Is your child a picky eater or is it something else? In this post we will discuss avoidant/restrictive food intake disorder, or ARFID, and treatment options for recovery.
Is my Child a Picky Eater or Is it Something Else?
Many children are picky eaters but some are exceptionally picky eaters. Parents are often concerned when their child seems to be willing to eat very few foods. These children will eat only a small range of foods. For example, only eating “yellow foods” or sticking to food typically eaten by very young children like pizza, mac and cheese, and chicken nuggets, even as they get older. While pickiness is developmentally normal in childhood, it is important that you are able to distinguish this pickiness from an actual eating disorder, which are much more serious and have effects that reach much further.
The long term effects of eating disorders are devastating. Without eating proper nutrition, there are severe risks to your health such as cardiac events, growth abnormalities, and bone density issues.
Are you or do you know someone (such as your child) who is an extremely picky eater? ARFID, or Avoidant Restrictive Food Intake Disorder (formerly known as Selective Eating) is a type of eating disorder that can negatively affect a person’s life both socially, mentally, and physically. If you sense that you have ARFID, there are several treatment options that can help you overcome ARFID and live a healthy life.
To learn more about ARFID treatment options and about the condition itself, please continue reading.
What is ARFID?
So what is ARFID? ARFID is a somewhat new diagnosis in the DSM-5. It stands for Avoidant Restrictive Food Intake Disorder but is sometimes referred to as “picky eaters” disorder.
An ARFID diagnosis is often given to people who experience difficulty with both eating and food. However, those given an ARFID diagnosis often don’t exhibit the classic symptoms of an eating disorder, like anorexia nervosa, bulimia, etc.
ARFID is unique for every individual. For some people, it could look like avoiding certain colors or textures of food, an avoidance of a specific food out of fear of nausea or vomiting, or or a fear of general classes of foods such as all fruits. ARFID is generally developed by a person fearing choking or vomiting. In some cases, a person had a traumatic experience that created this fear. It is recommended that an individual with these symptoms be evaluated by a speech therapist who is an expert in swallowing disorders to make sure that there is not a medical issue related to their ability to swallow.
While “picky eaters” disorders are typically found in children and adolescents, it can affect people at any age or developmental level. For adults who are “picky eaters”, they might only eat 10 to 20 different foods.
While “picky eaters” disorders typically present in children and adolescents, it can affect people of any age or developmental level. An adult picky eater might eat as little as 10 to 20 foods. Without treatment, ARFID can last a lifetime and become a major obstacle to eating healthy and socializing.
Living with ARFID: Is it Serious?
A person who suffers from ARFID may experience a lower quality of life. They often have problems with social situations and may find themselves avoiding school, work, friends, or family. In addition, ARFID can cause weight loss and nutritional deficiencies.
An important note is that not all individuals with ARFID are underweight. Even if the individual has a normal weight or overweight, it is highly likely that a person suffering from ARFID is malnourished due to the extremely limited foods they eat. ARFID can also be associated with other mental health conditions such as anorexia, autism, OCD, anxiety, and depression.
Children with ARFID
Once a child with ARFID gets old enough to start socializing and going out with friends out of the house, he or she may start to view their picky eating as more of a problem because eating with friends becomes impossible.
Teenagers with ARFID
As a teenager with ARFID, it can be very difficult to miss out on a social event and to be viewed as “strange” or “different” from their peers. Teenagers often articulate that living with ARFID is embarrassing because people know them as the “picky eater.” However, sometimes these feelings can be helpful to a teenager so that they feel some motivation to change their behavior or seek treatment.
Parents Whose Children Have ARFID
Parents of children suffering from ARFID often experience stress and anxiety because it is very difficult to find foods that their child will eat. The experience of eating together can become tense and often interferes with the entire family’s ability to enjoy meals, go to restaurants, celebrate holidays, or visit friends’ for dinner. Parents whose children have ARFID sometimes go to extreme lengths to find exact foods their children will eat just to ensure that their child does not starve. By doing this, the child will not get the adequate nutrition they need to be healthy. This process also ironically empowers ARFID in their child and inadvertently reinforces the disorder. For parents, it can feel like their entire life revolves around making sure that their child with ARFID has something to eat.
Warning Signs and Symptoms of ARFID
Spotting the warning signs and symptoms of ARFID can be very difficult. Here are a few warning signs outlined by NEDA:
Behavioral and Psychological Signs
A person with ARFID could:
- Dress in layers to hide weight loss or to stay warm
- Lose weight dramatically
- Have constipation, stomach pains, lethargy, cold intolerance, and/or excess energy
- Dramatically restrict the different types of food eaten
- Report constipation, upset stomachs, vague gastrointestinal issues, around mealtimes with no cause
- Only eat specific foods by their textures
- Have a fear of choking or vomiting
- Lack an appetite or interest in eating food
- Fear gaining weight
- progressively gets more picky in their eating
A person with physical signs of AFRID could have:
- Stomach cramps or other non-specific gastrointestinal problems like acid reflux or constipation
- Abnormal lab findings like anemia, low thyroid, low hormonal levels, low potassium, low blood cell counts, slow heart rate, etc.
- Lose their menstrual period or have irregularities (postpuberty)
- Impaired immune functions
- Muscle weakness or fatigue
- Dry or brittle nails
- Problems sleeping
- A feeling of being cold constantly
- Issues fainting
- Feelings of dizziness
- Poor wound healing
ARFID isn’t always easy to spot.
Types of ARFID Treatment
Treating ARFID can vary depending on the mental health professional and the goals of the patient. A mental health professional may recommend one of the below therapies or a combination of therapies. A general ARFID treatment goal should focus on weight gain (if required) and then by diversifying and adding to the variety of foods eaten.
Some common forms of ARFID treatment include:
1. Cognitive Behavioral Therapy
Cognitive behavioral therapy, or CBT, is a treatment type that targets negative thoughts and behaviors. It is a technique that can be used for many different problems including but not limited to addiction recovery to eating disorders. Relating to ARFID, cognitive behavioral therapy is often combined with relaxation training so that a person learns to relax the body while thinking differently and practicing new behaviors.
2. Exposure Therapy
During exposure therapy, a mental health professional will gradually expose their patient to fear-inducing foods through mental visualization, writing, and through verbal communication. A mental health professional will start with the least anxiety-causing to the most anxiety-causing, which gradually becomes more comfortable with the foods the patient fears.
A mental health professional will also give their patient coping tools and organize life practice sessions. In addition, they’ll likely combine exposure therapy with cognitive behavioral therapy to address any anxiety and negative thoughts around food.
3. Dialectical Behavioral Therapy
Dialectical behavioral therapy (DBT) empowers patients to manage their emotions in a healthy way. DBT teaches patients to manage their distress so that they remove harmful and destructive coping mechanisms. DBT can be very helpful for those suffering from ARFID because re-introducing foods that they have not been eating can be overwhelming and stressful for a patient suffering from ARFID. In some cases, a person could gag or vomit when they try new foods, so it is important that a patient with ARFID has a foundation of healthy coping skills as they try to change their relationship with different foods.
4. Family Based Treatment
There is evidence that Family Based Treatment, or FBT, may be the most effective form of treatment for ARFID. There are several sites around the country researching this form of treatment. In family based treatment, the family of the child with ARFID is intimately involved in helping the child reach goals related to increasing food intake. FBT was originally developed to treat patients with Anorexia but for ARFID it can be tailored to meet the needs of a patient afflicted. FBT can be combined with other forms of treatment protocols.
5. Group Therapy
Finally, group therapy can be an important part of therapy for a person suffering from ARFID. Group therapy create a supportive environment in which meals can be eaten with others. As treatment progresses, eating in public or visiting a grocery store as a group might occur. Being together with others who struggle with a similar illness is invaluable to immerse themselves in social situations with similar and understanding peers.
Preparing for ARFID Treatment
When preparing for ARFID treatment, it’s vital to set appropriate goals. You should have an idea of the changes you’d like to see happen. For example, decide whether social changes or a larger range of dietary options is your top priority.
How to Choose an ARFID Treatment Program
If an individual suffering from ARFID is very malnourished or so compromised emotionally that they cannot care for themselves, a residential treatment program is an option. In other cases, family members of a person with ARFID are burnt out and/or overwhelmed to the point that support can no longer be sustained. There are programs available that treat ARFID at a residential level or at an intensive outpatient program.
At a residential program, patients receive 24-hour support and treatment and live at the facility. While attending the program, patients usually receive a combination of individual, family, nutritional, and group therapy.
Outpatient programs are typically attended a few days each week in the form of group therapy sessions, typically with an option for individual sessions.
For some, a combination of a residential and then stepping down to an outpatient program gives the patient the best odds for successful recovery.
Suffering from ARFID?
Eating disorders are extremely serious. While it may be tempting to write off ARFID as nothing more than picky eating, it can drastically affect your health or the health of your loved one. ARFID can lead to dramatic weight loss, nutritional deficiencies, social anxieties, and a decreased quality of life.
Are you not sure if you or your children have ARFID? Take my free ARFID assessment:
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Dr. Amy Boyers is a licensed psychologist and has been in private practice in South Miami since 2001. She provides therapy to adolescents and adults, with a focus on women’s health, eating disorders, anxiety and mood disorders, and behavioral medicine.
Visit Amy’s practice listing: Amy Boyers, Ph.D.