When you hear the word eating disorders, chances are, you think of the three most common ones: anorexia nervosa, bulimia nervosa, and binge eating disorder. However, those aren’t the only eating disorders!

In today’s blog post, let’s look at the criteria for and diagnosis of ARFID, which stands for Avoidant Restrictive Food Intake Disorder.

If you look at those first two words — avoidant and restrictive — you may wonder how ARFID differs from anorexia. These individuals often restrict food and face severe risk factors, like malnutrition and sudden weight loss. However, there is no body image component. As nutritionist Elaina Efird, RDN, CD, CEDRD, CSSD explains, “They restrict their food intake for various reasons, but it doesn’t have anything to do with wanting to change their body or an extreme fear of gaining weight or being fat.” 

Instead, it relates to an aversion to food. There’s a false notion that ARFID is just “extreme picky eating,” but it’s much more nuanced than that. In fact, there are three subcategories of ARFID, as listed below.

Lack of Interest in Food

These individuals simply don’t think about food. They have no interest in eating meals or even snacks. “In most cases, when you ask them if any foods make them excited, the answer is no,” Elaina adds. They may even forget to eat. 

As a side note, these patients often report getting full very quickly. As we’ve explained in previous blog posts, when you don’t consume enough calories, your body responds by producing less ghrelin and leptin, your hunger and fullness hormones. It’s a chicken versus egg scenario though. “Are they getting full quickly, so they lose interest in food? Or do they lose interest in food, so they start feeling more full?,” asks Elaina.

Sensory Avoidance

This subcategory of ARFID relates to the textures, smells, and flavors of food. As an example, Elaina shares that she’s worked with a client who didn’t like anything mushy. This distaste extends beyond the usual culprits of jello and cottage cheese to include things like mashed potatoes, scrambled eggs,  and even a ripe banana. There is also no willingness to try any food that falls into that category. 

Whatever the reasoning, it often eliminates a lot of different foods. It has a big impact on quality of life, as it makes it tricky to eat away from home or even spend time with friends. “Food is a huge part of our culture,” Elaina emphasizes. “So it often takes away from their ability to engage in any social situation.”

Fear of Aversive Consequences

Here, the individual experiences fears like getting sick, choking, feeling nauseous, or having an allergic reaction because of a food. It may be rooted in a past experience, like the severe food poisoning that a client of Elaina experienced. “Ever since that episode, this person was very fearful of eating any food because she thought she was going to get sick again,” she explains. The food options for individuals who experience this fear tend to get smaller and smaller.

Now, let’s dig into the common symptoms of ARFID as well as the treatment plans.

These individuals tend to show signs of weight loss and even malnourishment, including electrolyte imbalance and vitamin deficiency. In fact, if an individual is avoiding enough foods or groups of food, they may need to do tube feeding to get the proper nourishment. Additionally, as mentioned above, they often lose quality of life as they struggle to socially engage with friends and family.

When it comes to treating ARFID, professional help extends beyond the dietician’s role. While the eating disorder obviously involves food, it also relates to emotions. A therapeutic approach, then, is one of the primary components of treatment. A therapist uses exposure therapy to slowly reintroduce certain foods to an individual in a safe space. Simultaneously, the dietician works with the patient to ensure that nutrition needs are met.

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