Avoidant/Restrictive Food Intake Disorder (ARFID)
Some individuals develop an eating issue that results in losing too much weight, yet that is not their intention. Something about the tastes, textures, smells and even colors of food cause an aversion and fear of eating. They have little to no appetite, eat very small portions and may experience digestive issues. Episodes of choking or vomiting can occur after feeding, worsening their fears. This is an eating disorder called Avoidant/Restrictive Food Intake Disorder (ARFID). Although it is more common in children—even very young ones—it can effect adults, as well.
Unlike other eating disorders such as anorexia nervosa, individuals struggling with ARFID are not striving to be thin or afraid of gaining weight, and they aren’t trying to influence their body shape. But due to inadequate calories and nutrients, the end result is still excessive weight loss, malnutrition and the accompanying health risks. In children struggling with ARFID, lack of growth and development is a major concern.
DSM-V Technical Criteria for ARFID
A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Source: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association
Just Picky Eaters?
It is not uncommon for children to be finicky about what they’ll eat. Some are not adventurous when it comes to trying new foods and/or are very sensitive to any bitter tastes. Others might refuse to eat anything green or want to eat the exact same thing for lunch every single day. This may be a stage that quickly passes or it could linger longer. But unlike ARFID, eating will improve overall with time (and patience!) to the point that the once picky eater will gradually start to enjoy a greater variety of foods. If you are dealing with a picky eater, you might find some helpful suggestions here: https://www.findingbalance.com/ask-our-panel/nine-year-old-picky-eater/?highlight=picky%20eater and also in the article “10 Tips for Raising Balanced Eaters.”
What distinguishes ARFID from picky eating is that the feeding issues remain and even worsen over time, requiring professional support. Also of note is that people with autism spectrum conditions, ADHD and intellectual disabilities are especially prone to developing ARFID.
What to do?
If you think that you or your child may be struggling with ARFID, it is important to seek guidance from a doctor, therapist and/or nutritionist. See “Finding Treatment” for more information on how to find the help you need.