Eating disorders can be complex and multifaceted, making accurate diagnosis and treatment crucial. Two disorders that often cause confusion are Avoidant/Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa. Both involve restrictive eating, but they manifest differently and require distinct approaches for effective management. At the same time, both disorders are rooted in disturbance in sensory processing. In this post, we delve into the overlap between ARFID and anorexia through the lens of a sensory processing disorder.
Understanding ARFID and Anorexia Nervosa
ARFID is a relatively newer diagnosis that involves a significant reduction in food intake due to various factors, including sensory sensitivities, a lack of interest in food, or a fear of negative consequences of eating, such as choking or vomiting. Individuals with ARFID may experience extreme picky eating, aversions to specific textures or colors of food, or a general lack of appetite. Unlike anorexia, ARFID does not necessarily involve a desire to lose weight or a distorted body image.1 Because ARFID is still a newer diagnosis, it often leads to misdiagnosis or delays in diagnosis.
Anorexia nervosa, on the other hand, is characterized by an intense fear of gaining weight and a distorted body image, which leads to severe food restriction. Individuals with anorexia often see themselves as overweight despite being underweight, and their eating behaviors are driven by a desire for weight loss and an obsession with body shape and size.2
Key Differences Between ARFID and Anorexia Nervosa
- Motivation Behind Food Restriction:
- ARFID: The restriction is often due to sensory sensitivities, a lack of interest in food, or past negative experiences related to eating. There is typically no desire for weight loss or a preoccupation with body image.
- Anorexia Nervosa: The restriction is driven by an intense fear of weight gain and a distorted perception of body image. The primary motivation is often to lose weight and maintain a low body weight.
- Body Image and Self-Perception:
- ARFID: Individuals with ARFID generally do not have a distorted body image. Their concerns are more about the sensory aspects of food or past experiences rather than their body weight or shape.
- Anorexia Nervosa: Body image distortion is a core feature. Individuals may see themselves as overweight even when they are dangerously underweight and may have an obsession with being thin.
- Eating Behaviors:
- ARFID: Eating behaviors in ARFID can include extreme selectivity in food choices, aversion to certain textures or colors, or avoidance of food due to fear of adverse consequences, such as choking or gastrointestinal discomfort.
- Anorexia Nervosa: Behaviors often include strict calorie counting, excessive exercise, and rituals around eating. Food intake is meticulously controlled with the goal of losing weight.
- Physical Health:
- ARFID: Physical consequences can include malnutrition and weight loss, but the primary issue is not necessarily driven by a desire for thinness. Growth delays and nutrient deficiencies are common, especially in children and adolescents.
- Anorexia Nervosa: Severe malnutrition is a result of extreme caloric restriction and can lead to a host of medical complications including cardiac issues, osteoporosis, and organ failure due to the drive for thinness.
Co-occurrence of ARFID and Anorexia
Overlap between ARFID and anorexia is frequently seen when individuals with ARFID also develop symptoms and features of anorexia. In addition to food sensitivities and aversions, they may also have concerns about body weight and shape, preference for less calorically dense foods, negative body image or body dysmorphia, and fear of weight gain. There is increasing research that anorexia is also a disorder that involves sensory processing disturbances. These individuals may display a lack of interoceptive awareness and inability to feel hunger and fullness cues, which have an influence on how they process taste and sensations.3
ARFID is common in neurodivergent individuals. Because anorexia is based in sensory disturbances as well, it is imperative to understand how this overlap may manifest for people with ADHD or autism. For example, while fear of weight gain is a common characteristic of anorexia, it is not an experience shared by all with the disorder. For a neurodivergent individual, their eating disorder symptoms may arise from a need for safety and control where they may feel challenged with change and lack of a routine.
Additionally, those with co-occurring ARFID and anorexia may experience nutritional deficiencies, gastrointestinal discomfort, challenging eating in social settings, fear of judgement from others, and mistrust and disassociation from their bodies.4
Treatment of Co-occurring ARFID and Anorexia
Treatment of these overlapping eating disorders requires medical oversight, nutritional rehabilitation, as well as work toward establishing trust and safety in the body. In collaboration with an eating disorder therapist and registered dietitian, clients may work through food exposures, increasing their food variety, and re-establishing interoceptive awareness.
Understanding whether one is dealing with ARFID, anorexia nervosa, or a combination of both is crucial for effective intervention and recovery. Treating clients from a sensory processing disorder perspective can be helpful in identifying when overlapping ARFID and anorexia are present. Both disorders require compassionate, creative, and individualized care and support from a team of professionals including an eating disorder registered dietitian, therapist, doctor, and psychiatrist. At Laura Cipullo Whole Nutrition Services, our team of dietitians is here to support.
References
- Zimmerman J, Fisher M. Avoidant/Restrictive Food Intake Disorder (ARFID). Curr Probl Pediatr Adolesc Health Care. 2017 Apr;47(4):95-103. doi: 10.1016/j.cppeds.2017.02.005. PMID: 28532967.
- Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry. 2015 Dec;2(12):1099-111. doi: 10.1016/S2215-0366(15)00356-9. Epub 2015 Oct 27. PMID: 26514083.
- Cobbaert L, Hay P, Mitchell PB, Roza SJ, Perkes I. Sensory processing across eating disorders: A systematic review and meta-analysis of self-report inventories. Int J Eat Disord. 2024 Jul;57(7):1465-1488. doi: 10.1002/eat.24184. Epub 2024 Mar 21. PMID: 38511825.
- Becker KR, Breithaupt L, Lawson EA, Eddy KT, Thomas JJ. Co-occurrence of Avoidant/Restrictive Food Intake Disorder and Traditional Eating Psychopathology. J Am Acad Child Adolesc Psychiatry. 2020 Feb;59(2):209-212. doi: 10.1016/j.jaac.2019.09.037. Epub 2019 Nov 26. PMID: 31783098; PMCID: PMC7380203.
- https://neurodivergentinsights.com/misdiagnosis-monday/anorexia-and-arfid?format=amp
