By: Kathy Hubbard
Children often go through phases of picky eating. We’ve all been there either with our own children, a friend, or ourselves. But a person whose diet is so limited it leads to medical, nutritional, and/or psychosocial problems, might be suffering from Avoidant/Restrictive Food Intake Disorder (ARFID).
“In 2013, ARFID was added to The Diagnostic and Statistical Manual of Mental Disorders and is defined as a disturbed eating pattern characterized by extreme anxiety in eating situations and aversions to specific smells, tastes, temperature, textures, colors, categories, or brands of food. Children and adults who are affected often are limited to a small number of “safe foods” they are able to eat. Some experts estimate that approximately three percent of children are living with ARFID,” the National Association of Eating Disorders website explains.
Sometimes ARFID is associated with other health conditions such as attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), anxiety and autism. It affects more males than females.
Unlike anorexia and bulimia, ARFID isn’t about body issues or self-esteem. It’s motivated by a lack of interest in eating or food, and a fear of aversive consequences such as choking or vomiting. One report I read went so far as to say the person may actually fear dying if they eat particular foods.
“Case studies show that many people with ARFID have suffered from a traumatic childhood experience: a choking incident as a toddler; a feeding issue as an infant; an umbilical cord around the neck during the birth; or even in-utero trauma. Difficult births or an incident that happens to the mother while the baby is in the womb can cause ARFID,” NEDA says.
The Cleveland Clinic says it might be the result of anxiety, fear, genetic changes, social cultural and environmental influences. And it’s important to point out that it can affect anyone, not just children, although they are affected most often.
People with ARFID will have a short list of foods they’ll eat, most often what we’d describe as “comfort” food such as white bread, French fries, sweets, plain noodles, crackers and the like. Cleveland says that healthcare providers call ARFID “selective eating disorder” because the person may only choose a few things that are okay to eat. They may also “create rituals or patterns of behavior around the way they eat, like eating their food in a specific order.”
Children can become withdrawn, depressed and suffer from anxiety. They avoid socializing because they don’t want other children to ask why they’re not joining in eating a piece of pizza or a hamburger. They get tired of hearing all the reasons they should eat, and they shut down.
The symptoms include losing a significant amount of weight, being constipated, or having abdominal pain, stomach cramps or an upset stomach. The person may also exhibit low body temperature, lethargy, fainting or dizziness, fine hair on the body, and muscle weakness. They may have difficulty paying attention. Females may have irregular menstrual cycles.
“The consequences of ARFID can be life-threatening,” Cleveland says. “Sometimes, a person diagnosed with ARFID won’t have any signs or symptoms because their body adapts to stress. It’s possible that test results could be inconclusive, even though the condition is life-threatening.”
The healthcare provider will look for certain criteria when diagnosing ARFID. The criteria include having the above mentioned symptoms as well as ruling out that the limited food intake isn’t caused by food insecurity, religious fasting, an underlying medical condition, or medication side effects. Blood and urine tests are utilized to check the patient’s general health and nutrient levels as well as organ function.
“The main treatment for ARFID is cognitive behavioral therapy (CBT). This therapy helps the person recognize problematic thoughts and behaviors that affect their health; feel less fear or anxiety around food; be more comfortable with sensory challenges,” Cleveland says.
They also say that some medications can help restore the mind and body. They include antipsychotic medications, antidepressants or medications that stimulate appetite. Sometimes a feeding tube is needed to provide essential nutrients.
NEDA says that some forms of family-based therapy and parent-based behavioral approaches have been successful. But no matter what treatment one chooses, it’s essential to seek professional help as soon as possible. ARFID is serious.
Kathy Hubbard is a member of the Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com. This article was written for publication in the Bonner County Daily Bee on February 26, 2025.
