Avoidant/Restrictive Food Intake Disorder (ARFID) is a newly recognized eating disorder that can occur throughout life—in infants, children, teens and adults, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which is published by the American Psychiatric Association. The disorder was originally diagnosed in infants and children as a feeding disorder, but the DSM-5 recognizes that it stretches beyond early childhood.
While it involves food restriction like anorexia, ARFID's underlying motives are dislike that of a distorted body image, which is at the core of anorexia nervosa. ARFID includes rigidity around eating and avoiding particular types of food that results in an insufficient amount of calories.
The disorder goes beyond being a picky eater or staying away from foods for reasons, such as nut allergies or lactose intolerance. The avoidance of food may stem from incorrect information and beliefs about food intolerance and nutrition. The rigid beliefs conflict with factual evidence about food that results in people with the disorder avoiding particular types of foods. Some people with ARFID may dislike the smell, taste, texture or temperature of certain types of foods. The DSM-5 indicates that these symptoms tend to appear by the age of 10 and may continue into adulthood.
In addition, the disorder may be the result of a trauma that's related to food, such as choking or painful throat spasms that are caused by dysphagia.
According to the DSM-5, the diagnosis of ARFID includes the following criteria.
There is no other distinct mental disorder or medical condition.
The eating can include a lack of interest in eating or food.
Rigidity and refusing to eat foods because of their smell, taste, texture or appearance.
Worry about the results of eating.
The individual will continuously fail to meet his nutritional or caloric needs, which causes a great amount of weight loss or the inability to gain any weight. In children, it may cause them not to meet their growth milestones.
Deficiencies in micro-nutrients—a chemical element or substance that's required in trace amounts to allow for the normal growth and development of a person—can result in the individual needing to be fed by enteral feeding, which is a method of feeding that uses the gastrointestinal tract to deliver part or all of a person's caloric requirements by using a tube. Or, the individual may be given oral nutritional supplements.
The disorder will usually cause an interruption around the individual's social functioning, such as stress during meals with the family or not participating in social events that include food.
It's important to note that ARFID is not caused by a lack of food or a cultural practice, such as religious fasting or being restricted from eating particular foods. It's also separated from both anorexia nervosa and bulimia nervosa, because there's no perception of distorted body image.
With the weight loss and nutritional deficiencies that can result from ARFID, many times family and friends can become frustrated with the individual with the disorder. In social settings, others may be offended when the individual refuses to accept food that's been offered to them. This is particularly true in cultures where food is in short supply—or has been scarce in the history of the culture—and sharing food with others is considered an honorable gesture. The disorder can cause family tension in general.
Infants with ARFID may be finicky, fussy and hard to comfort during feeding.
The relationship between the parents and child may contribute to the disorder in situations where food is given abruptly or even forcefully.
Other factors can include the disposition of the infant, such as staying away from different experiences. Avoiding food may be his way of expressing a hesitance to try foods that are new to him.
It's important to note that many children develop different eating patterns at some time in their lives, such as stubbornly refusing to eat vegetables for a while or opting for only chicken nuggets or fish sticks for dinner. For most children, those patterns usually subside on their own without the need for intervention. Individuals with ARFID have consistent or continually worsening problems with their food intake.
Eating disorders are familial illnesses. Traits like temperament predispose people toward developing a disorder that may be passed from generation to generation.
Higher rates of feeding disturbances in children who have mothers with eating disorders.
History of gastrointestinal conditions, such as gastroesophageal reflux disease.
Incidents of choking on food can be a precipitator.
Cultural pressures to eat pure and healthy foods that emphasize food processing, sourcing, packing and environmental impact that can be an influencer on food beliefs, as well as intake.
Cognitive Behavioral Therapy is used to challenge the rigid beliefs individuals have surrounding food, as well as the fear of choking. The therapist can provide information about nutrition, especially if the food avoidance is based on incorrect information.