorder.
People with Avoidant-restrictive food intake disorder are not purposefully controlling their restriction of food intake. Most would genuinely love to be able to eat a wider variety of foods and have a better relationship towards food.
3. Fear based ARFID
Aversive ARFID is based on a fear of the negative consequences of eating certain foods. This could be a fear of choking, vomiting, pain, difficulty swallowing, and nausea. This causes the individual to have an aversion to those foods.
As a child, you likely had adverse consequences when eating different textures of foods. The unconscious remembers this and then to protect us it stops us from eating those types of food again.
An aversive consequence could have developed from an allergic reaction, or stomach aches not related to the food, but the child made an association between pain and food and thus led to eating only their acceptable foods.
Food phobias can develop with this type of avoidant-restrive food intake disorder. With a food phobia you might experience an absence of food groups such as fruit as they have seeds in them and have a slushy texture.
Adults with ARFID
Sometimes an adult can develop avoidant-restrive food intake disorder when they have not been diagnosed as a child. They developed it in adulthood. There may well be another co-morbid condition contributing to this as well such as Autistic spectrum disorders, or a depressive disorder. You could have experienced a level of trauma. Trauma does not have to be a major thing, examples of trauma are undue stress, grief, abandonment and or abuse. Minor traumas could have happened, for instance, bullying at work, bullying by a partner, dealing with a child who has complex needs and it is stressful. Over some time the stress leaves us depleted and this is where eating disorders can begin, albeit slowly.
An adult is also likely to experience a level of emotional eating. This is where eating combats an emotion. For instance you’re feeling stressed and food calms you down. Your relationship towards food could be distorted.
Further Reading – How to treat ARFID in Adults
ARFID Treatment for Adults
Arfid disorder treatment can include many different modalities. It is helpful to enquire into as many as possible so you can find the right approach for you. Many people with Avoidant-restrictive food intake disorder find a multi-disciplinary approach helpful. Some Eating disorder centres will have a treatment program where you are addressing your nutritional needs and psycological state.
You may choose a treatment programme more aligned with your needs. If you are suffering from one type of ARFID, you can choose a therapist for that specific neeed. If you are suffereing with the 3 types of ARFID, this is where a multi-disciplinary approach may help.
People find help from trained professionals who have experience with Avoidant-restrictive food intake disorder in these fields
A dietician can help reduce mealtime feeding and anxiety. They assess nutritional needs and deficiencies and give advice on how to introduce new foods and enteral feeding. They can also identify foods that will fit in with your sensory preferences so your nutritional needs can still be met.
Can help you to assess your physical needs and abilities in being able to access food, chew and eat properly. They can help with systematic desensitization and finding ways to overcome your avoidance with exercises. This therapy can be helpful if you have had speech difficulties in your childhood and it affected the way you can use your tongue and mouth.
Psychotherapist/Hypnotherapist.
This treatment Can help someone with the 3 types of ARFID such as psychological fear, sensory, and avoidance. The therapist will address any underlying anxiety around food. If a traumatic experience is contributing to your ARFID they will help you to address that. They can help you to find ways to navigate social settings around food that may cause anxiety.
They may well incorporate treatments such as CBT (Cognitive-behavioral therapy) and or behavioural therapy, which helps you to break down your behaviours and your thoughts to observe what is contributing towards your Avoidant-restrictive food intake disorder.
Read more about ARFID treatment here
Further Reading – What to expect during therapy
ARFID and other Mental Disorders
The goals of treatment can vary from person to person. With some people, it may be improving your physical health and ensuring you are meeting your nutritional needs. This can involve working closely with a dietitian or nutritionist who can develop a meal plan that takes into account the individual’s sensory preferences and ensures they are getting all the necessary nutrients.
A therapist such as psychotherapist can help you in managing day to day life with other mental disorders that could be affecting your eating. They could help with your emotional eating.
A multi-discipline approach helps you to address your Avoidant-restricive food intake disorder from all angles. It allows you to be in control of your own treatment program.
There is no need to suffer alone, there is help out there from charities which are listed below and trained professionals.
Charities that help with ARFID in Adults
ARFID Awareness UK – https://www.arfidawarenessuk.org/copy-of-what-is-arfid-1
Beat Eating Disorders – https://www.beateatingdisorders.org.uk/
Mind – https://www.mind.org.uk/
Do you want help with ARFID?
Book in your FREE call and find out how an ARFID therapist can help you, or call 07979 344820
