When Is It More Than Just “Picky Eating”? What You Need To Know About ARFID

When Is It More Than Just “Picky Eating”? What You Need To Know About ARFID

No one tells you how much of parenting will revolve around feeding your kids. Eating seems like it should be such an intuitive thing – until it isn’t. If you have a child who doesn’t like to eat, then you know how quickly feeding concerns can overwhelm your life. Unfortunately, many families with “finicky” or “picky” eaters spend years of their lives trying to investigate, cope with, and resolve their child’s struggles with food.

Many young children who struggled with “picky” eating have historically been labeled as having a Feeding Disorder and were treated primarily by pediatric feeding experts, occupational therapists, or speech and language pathologists. However, older children and adults with eating problems that fell outside of the “traditional” eating disorder box struggled to be diagnosed and receive treatment.

But now there is a new acronym in eating disorder treatment: Avoidant/Restrictive Food Intake Disorder (ARFID). This diagnosis captures a wide variety of feeding and eating challenges related to limiting food intake due to low interest in food or aversions to certain types of foods, and is not limited to children. Unlike other eating disorders, ARFID is not typically characterized by body image concerns.

Warning signs of ARFID

So how do you know if someone’s challenges with eating are “normal” or if they are a medical or mental health problem? When it comes to eating, all of us have some strong preferences – flavors, temperatures, level of spice, etc. It is also common for toddlers to go through a developmental period where their range of preferred foods narrows for a while and they may eat less. Many people may also temporarily change their eating habits following an illness or an incident of choking. And there are medical conditions and allergies that can cause us to make changes to our diet and become more cautious about our food intake.

These behaviors go from being “normal” to an eating disorder when it starts to affect someone’s physical or mental health: their height or weight, their nutritional status, and/or their social, emotional, and cognitive wellbeing. In other words, if intense preferences, loss of appetite, aversions, or fears start to interfere with the ability to live life fully, that means it’s time to get help.

Three subtypes of ARFID

ARFID is generally understood as having three main types, known to professionals as ARFID “presentations,” and many patients experience symptoms or behaviors of more than one presentation. These subtypes are:

  • Low interest in food and low appetite. Many individuals with ARFID may have struggled with feeding from birth, sometimes being designated as “failure to thrive” by their pediatrician. They may lack hunger cues, get full easily, and tend to avoid eating. Sometimes this low appetite stems from another medical condition or from a medication; for instance, having ADHD can make it hard to stay in tune with hunger cues, and stimulant medications to treat ADHD can blunt appetite.
  • Selective eating due to sensory sensitivity. In this presentation, selective eating is driven by intense aversions to or strong preferences for certain textures, colors, smells, and tastes. This high level of sensitivity is common among individuals on the Autism Spectrum but can also be present in those who are not. These individuals will have a very limited number of foods they feel safe eating. Often, pre-packaged foods from a specific brand or items from a particular fast food restaurant are the only acceptable foods, as they are consistent, predictable, and easier to eat.
  • Avoiding foods because of a specific feared outcome. Common food-related phobias include fears of vomiting, choking, allergic reaction, illness, or pain. Symptoms  may suddenly appear after a traumatic eating-related incident, or the fear may grow slowly over time after experiencing multiple upsetting events. This presentation is most often associated with a sudden and significant drop in weight that may lead to hospitalization.

Finding treatment for ARFID

If your loved one has symptoms of ARFID, your family may have been struggling with feeding challenges for a while. Parents are often given the advice to “ignore it” or told it’s a phase your child will grow out of. You may have even been blamed or shamed for the way you or your child eats. ARFID is not your fault. We know that eating disorders are not a choice and that parents do not cause eating disorders.

The good news is that ARFID is treatable. If you recognize any of the warning signs of ARFID, you deserve the right support. With Family-Based Treatment (FBT) and Cognitive Behavioral Therapy (CBT), recovery can happen at home. Getting an evaluation and a treatment plan is the first step in healing a fraught relationship with food,and helping your whole family find more peace and connection–during meals and beyond the dinner table.

Oona Hanson
Oona Hanson

Family Mentor

About Equip

Equip is a virtual eating disorder treatment program helping families recover from eating disorders at home. Equip’s holistic, data-driven, gold-standard care program is delivered by a team of five care professionals, giving families confidence they’re providing the best opportunity for progress and lasting recovery.

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