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What is Avoidant/Restrictive Food Intake Disorder?


 

Have you ever felt anxious at the thought of having to eat a certain food? For individuals with Avoidant/Restrictive Food Intake Disorder (ARFID), this may be an all too familiar scenario in daily life.

ARFID is characterized by a pattern of eating which involves avoiding certain foods and/or eating in restricted amounts. So how did we come to recognize ARFID as a unique condition?

 

What exactly is ARFID?

 

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by a continuous failure to meet nutritional and/or energy needs. Unlike other eating disorders, ARFID isn't necessarily linked to concerns about body weight or shape. Instead, people with ARFID might avoid certain foods due to their sensory characteristics (like color, texture, or smell), have a general disinterest in eating, or experience anxiety about the consequences of eating, such as choking or vomiting.

 
Why does it happen?

 

The exact cause of ARFID is not fully understood, but it's likely a combination of genetic, psychological, and environmental factors. Some may have a tough time with how certain foods feel or taste because they’re extra sensitive to textures or flavours. Others might have had negative experiences with food, such as choking or allergic reactions, leading to fear around eating. And then, some people may naturally have a lower interest in food or lack hunger signals from their body.

 

Who does it affect and who is at risk for it?

 

ARFID can affect anyone, no matter their age, gender, or background. Those with a family history of mental health conditions, who have had bad experiences with food, and people who are extra sensitive to how things feel, taste, or smell might find certain foods hard to handle and be at greater risk of developing ARFID.  

 

History of ARFID

 

Before 2013, when ARFID was added to a big book of mental disorders called the DSM-5 [1], people showing ARFID symptoms often fell through the cracks of getting proper care. A common assumption was that people with ARFID symptoms were thought of as picky eaters, especially children. Many believed they would simply “grow out” of their eating behaviors, and extreme cases were thought to be due to poor parenting or lack of discipline. Adults experiencing these issues were frequently dismissed altogether with their conditions often unrecognized and untreated.

 

What’s more, historically, eating disorders like anorexia or bulimia, have taken the spotlight amongst healthcare professionals. This focus has left a gap in understanding and treating less understood and less visible eating disorders like ARFID. In the past,treatment for ARFID involved using trial-and-error approaches or trying methods used to treat other eating disorders or mental health conditions, in the hopes of finding something effective.

 

Ultimately, when ARFID was added to the DSM-5, it was a game-changer for how we see and treat the disorder. This was a huge step in helping to diagnose and increase awareness of ARFID, leading to more research and treatments aimed at helping those affected [2].

 
Impact of ARFID on Daily Life

 

Today, understanding of ARFID has grown, including our knowledge of its impacts on daily life. Individuals with ARFID may experience:

 

Physical Impacts

 

  • Nutritional deficiencies: restrictive eating can lead to not getting enough vital nutrients, causing problems like anemia (low count of red blood cells), weight loss, delayed growth in children, low energy and fatigue.

  • Skin and hair: when the body conserves energy for important organs, it may lead to skin that looks dull, dry, thinned, and brittle nails.

  • Stomach: nausea, feeling bloated, constipation, and feeling full quickly are common.

  • Hormonal changes: not getting enough nutrients can mess with hormone levels, leading to low blood sugar, decreased sex interest, and missed periods.

  • Heart and blood: there could be low blood pressure, slower heart rate, and irregular heartbeat.

  • Bone health: there is a higher risk of having bones that are less dense and strong due to not getting enough nutrients.

 

Emotional Impacts

 

  • Anxiety, stress: worrying or fearing certain foods or eating situations can result in anxiety and stress of being unable to eat.

  • Isolation: individuals with ARFID may avoid social situations where food is involved like parties, lunches, etc. which may result in social withdrawal.

  • Depression: social isolation and ongoing struggles may contribute to feelings of depression and loneliness.

  • Self-esteem: individuals may feel that they are different from others due to their struggles which may impact their self-esteem.

Cognitive Impacts

 

Reduced attention, memory, learning: decreased nutrition may result in reduced attention, memory and learning which can affect school or work performance.

 
What Does the Research Say?

 

There is also a growing amount of research about ARFID aimed at understanding ARFID’s causes, symptoms, and interventions. Here are some key findings:

 

Three-Dimensional Model of the Neurobiology of ARFID

 

Have you every wondered the science behind why some people have no interest in food, are overly sensitive to how food tastes or feels, or have a fear of consequences after eating? There’s an interesting way researchers are trying to understand this, known as the Three-Dimensional Model, which proposes three biological reasons behind ARFID behavior:

 

1. It’s All About the Senses

 

First, imagine eating your least favourite food. Now, imagine that discomfort you feel multiplied by ten. This is what it is like for people who have sensory sensitivity due to ARFID. They are not just being “fussy” – their taste buds are on high alert! Research like a study involving kids who were very picky eaters, showed that these kids often have an increased sense of taste, making them super sensitive to flavours that most of us might not notice [3].

 

2. Not Hungry? There’s a Reason

 

Next, let’s talk about having a lack of interest in food. We all have days when we’re not that hungry, but for individuals with ARFID, this feeling is constant. Scientists think this might be because certain parts of the brain aren’t activating as they should. These areas like the hypothalamus (control center for food intake) and the anterior insula (which helps us taste), might be a bit more relaxed for those with ARFID, making food and eating seem less appealing [4].


3. The Fear Factor

 

Lastly, fear of aversive consequences, like choking or vomiting, plays a big role in restrictive eating behaviors in ARFID. This may be because the brain’s alarm system, especially areas that handle fear and caution (like the amygdala and anterior cingulate), are overly sensitive. Research on how individuals respond to frightening situations has shown that people who are cautious and highly alert to threats tend to have an increased activation in these brain areas [5].

 

Body Weight Differences

 

When we think about eating disorders, we often imagine them to be closely tied to weight and body image. However, ARFID breaks that mold. People of all weights may develop ARFID making it a unique case in the spectrum of eating disorders. As such, researchers have wondered: how does weight play into ARFID?  


One study aimed to understand how children with ARFID react to food differently depending on their weight [6]. It compared the brain responses of kids at a healthy weight to those who were overweight or obese, all of whom had ARFID. What did they find? They found that overweight or obese children with ARFID might have a stronger response to food, particularly high-calorie options, as their brains showed more activity in areas related to emotions, rewards, and making decisions (orbitofrontal cortex) and in understanding bodily signals (anterior insula).

 

Overcoming ARFID: Treatment Options

 

Throughout the years, there has been more focus on ARFID which has shed light on different therapeutic approaches for treating ARFID. While no standard treatment has been established yet, different kinds of therapies are used to treat ARFID depending on the individual and their needs. Treatment may involve:

 

Cognitive Behavioral Therapy (CBT)

 

CBT is a type of psychotherapy used to treat a wide variety of mental health conditions. In CBT, a trained therapist teaches skills to approach novel foods in a stepwise manner by recognizing problematic thoughts and behaviors, including those that contribute to fear and anxiety around certain foods.

 

Occupational Therapy (OT)

 

OTs take a holistic approach to restoring health through assessments and interventions aimed at restoring meaningful activities. OTs complete a full assessment and apply interventions based on a person’s sensory, motor, developmental, environmental, and behavioral factors that could be affecting eating.

 

Exposure Therapy

 

Exposure therapy can be used to help decrease the fear and anxiety attached to certain foods. This can involve the use of relaxation techniques, mental visualization, learning positive coping, and gradual exposure to foods in safe environments.

 
Next Steps

 

The journey of understanding, living with, and treating ARFID is an ongoing process.Despite current efforts, our understanding of ARFID is still quite limited which highlights the importance of ongoing dialogue, research, and advocacy. As awareness grows, there is hope for individuals struggling with ARFID to embark on a path toward recovery with the right support and resources.











Sources Used


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive food intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8). https://doi.org/10.1007/s11920-017-0795-5

Golding, J., Steer, C., Emmett, P., Bartoshuk, L. M., Horwood, J., & Smith, G. D. (2009). Associations between the ability to detect a bitter taste, dietary behavior, and growth. Annals of the New York Academy of Sciences, 1170(1), 553-557. https://doi.org/10.1111/j.1749-6632.2009.04482.x

Holsen, L., Lawson, E., Blum, J., Ko, E., Makris, N., Fazeli, P., Klibanski, A., & Goldstein, J. (2012). Food motivation circuitry hypoactivation related to hedonic and nonhedonic aspects of hunger and satiety in women with active anorexia nervosa and weight-restored women with anorexia nervosa. Journal of Psychiatry & Neuroscience, 37(5), 322-332. https://doi.org/10.1503/jpn.110156

Lang, P. J., & McTeague, L. M. (2009). The anxiety disorder spectrum: Fear imagery, physiological reactivity, and differential diagnosis∗. Anxiety, Stress & Coping, 22(1), 5-25. https://doi.org/10.1080/10615800802478247

Liya, K., Van De Water, A. L., Kuhnle, M. C., Harshman, S., Hauser, K., Eddy, K. T., Becker, K. R., Misra, M., Micali, N., Thomas, J. J., Holsen, L., & Lawson, E. A. (2021). Neurobiology of avoidant/Restrictive food intake disorder in youth with overweight/Obesity versus healthy weight. Journal of the Endocrine Society, 5(Supplement_1), A22-A23. https://doi.org/10.1210/jendso/bvab048.043

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