Understanding and treating ARFID

Share this article:

The medical and social consequences of Avoidant/Restrictive Food Intake Disorder (ARFID) are often compared to those seen in other eating disorders such as Anorexia Nervosa. A major difference between ARFID and other eating disorders is that people with ARFID are not concerned with body image and are typically not worried about changes in weight. Dr. Julie Lesser, MD, explores how ARFID develops and who it can affect.

What causes ARFID to develop?

ARFID presents in different ways and can develop at any point in life. For some people, a highly selective pattern of eating starts in early childhood, with avoidance of specific foods or new foods, due to texture or taste. This restrictive pattern may make it hard to eat in various social settings or may impact growth and development.

Other conditions that impact appetite may also lead to ARFID since with certain medical conditions, people don’t feel normal hunger cues.

“Sometimes we see overlap with depression in those who lose interest in eating and then develop a separate problem with their weight and eating pattern that meets the criteria for ARFID,” Dr. Lesser says. “It’s important to recognize that it’s not that someone is choosing not to eat; they’re actually having a different experience with appetite and are impacted by the weight loss or changes in nutrition.”

A third way that ARFID can start is with a negative experience surrounding a particular food, such as an episode of choking or vomiting. “People may cut back on a due to a specific fear of something bad happening,” she says.

Can a parenting style lead to ARFID or another eating disorder?

Dr. Lesser hears this question often and her answer is no.

“We don’t think families or parenting styles are causing the problem or contributing, although it may be stressful for the family” she says. “There are sensory differences in ARFID and traits in other developmental or genetic factors involving metabolism that contribute to eating disorders like Anorexia Nervosa and ARFID.” Families may have one child who has the problem and other children who eat with a regular pattern.

Does ARFID affect a particular demographic?

ARFID is often diagnosed in children and adolescents, but it can occur in adulthood as well. In addition, Dr. Lesser says ARFID affects males and females at around the same rate.

It was first recognized officially as a diagnosable illness in the DSM 5 beginning in 2013; and due to this, Dr. Lesser says that much research into ARFID is in early stages and is still in progress. Like other eating disorders, however, it can develop regardless of race, gender, wealth, or many societal factors.

Does ARFID have common co-occurring disorders and illnesses?

It’s typical for someone who is diagnosed with ARFID to also have a co-occurring anxiety or mood disorder, or to have a phobia or Obsessive compulsive disorder (OCD). Dr. Lesser says that in addition to co-occurring mental illness, it’s important to consider physical illness that can come as a consequence of or be contributing to poor nutrition.

“That’s important to treat because medical conditions and being underweight can cause things including a low mood and preoccupations. More cognitive rigidity can be connected to not getting enough nutritional on a regular basis,” she says.

For younger people, Dr. Lesser also mentions that if there is significant nutritional deficiency, it can lead to weight loss or failure to achieve an expected weight, as well as interference with psychosocial functioning.

How is ARFID treated?

Rogers uses a combination of cognitive behavioral therapy with exposure and response prevention and family therapy to treat ARFID. We address nutritional and weight deficits and assist with eating since being underweight may maintain the problem. Dr. Lesser says this approach “helps people to tolerate emotional experiences and to change behaviors including avoidance in a step wise way” which helps with getting someone to eat a wider variety of food and in higher quantities.

Dr. Lesser also advises that someone with ARFID is typically more receptive to using rewards as incentives in treatment than those with anorexia nervosa, which is something Rogers providers keep in mind when developing each individual’s treatment plan.

“Our goal is to promote warmth and positive regard for all of our patients,” Dr. Lesser shares. “They should feel very supported by the team at Rogers and that we are helping set up the climate with their support system in the same way set goals decide on incentives and positive ways to help with treatment.”

Finding eating disorder care at Rogers Behavioral Health

Treatment for eating disorders like ARFID is offered at many Rogers locations across the country – including residential and inpatient care in Oconomowoc, WI. You can call 800-767-4411 for a free, confidential screening for treatment or 888-927-2203 for treatment at one of our other locations. A screening can also be requested online.

If you think you may have ARFID or another eating disorder, please take our eating disorder quiz or review our fact page. Of course, this is not a diagnosis, but can bring some peace of mind if you are experiencing anxiety over possibly having an eating disorder.