ARFID, also known as Avoidant/Restrictive Food Intake Disorder, is a newly recognized eating disorder characterized by individuals having an extreme aversion to certain foods or food groups, leading to limited or restrictive food intake1,2. This disorder can pose significant challenges for those struggling with ARFID, as it can greatly impact their overall health3. Some individuals may have strong aversions to certain foods due to sensory issues or past negative experiences; however, individuals with ARFID experience these aversions to such an extreme degree that it impairs their ability to maintain a balanced diet. This can result in weight loss, nutrient deficiencies, malnutrition, and other health complications2,3,4.
In contrast to other eating disorders like anorexia nervosa or bulimia nervosa, ARFID does not involve body image concerns1,2, rather, a genuine fear or anxiety around certain foods, which can make mealtimes a source of stress and discomfort.
Researchers have identified different subtypes of ARFID, including sensory-based and fear-based restrictions, with some individuals experiencing a mix of both5. Each subtype presents its own set of challenges and behavioral patterns and may require a different approach to diagnosis and treatment.
Avoidant ARFID
What sets eating apart from other activities is that it engages all eight senses: sight, smell, taste, touch, hearing, vestibular (sense of balance), proprioception (sense of body position), and interoception (internal awareness)6. Individuals with the avoidant type of ARFID have a heightened sensitivity to such aspects and may find certain foods to be intolerable due to these sensory sensitivities5. For example, a person with the avoidant type of ARFID may refuse to eat foods with a certain texture, like mushy or crunchy foods, because they find them unpleasant to eat.
Restrictive ARFID
Have you ever become so engrossed in a task that you forgot to eat or even missed a meal? This phenomenon is not uncommon among individuals who are highly focused on their work or activities; however, for those with the restrictive type of ARFID, the reasons behind missing meals may be quite different. Specifically, individuals with the restrictive type of ARFID may not eat due to poor interoception and/or lack of interest in eating5. Interoception refers to the ability to perceive internal bodily sensations, such as hunger and fullness cues6. Difficulty in recognizing these cues can lead to unintentionally skipping meals.
Aversive ARFID
Negative experiences with certain foods can have a lasting impact on our perception and future willingness to consume them. For example, if someone gets food poisoning from eating sushi at a restaurant, they may develop a fear or disgust towards sushi in general. This understandable reaction may serve as a defense mechanism to prevent future illness or discomfort and, for most people, does not significantly affect their overall diet. They may simply avoid the food that caused them harm and continue to eat many other foods. Similarly, with the aversive type of ARFID, food avoidance may be due to negative experiences or fear of choking, vomiting, food poisoning, or other adverse effects5; however, these individuals may avoid a variety of foods, not just those that have directly harmed them. If left untreated, it can lead to nutritional deficiencies and other health problems2,3.
Mixed ARFID
Finally, mixed ARFID combines both sensory-based and fear-based restrictions: that is, individuals may avoid certain foods due to their texture, taste, or smell, as well as fear of choking or vomiting5. Research suggests that individuals with ARFID may experience each subtype to varying degrees, meaning one may be predominant7. This dual impact can make it even more difficult to meet nutritional needs and maintain a healthy weight.
Key Takeaways
In conclusion, while classifying ARFID subtypes can be useful for diagnostic and treatment purposes, it is important to consider the unique needs and challenges of each ARFID patient. In doing so, clinicians can provide more effective and compassionate treatment that addresses the root causes of the disorder and supports long-term recovery.
References
- National Eating Disorders Association. Avoidant Restrictive Food Intake Disorder. Nationaleatingdisorders.org. Published 2023. Accessed July 1, 2024. https://www.nationaleatingdisorders.org
- Attia E, Walsh BT. Avoidant/Restrictive Food Intake Disorder (ARFID) – Avoidant/Restrictive Food Intake Disorder (ARFID). Merck Manual Professional Edition. Published July 2022. Accessed July 1, 2024. https://www.merckmanuals.com/professional/psychiatric-disorders/eating-disorders/avoidant-restrictive-food-intake-disorder-arfid?query=avoidant/restrictive%20food%20intake%20disorder
- Nitsch A. ARFID (Avoidant Restrictive Food Intake Disorder) | Symptoms & Treatment. ACUTE. Published May 26, 2022. Accessed July 1, 2024. https://www.acute.org/blog/avoidant-restrictive-food-intake-disorder-arfid-signs-symptoms-treatment
- ARFID Eating Disorder: Comprehensive ARFID Treatment. The Emily Program. Accessed July 1, 2024. https://emilyprogram.com/eating-disorders-we-treat/avoidant-restrictive-food-intake-disorder/
- Douglas S. The Link between ARFID and Neurodiversity. dietwise.net.au. Published May 29, 2024. Accessed July 1, 2024. https://dietwise.net.au/2024/05/29/the-link-between-arfid-and-neurodiversity/#:~:text=Mixed%3A%20characterized%20by%20having%20two
- Saunders (Bulman) M. The Sensory Experience of Eating: Part 1. The Healthy Eating Clinic. Published February 8, 2023. Accessed July 1, 2024. https://healthyeatingclinic.com.au/the-sensory-experience-of-eating-part-1/
- Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports. 2017;19(8). doi:https://doi.org/10.1007/s11920-017-0795-5
