The restricting behavior can be due to sensory sensitivity, trauma, or lack of interest in food. ARFID was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013, replacing Feeding Disorder of Infancy or Early Childhood and expanding the diagnostic criteria to include individuals across the lifespan. Approximately 1.5% of children and adolescents develop ARFID, and less than 1% of individuals age 15 and older meet criteria for ARFID.
ARFID Signs and Symptoms
Diagnostic criteria for ARFID is the same in the DSM-5 and the DSM-5-TR. The diagnostic criteria for ARFID are:
A disturbance in eating, which can manifest as a lack of interest in eating, avoidance of food due to “sensory characteristics,” or worry about possible “aversive consequences of eating” (such as choking or vomiting), manifesting in one or more of the ways: Weight loss that is significant, or failure to reach growth milestones in children Malnutrition The need for tube feeding or nutritional supplements Significant functional interference The restrictive eating pattern is not due to lack of available food or a cultural practice The restricting or avoiding is not related to episodes of another eating disorder, such as anorexia nervosa or bulimia nervosa, and the restricting or avoiding is not a deliberate effort to change the shape or appearance of the body The disturbance is not due to a medical condition or another mental health diagnosis, and the symptoms are beyond what is accounted for by another diagnosis
If an individual previously met the criteria for ARFID but no longer meets criteria, the diagnosis is specified as in remission.
ARFID Types
Although the DSM does not officially classify different subtypes of ARFID, research has shown that there are different triggers for symptom onset: irritable/impulsive, sensory food aversions, and posttraumatic feeding disorder. The irritable/impulsive subtype refers to those who become irritable or emotionally dysregulated at mealtimes. They do not have control over their emotional response and might struggle with body self-control. Finally, post-traumatic feeding disorder is a trauma response that develops following an aversive feeding experience, such as choking or vomiting. The individual exhibits significant anxiety that another aversive experience will occur while they are eating.
ARFID Comorbidities
ARFID, like other eating disorders, carries risk of malnutrition, unhealthy low weight, heart problems, and sudden death. People who meet the diagnostic criteria for ARFID may also be diagnosed with anxiety disorders, obsessive-compulsive disorders, autism, attention-deficit/hyperactivity disorder, and intellectual disability.
ARFID Causes
Because the exact cause of ARFID is not known, limited information is available regarding what leads the symptoms to emerge. Many experts believe that a combination of psychological, genetic, and triggering events can lead to ARFID. Available research suggests that ARFID is equally prevalent in males and females, though autistic boys are more likely to develop ARFID than autistic girls. However, autistic individuals of all genders are at higher risk for developing ARFID compared to the general population due to sensory issues around food and eating. People with a comorbid diagnosis, including anxiety and OCD, are at increased risk for developing ARFID compared to the general population. Finally, like many other disorders, ARFID has a genetic component. Although research surrounding the specific genetic factors that contribute to an individual developing ARFID is still developing, one study suggests that people with a family history of ARFID have a 17% chance of developing the disorder, compared to 1.5% of the general population.
Diagnosing ARFID
Physicians and mental health professionals such as psychologists can diagnose ARFID. The assessment will likely include a thorough diagnostic interview with either the individual or (if they are a minor) a parent or guardian. They may also observe the individual’s behavior. In order to determine the severity and best treatment approach, the provider may also request a medical assessment to assess for malnutrition and (in children) possible growth delays.
ARFID Treatment
Unfortunately, limited information is presently available regarding effective treatment options for ARFID. Treatment goals for ARFID typically include maintaining a healthy weight and engaging in healthy eating habits, increasing the variety of foods the person will eat, and addressing anxiety or trauma symptoms surrounding fear of aversive outcomes from eating.
Psychotherapy
Therapy can help address many mental health diagnoses. In particular, cognitive-behavioral therapy has been found to be effective for various types of eating disorders, though research has not been conducted on its effectiveness with ARFID at this time. For individuals with post-traumatic feeding disorder, trauma informed therapy could help address the underlying trauma contributing to these symptoms.
Occupational Therapy
Although research on occupational therapy as a treatment for ARFID has not been conducted, sensory-based occupational therapy interventions can benefit people with sensory issues related to autism and ADHD. If the individual’s food avoidance is due to sensory issues, occupational therapy might help overcome this limitation.
Coping With ARFID Symptoms
Individuals with eating disorders are at risk for severe and sudden medical complications due to their eating disorder. Because of this, the first priority with ARFID is to address any medical conditions caused or exacerbated by the eating disorder. Second, they must consume sufficient calories and nutrition to survive. While a long-term goal of ARFID treatment is to increase the variety of foods that the person can tolerate, in the short-term, meal supplements and protein shakes can help maintain healthy nutrient intake.
A Word From Verywell
Keep in mind that relapse can be part of recovery. This can feel frustrating, but you can overcome a relapse. Symptoms can fluctuate, and this does not mean that recovery is impossible or that you will never get there. Be prepared to cope with relapses, and have a plan in place with your treatment team for how you will handle this if it occurs. Know that you can always keep moving forward in your recovery.
