Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder, and so ARFID treatment should be pretty similar to the treatment for, say, anorexia or bulimia, right? Well, yes and no. First, it’s important to note that every eating disorder manifests differently, and so treatment is always individualized. But secondly, ARFID has some distinct characteristics that set it apart from other eating disorders, and so ARFID treatment is adjusted to address these unique aspects.
ARFID is an eating disorder characterized by eating a very small amount and variety of foods. While the prevalence of ARFID is still largely unknown, it’s most common in children (although adults can have it as well), and can result in many of the same health consequences as other eating disorders. But because ARFID typically doesn’t involve the same weight distress that characterizes other common eating disorders, many patients struggle to feel seen.
Awareness about ARFID is increasing, and experts continue to learn more about the intricacies of this diagnosis. But still, ARFID is often left out of the conversation about eating disorders, leaving many patients and families with questions about what ARFID treatment and recovery looks like, and how to get help. Here, we’ll take a look at how ARFID differs from other eating disorder diagnoses, and what to expect from treatment.
How is ARFID different from other eating disorders?
“The main thing that distinguishes ARFID from other eating disorders is the lack of concern about body weight or shape,” says Equip Senior Director of Program Development Jessie Menzel. “Patients with ARFID often want to gain weight and are upset that they weigh so little or haven't grown. Now, that doesn't mean that someone with ARFID can't experience body dissatisfaction, but body dissatisfaction is not the driving reason for their disordered eating.”
While myths about ARFID abound, Menzel is adamant about underscoring two major facts: “It's not just picky eating and it doesn't only affect kids!” she says. “ARFID really captures a whole range of eating problems that aren't motivated by weight or shape—it includes extreme picky eating, but it also includes food phobias like fear of vomiting, choking, or having an allergic reaction. It includes people who just aren't motivated to eat or interested in eating, period. And while many people with ARFID can trace their eating problems back to childhood, ARFID can onset at any point and there are many adults struggling with ARFID who also need treatment.”
How is ARFID treatment different from other eating disorder treatment?
“While there are many similarities between ARFID treatment and other eating disorder treatments, it's extremely important for ARFID to be recognized and treated as a unique eating disorder,” Menzel says. “Exposure—or helping a patient face and cope with anxiety-provoking or challenging foods and experiences—is really at the core of most ARFID treatments. And while you can find exposure in treatment for other eating disorders, it is really a central focus in treatments for ARFID.”
ARFID can present in one (or more) of three ways, all of which which contribute to a lack of food variety and make exposure extremely important:
- Lack of appetite or interest in eating
- Sensory sensitivities to food (i.e., not eating things because of the texture, appearance, or smell)
- Fear of aversive consequences (like choking, vomiting, or having an allergic reaction)
“Exposures are meant to desensitize you to new, unfamiliar, or ‘unsafe’ foods with the goal of adding those foods back to your safe foods list,” she says. “Dietitians may help patients make an ‘always/sometimes/never’ list of foods, and the goal of exposures is to move ‘never’ foods into the ‘sometimes’ or ‘always’ columns.”
Equip Peer Mentor Kelsey Gilchriest notes that exposures can happen in different ways. “Some patients may start with smelling, holding, or licking a food from their ‘never’ list while working up to eating a bite and then increased portion sizes, while other patients may start with imaginal exposures, which are where the patient imagines trying a new food or even being around others as they eat unfamiliar food,” she says.
Menzel adds that it’s often important to target other conditions that can make eating harder in the scope of ARFID treatment. “Things like functional GI disorders, food allergies and sensitivities, or sensory processing disorders need to be addressed,” she says. “It's important that we do everything we can to make eating an easier or less painful experience for a person with ARFID.”
Another important characteristic to consider in ARFID treatment is the potential overlap between ARFID and certain other diagnoses. Research has shown that individuals with autism spectrum conditions, ADHD, and other psychiatric disorders are much more likely to develop ARFID. “Other distinguishing traits could include higher sensory sensitivities or more intense anxiety,” Gilchriest says. If any of these conditions or issues are present, it’s important that they be addressed during treatment.
The key to recovery: ARFID treatment from experts who get it
When Gilchriest wrote about her own experience with ARFID, she described it succinctly as “isolating”. Unlike many other patients she met in treatment, Gilchriest had never suffered from anorexia, bulimia, or binge eating disorder. What began as a picky attitude toward food eventually evolved into extreme fear and aversion, and by the time she’d graduated from college, Gilchriest struggled to eat at all.
Even once she was in treatment for ARFID, some of the providers on her team had never heard of the condition—and others doubted the severity of her symptoms or the details of her experience. “I had to really advocate for myself when I was in treatment,” she says. “I had to prove to my providers that I was telling the truth before they adapted their rules and processes for me. In an ideal world, I wouldn't have had to spend that time advocating for those things—but there is still so much we don't know about ARFID.”
Looking back on her own journey, Gilchriest understands just how crucial it is to find healthcare providers who are not only experienced with ARFID, but also compassionate, empathetic, and trusting. She encourages anyone struggling with ARFID to seek out these kinds of physicians and specialists, and she implores medical and psychiatric experts to strive for those standards of caregiving.
Menzel also stresses the importance of working with a multidisciplinary team of experienced clinicians who understand the depth and complexity of ARFID. “Many people with ARFID are being treated solely in medical spaces: in feeding disorder clinics, gastroenterology, or with allergists,” she says. “I often find that help from a therapist or psychiatrist is what's been missing from someone's treatment journey and can make a huge difference. And for children struggling with ARFID, a therapist can give adequate support to the parents as well as the child, something that is often missing from treatments in other spaces.”
Gilchriest calls out Equip’s 5-person treatment team as crucial to recovery for ARFID patients, noting that the comprehensive support from clinicians who truly understand the eating disorder can make a world of difference. “Our dietitians are well-versed in treating ARFID, and recognize that there are key differences when treating a patient with ARFID compared to treating someone with another eating disorder. Dietitians focus on building off of a patient's safe foods list, and collaborate with the rest of the team on coming up with an exposure plan,” she says. “Our mentors are also vital to our team approach, as ARFID can be an isolating and confusing experience, even within the eating disorder treatment community. Both peer and family mentors offer their lived experience to surround patients and families with the message that they are not alone and that recovery is possible."
In the end, ARFID is a serious condition—not just picky eating or something a child will grow out of—and it needs treatment. Though ARFID may not be as widely known as other eating disorders, making good care feel elusive, effective ARFID treatment is out there; and as awareness increases about this unique disorder, we hope that it will become easier to find.
If you or someone you love is struggling with ARFID, you can schedule a consultation to speak with an Equip expert about your treatment options today.
- Białek-Dratwa, A., Szymańska, D. et al. ARFID—Strategies for Dietary Management in Children. Nutrients 2022, 14, 1739. https://doi.org/10.3390/nu14091739
- Koomar, Tanner et al. “Estimating the Prevalence and Genetic Risk Mechanisms of ARFID in a Large Autism Cohort.” Frontiers in psychiatry vol. 12 668297. 9 Jun. 2021, doi:10.3389/fpsyt.2021.668297
- Becker, Carolyn Black and others (eds), 'Novel Ways to Use Exposure for Eating Disorders', Exposure Therapy for Eating Disorders, ABCT Clinical Practice Series (2019; online edn, Oxford Academic, 1 Nov. 2019), https://doi.org/10.1093/med-psych/9780190069742.003.0015