Avoidant Restrictive Food Intake Disorder (ARFID)

Now Providing Treatment for ARFID in Los Angeles

Are you or is someone you love a picky eater? Maybe you have been a picky eater since early childhood and have a very narrow list of foods you are comfortable eating. Do the thoughts of eating your non-preferred foods scare you? Maybe you find it embarrassing when you go out with friends because you won’t eat what everyone else is eating. Maybe you or your child has recently become afraid of choking and now refuses to eat anything solid. Maybe you have an extreme fear of throwing up that has caused you to avoid eating. Maybe you’ve lost weight but rather than fearing weight gain you fear eating itself. You or your loved one may have ARFID.

We provide treatment for children, teens, and adults with ARFID.

What is ARFID?

ARFID is an eating disorder that was formalized as a diagnosis only in 2013 with the publication of the Diagnostic and Statistical Manual, 5th Edition (DSM-5) in 2013. Thus, there are not as many established treatment protocols for or providers who are trained in treating this disorder.

Individuals with ARFID eat a limited variety or amount of food which causes problems in their lives. The problems can be health-related—such as losing too much weight or having nutritional deficits—or social — for example, being unable to eat with others. However, people with ARFID, unlike individuals with anorexia nervosa, do not worry about their weight or shape or becoming fat.

Three Types of ARFID

There are three primary types of ARFID:

  • Sensory sensitivity: people with this type usually have sensory issues from early childhood that make them sensitive to certain textures or strong tastes. They find that unfamiliar foods have strange or intense smells, textures, or tastes, and they feel safer eating familiar food.
  • Low interest: people with this presentation tend to have lower levels of hunger and not find food as rewarding. This usually begins at a young age as well. They may find that they don’t get hungry often, get full quickly, or find eating to be a chore.
  • Fear of aversive consequences: people with this variation develop fear of choking, swallowing, or vomiting usually in response to a traumatic situation they experienced themselves or witnessed. They may stop eating foods that they believe will cause these outcomes. This type usually has a more sudden onset and can develop at any age.

People can have one or more types of ARFID. Sometimes ARFID can co-occur with Anorexia Nervosa.

How is ARFID treated?

Dr. Muhlheim has received training from Dr. Jennifer Thomas, one of the co-authors of CBT-AR, cognitive-behavioral therapy for ARFID. In this approach, first, we conduct a detailed assessment to clarify the diagnosis. Next, we provide psychoeducation regarding factors that maintain the disorder and develop a treatment plan. We provide education and teach you strategies to manage anxiety. If a person needs weight restoration, we work to help them gain weight first by gradually increasing their intake.

For ARFID, fear of aversive consequences type, we follow an exposure-based protocol as described in greater detail here.

For ARFID, low-interest type, we introduce exposure exercises to help you learn to tolerate sensations such as feelings of fullness. We work to put you on a schedule of regular eating and help you to increase the quantities and frequency of food consumed. Not eating enough sustains ARFID because it causes early fullness and dulled hunger cues due to restricted stomach capacity.

For ARFID, sensory sensitivity type, we work with you to develop a list of your preferred foods. We ask you to incorporate minor variations into the preparation of these foods and to try to add back any recently dropped foods from your repertoire. We then review an extensive list of target foods, with the goal of identifying foods about which you are interested in learning. You are then asked to select 5 of these foods each week to bring to session. In session, together we will go through the 5 questions where you are asked to describe what the food looks like, what it feels like in your fingers, what it smells like, what it tastes like, and what it feels like in your mouth as you taste and swallow a teeny bit.

There is no pressure to enjoy the food. In fact, we assume that because this food is so unfamiliar, it is not possible for you to like it upon the first taste. This is why you are then encouraged to do the same thing with these 5 foods for a total of 15 times over the next few weeks as homework. Only after 15 trials are you asked whether you want to add any of the foods you have learned about into your regular meals. The goal is to add foods to diversify your diet (eating from all the 5 major food groups) and reduce any nutritional deficits as well as increasing your comfort eating in social situations.

Treatment for ARFID requires your active participation and you must be willing to do at-home practices. If your child has ARFID you will be expected to be an active participant in their sessions and at-home practices.

This can be a slow and sometimes tedious process, but the good news is that with time and effort you can expand your repertoire of accepted foods, improve your diet, increase your food flexibility, and increase your comfort eating in various settings.

Sources

Thomas J. J., Wons B. W., & Eddy K. T. (2018). Cognitive‐behavioral treatment of avoidant/ restrictive food intake disorder. Current Opinion in Psychiatry, 31, 425–430.

Thomas J. J., & Eddy K. T. (2019). Cognitive‐behavioral therapy for avoidant/restrictive food intake disorder: Children, adolescents and adults. Cambridge, UK: Cambridge University Press.