Avoidant Restrictive Food Intake Disorder (ARFID) - Understanding causes & treatments
By Dr Laura Keyes (Clinical Psychologist) & Joana Gomes (work experience student).
ARFID has been gaining media attention with recent news interviews and stories from parents of young children with ARFID who are struggling to access a diagnosis and support. But what is ARFID, what are the causes and importantly how can we understand and treat ARFID?
So what is ARFID?
Arfid stands for Avoidant Restrictive Food Intake Disorder. This is a relatively newly recognized eating disorder (though of course it has been experienced by people and just not recognised as such, or misdiagnosed as another eating difficulty). ARFID can affect both children and adults. ARFID is a complex challenge which can lead to significant weight loss, nutritional deficiencies, and impairments in daily functioning (such as not being able to concentrate, having very little energy, and problems at mealtimes with others or eating out). However, many people with ARFID are not always underweight if their 'safe foods' are high in calories to maintain a reasonable weight. This then creates the challenge of accessing appropriate support if eating disorder services base their criteria for support around being underweight, leaving many people with ARFID with no support. BEAT report that calls to their service about ARFID have increased seven fold.
Key indicators for ARFID typically include:
· Lack of interest in eating and food, not feeling hunger sensations and feeling full quickly.
· Sensory Avoidance of food tastes, textures, temperature, colour, appearance and aromas.
· Intense Fear of 'Aversive' Consequences such as illness, choking, nausea and allergies being triggered.
ARFID very often (but not always) occurs for people who are Autistic - depending on the study up to half of children with ARFID also were Autistic.
And what isn't ARFID?!
ARFID is very different from anorexia nervosa, as it is not driven by body image or weight concerns or a desire to lose weight - it is an intense difficulty with deciding on what to eat and the act of eating itself being very difficult. For individuals with ARFID, fear of food may stem from knowing they must eat to survive, but they may have no interest in eating food, or be put off by the temperature/texture/taste/aromas (which may feel disgusting or frightening). They may also fear choking or being sick, and most people with ARFID will fear of eating any new foods so stick to the same few 'safe foods'.
ARFID is more than just someone being a fussy eater or picky in what they choose to eat. Dr. Gillian Harris (Clinical Psychologist) highlighted this in her quote "The difference between a 'picky eater' and a child with ARFID, is that a picky eater won't starve themselves to death. A child with ARFID will." Children with ARFID have been known to faint on holiday, for example, with a lack of 'safe' familiar foods available and unable to try any new unfamiliar foods.
Eating difficulties are much more common in children with Autism and sensory processing disorder (SPD). There are often other associated issues with eating, such as needing to keep foods separate and not touching on a plate, or only eating certain textures/temperatures of food. There can also be issues with not being able to mix different foods in their mouth at the same time, and being very fixed about times and routines/rituals for eating (such as sitting in the same place, at a specific time using specific cutlery).
So what causes ARFID?
ARFID does not have one specific identified cause; instead, researchers and clinicians observe a variety of potential contributing factors, including biological, psychosocial, and environmental influences. These typically include...
· A child being predisposed to ARFID due to biological or genetic makeup: such as being Autistic and having associated sensory sensitivities, being a highly sensitive person, having a developmental/learning disabilities - so the person's relationship to their body and senses are already very heightened. Also genetic factors such as having recurrent tonsilitis/enlarged tonsils resulting in difficulties swallowing, and tongue tie can result in early feeding difficulties and negative associations with food.
· Psychosocial factors can include disrupted eating patterns alongside other mental difficulties, such as high anxiety levels in the person and their family members resulting in a lot of anxiety around eating and trying new foods. High expressed emotion and anger when eating together as a family due to frustration about the person's eating difficulties can also have an impact. Autism in the wider family may also mean difficulties in perspective taking to imagine how frightening and anxiety provoking food and eating can be, sometimes viewing that the person "won't" rather than they "can't" eat right now.
· Environmental influences can include traumatic events such as choking episodes, being forced to eat or punished for not eating, as well as specific mealtime rituals and routines which can influence anxiety levels when eating.
How can we treat and support people with ARFID?
The main evidence based treatment so far for ARFID is cognitive behavioural therapy (CBT). This therapy will help you or your child to:
· Recognize problematic thoughts and behaviours that affect your health.
· Feel less fear or anxiety around food.
· Be more comfortable with sensory challenges.
There are also other approaches which can be helpful. These include Acceptance & Commitment Therapy (ACT), a therapy approach which looks at your values and willingness, and strategies to cope with discomfort and anxious thoughts.
Also Occupational Therapy can be hugely beneficial including an assessment of the person's sensory system, sensory integration work to reduce anxiety levels and working on ARFID related challenges around food.
How we can help:
Our team are passioante about supporting young people and adults with ARFID. We find Psychology & OT (sometimes working jointly) sessions help to understand the person's sensory world and anxiety, and develop goals and ways to work towards these using a range of approaches.
Dr Laura Keyes (Clinical Psychologist) specialises in assessing and supporting people who are Autistic and/or ADHD, alongside any mental health difficulties or sensory challenges experienced. She has a passion for supporting people adn their families with ARFID.
Rhiannon Steed (Occupational Therapist) specialises in sensory processing assessment and integration for people who are Autistic and/or have ADHD. She offers specific interventions and support for adolescents and adults with ARFID who are 12+ years of age.
Kyla Georgios (Occupational Therapist) provides sensory processing assessment and integration - typically for people who are Autistic and/or have ADHD.
If you would like more information about how our team can help with ARFID do get in touch with us!
T: 07880610449
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