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What is AFRID?

Updated: Oct 9, 2020

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Avoidant/Restrictive Food Intake Disorder, or ARFID, is characterized by staying away from certain foods or eating very little food. Like anorexia, ARFID results in malnutrition, but unlike anorexia, it is not a result of body image issues. ARFID is common in infants or children and can persist into adulthood.



Diagnosis Criteria

According to the DSM-5, ARFID is diagnosed when:

  • An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

  • Significant nutritional deficiency.

  • Dependence on enteral feeding or oral nutritional supplements.

  • Marked interference with psychosocial functioning.

  • The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

  • The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

  • The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.



Symptoms

Credit to NEDA.

Behavioral and psychological

  • Dramatic weight loss

  • Dresses in layers to hide weight loss or stay warm

  • Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

  • Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause

  • Dramatic restriction in types or amount of food eaten

  • Will only eat certain textures of food

  • Fears of choking or vomiting

  • Lack of appetite or interest in food

  • Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).

  • Nobody image disturbance or fear of weight gain

Physical

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

  • Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

  • Difficulties concentrating

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

  • Postpuberty female loses menstrual period

  • Dizziness

  • Fainting/syncope

  • Feeling cold all the time

  • Sleep problems

  • Dry skin

  • Dry and brittle nails

  • Fine hair on body (lanugo)

  • Thinning of hair on head, dry and brittle hair

  • Muscle weakness

  • Cold, mottled hands and feet or swelling of feet

  • Poor wound healing

  • Impaired immune functioning



Causes

From NEDA and Healthline.

The cause of ARFID is unknown, but researchers do know these risk factors:

  • Individuals on the autism spectrum, with ADHD or other intellectual disabilities

  • Children who are severe picky eaters

  • Coexists with anxiety disorders; at high risk for other psychiatric disorders

  • Specific demographics such as male and under age 13

  • Physical causes such as gastrointestinal symptoms and food allergies

  • Children who simply don’t like foods of a particular texture, taste or smell

  • The inadequate emotional response from a parent or caregiver

  • A child is afraid or stressed

  • Child fearful of a past traumatic incident like choking



Statistics

NEDA.

Of a group of adolescents with eating disorders, 14% of them met the criteria for AFRID. They were more likely to be younger and male. Symptoms include food avoidance, decreased appetite, abdominal pain, and emetophobia.

Of the adolescents with ARFID, half report a fear of vomiting or choking. One-fifth of those children say they avoid certain foods because of sensory issues. Mood disorder was found in one-third of those adolescents. Anxiety disorder was found in three-quarters. One-fifth of adolescents were on the autism spectrum.

Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., ... & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49-52.

Nicely, T. A., Lane-Loney, S., Masciulli, E., Hollenbeak, C. S., & Ornstein, R. M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of eating disorders, 2(1), 1.


Health Consequences

Walden.

  • Malnutrition

  • Failure to gain weight (children)

  • Gastrointestinal complications



Treatment Options

From Healthline and Walden.

If the situation is an emergency, the child may require hospitalization and a feeding tube for adequate nutrition.

Next, nutritional needs must be met. Children may have to go on a special diet or ingest dietary supplements to regain the recommended weight.

Counseling, nutritional or psychological, may be required.

Our ARFID-specific treatment includes:

  • Cognitive Behavioral Therapy (CBT)

  • Dialectical Behavior Therapy (DBT)

  • Meal Coaching

  • Food Exposure Therapy

  • Family-Based Education

  • Individual and Group Counseling

  • Nutritional Counseling


Book: Clinical Handbook of Complex and Atypical Eating Disorders

Author: Anderson, L.K.; Murray, S.B.; Kaye, W.H.

Publish Date: September 26, 2017

Price: $69 (Paperback)

Description: "Clinical Handbook of Complex and Atypical Eating Disorders brings together into one comprehensive resource what is known about an array of complicating factors for patients with ED, serving as an accessible introduction to each of the comorbidities and symptom presentations highlighted in the volume. The first section of the book focuses on the treatment of ED in the presence of various comorbidities, and the second section explores the treatment of ED with atypical symptom presentations. The third section focuses on how to adapt ED treatments for diverse populations typically neglected in controlled treatment trials: LGBT, pediatric, male, ethnically diverse, and older adult populations. Each chapter includes a review of clinical presentation, prevalence, treatment approaches, resources, conclusions, and future directions. Cutting edge and practical, Clinical Handbook of Complex and Atypical Eating Disorders will appeal to researchers and health professionals involved in treating ED."

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