Home Clinical Psychology & Psychotherapy Eating Disorders Awareness Week: Expert Shines a Light on ARFID

Eating Disorders Awareness Week: Expert Shines a Light on ARFID

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Every year, Eating Disorders Awareness Week raises awareness and fights the myths and misunderstandings that surround anorexia, bulimia, binge eating, and other eating-related disorders.

This year, the UK’s eating disorder charity, Beat, is shining a light on a largely unknown and misunderstood condition: ARFID (avoidant restrictive food intake disorder).

To help demystify the condition, psychotherapist and eating disorder specialist Fiona Yassin explains what ARFID is, the risks, the symptoms to look out for, and how it can be treated.

What is ARFID?

The eating disorder or feeding disturbance known as avoidant restrictive food intake disorder (ARFID) is a chronic inability to achieve adequate nutritional and energetic needs. Although it can develop in late adolescence and adulthood, this disorder is most common among children and affects both genders.

Yassin, founder and clinical director of The Wave Clinic, a world-leading clinic specialising in trauma treatment, eating disorders, mental health, and addiction treatment for teenagers, young adults, and families, said: “ARFID entails more than just ‘picky eating’ or ‘selective eating’. People with ARFID may avoid food, eat very little, or limit their access to various foods, which can result in nutritional deficits.

“Picky eating and selective eating disorder come under the umbrella of ARFID, and as such, there are a number of crossovers. However, the disliking of specific foods or general lack of interest in eating is typically more intense in people with ARFID.”

Although picky eating is common, especially in children, it can become problematic when the refusal to eat interferes with their ability to meet energy and nutritional requirements. This can lead to weight loss, malnutrition, or a failure to maintain growth and development.

Yassin continues: “While ARFID is an eating disorder, it is also a mental disorder similar to that of anorexia nervosa and bulimia nervosa. Research has found that psychiatric co-morbidities, particularly anxiety and obsessive-compulsive disorder, are commonly linked to ARFID.”

Symptoms of ARFID

“The symptoms of ARFID can vary greatly depending on the person’s developmental environment. Common symptoms include avoidance of sensory triggers, restrictive eating patterns, and eating experiences based on fear,” explains Yassin.

An important first step to take before seeking ARFID treatment is to familiarise yourself with the warning signs and symptoms. To help determine whether you or your child may require professional eating disorder therapy, look out for typical ARFID symptoms, such as:

  • Consuming meals with the same properties, such as those with a crunchy texture
  • Avoiding fruit, meat, beans, and other sources of protein
  • Eliminating certain foods from the diet
  • Struggling to gain weight
  • Nutritional deficiencies (iron, vitamin A, and vitamin C are most common)
  • Skipping one or more dietary categories entirely
  • Becoming anxious when eating unfamiliar foods
  • Food restrictions negatively impacting customary social practices

What are the health risks of ARFID?

As a result of the body being deprived of essential nutrients, it is compelled to slow down its functions to preserve energy, posing serious health risks.

Yassin says, “The body is generally resilient in dealing with the stress of eating disorders. However, similar to cardiac arrests, electrolyte imbalances within the body can be fatal without showing any warning signs. It is, therefore, vitally important to understand the various ways that eating disorders impact the mind and body.”

The risks associated with ARFID include a variety of physical, psychological, and behavioural factors. These risk factors are unique to each individual, which means ARFID sufferers will have different perspectives, experiences, and symptoms.

Physical health risk factors

Anorexia nervosa and ARFID share many of the same physical symptoms and medical consequences, as both conditions are characterised by an inability to meet dietary needs. Physical health risks include:

  • Dramatic weight loss
  • Gastrointestinal signs such as constipation and acid reflux
  • Digestion difficulties (such as an upset stomach or a feeling of fullness) around mealtimes that have no apparent cause
  • Menstrual irregularities, such as missing periods
  • Issues with concentration
  • Abnormal laboratory results (anaemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Dizziness or fainting
  • Shivering or constantly feeling cold
  • Issues with sleep
  • Dry skin
  • Fragile and brittle nails
  • Thinning of hair
  • Muscle weakness and soreness
  • Discolouration of hands and feet
  • Immune system dysfunction

Behavioural and psychological risk factors

  • Reduced food intake
  • Wearing multiple layers of clothing to keep warm or cover up weight loss
  • Unusual high energy levels or extreme tiredness
  • Drastic changes in the types or amounts of food consumed
  • Worry of choking or vomiting
  • Lack of interest or appetite for particular foods
  • Limited range of preferred foods that become smaller over time
  • No body image disturbance issues or concern over weight change

How is ARFID treated?

In most cases, an intensive and specialised treatment approach is required due to the distinctive characteristics of ARFID and its prevalence among young individuals.

Yassin says, “Feeding therapy, counselling, and nutrition advice are all possible forms of treatment. A speech-language pathologist can perform a swallowing and feeding evaluation if choking is a worry.

“The underlying reason for avoiding food, such as a phobia, an intolerance to texture, or a lack of interest in eating, will usually dictate the treatment’s objectives for ARFID. However, in most cases, the main goals of treatment are to obtain and maintain a healthy weight and balanced diet, eat a wider variety of foods across the food groups, and learn how to eat without fear of discomfort or choking.”

“Doctors may recommend medications to relieve anxiety or stimulate the appetite. If anxiety is a problem, healthcare professionals will show children and families how to deal with concerns about food.”

Most children with ARFID can get care at home, but a small number will require admission to a more intense hospital-based programme. This tends to be for individuals who are severely underweight, malnourished, or suffering from serious health problems. Additionally, some children with ARFID will require food formula or tube feeding to increase food intake and avoid nutritional deficiencies.

How can parents help children and young people?

“ARFID can be challenging, but teaching children and young adolescents about healthy eating and addressing their worries can help them feel better and improve. Research studies have shown that children are more likely to adopt successful eating behaviours when the entire family collaborates,” Yassin explains.

ARFID is associated with intense feelings and concerns over food, so encouraging healthy eating and exercise among family members is extremely important. Yassin shares five ways parents can help and support their children and young people:

  • Set a good example. Serve and consume a range of cuisines
  • Plan consistent meals and snacks
  • Maintain a friendly atmosphere at the table and refrain from conflict when eating food
  • Don’t force your child to eat; encourage them to try different things
  • Reward healthy eating habits

Yassin concludes, “If you are a parent of a child who might be struggling with ARFID or other eating disorders, call your doctor for advice. The doctor can make recommendations for mental health and nutrition specialists who have experience dealing with children and adolescents who possess eating disorders.”

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