Contributor: Emily Keehn, M. Ed., LPC, Dialectical Behavior Therapy Specialist for Timberline Knolls Residential Treatment Center.
Typically ARFID is considered a disorder that affects children and adolescents, but it also affects adults.
Picky eating can turn into Avoidant Restrictive Food Intake Disorder (ARFID) and can affect a person at any age or developmental level.
It can lead to weight loss, nutritional deficiencies, dependence on feeding supplements, mental and emotional impairment and is not contributed to by a disturbance in body shape or size .
A study was conducted to look at ARFID symptoms which are secondary to picky eating in adults. The goal was to describe the symptoms of ARFID, reduced quality of eating, and other co-occurring eating disorders.
The researchers found some overlap between ARFID and anorexia nervosa. In a review of treatment modalities for both disorders, many individuals who had ARFID diagnosis were sent for eating disorder treatment, up to 22% in chart reviews .
Picky eating in adults has also been associated with higher rates of depression and obsessive-compulsive disorders as well as lower quality of life versus children and adolescents who are diagnosed with picky eating.
Often ARFID in adults tends to have a small range of foods that they will eat, sometimes less than 20 foods. Individuals may often refuse to try new foods, or report higher rates of texture or sensory issues to foods.
Studies have also shown that those who report picky eating o include higher rates of refusal to try new foods, dietary rigidity, and sensory sensitivity typically eat from a narrow range of foods are typically classified as having ARFID .
What is ARFID?
ARFID, which is a new diagnosis within the DSM-V defines individuals who have symptoms that do not match a traditional eating disorder diagnosis but experience clinically significant struggles with eating and food.
Often, a person who does meet this criterion has some type of issue with eating which can stem from difficulty digesting specific foods, food avoidance to various colors or textures of food, eating small portions, little or no appetite, or being afraid to eat after a frightening episode of choking or vomiting .
Other qualities of life concerns are difficulty with social interactions, social functions, work or school responsibilities due to inadequate nutritional needs and co-occurring disorders.
Some individuals may avoid work or school lunches, inability to complete tasks due to duration it takes to complete a food or meal, and isolation from friends and family.
Changes are possible for ARFID in adults. It typically helps to know what type of changes you would like as well as your treatment teams goals.
Some individuals like to see social changes or a larger range of foods to be able to eat, and some being more comfortable with eating outside of the home.
There are therapies that can help with exposure, anxiety, and thought processes that surround the avoidant restrictive food intake disorder .
Often therapists will work on a hierarchy of fear foods from least fearful to most anxiety provoking.
From that, the therapist and the client will work on being able to expose the client to foods moving up the hierarchy category slowly.
This type of work includes mental visualization, writing and verbally talking through steps to exposure, practicing distress coping skills and cognitive behavioral therapy to address negative thoughts, and life practice sessions to sensitize clients to various situations and foods.
Other therapies that work to help with ARFID is Cognitive Behavioral Therapy and Dialectical Behavioral therapy.
In conjunction with exposure and anxiety therapy, individuals will work with their treatment team to address any unhealthy or negative thoughts and behaviors that are treatment-interfering.
Often the person’s behavior or fear of exposure will create a cycle of treatment-interfering behaviors which can be addressed in therapy.
With Dialectical Behavioral Therapy a person learns mindfulness within the moment, distress tolerance skills to manage high anxiety-provoking situations, as well as emotional identification.
With these tools, a person is able to understand better what their body is trying to say to them, versus such anxiety.
Often a food may remind them of being ‘forced’ to eat certain foods when young and having an adversative reaction, or having a highly adverse event, such as becoming car sick or choking on food when young.
These situations can lead to avoidance of that food as well as similar foods and go from picky eating to ARFID.
Other effective treatments include group therapy and group meals to work on sensory issues within a supportive setting . Many times groups will go out into the community and eat in a public place or go grocery shopping together.
Within this type of environment, the individual can gain support from other members who struggle with similar issues, as well as learn how to manage live situations with the backing from a member of their treatment team.
There are various levels of treatment for an individual struggling with ARFID. One is a residential therapy which allows for the person to live in with 24-hour support and treatment.
This level usually involves several aspects of individual therapy, family therapy, nutritional support, group therapy, and skills-based groups.
Another level is Intensive Outpatient Programming which the individual attends 3-7 days a week for three hours at a time.
This level is usually a group format only, with a supportive meal and therapeutic sessions outside of the group setting. Outpatient therapy is the last level of support where a person can come up to 3-4 days a week of individual sessions for support.
Often this is the last level of a step down when coming out of a higher level of care, or the first level of support when assessing what type of treatment would work best.
Many individuals who struggle with ARFID attend an eating disorder facility that addresses concurrently both the eating disturbances and offers anxiety treatment. Currently, there are no facilities that address just the ARFID diagnosis.
Adults that struggle with this disorder may also choose to attend an anxiety treatment facility first, and then move on to an eating disorder facility to address the eating concerns. Often the best approach is one that treats both disorders together for the most significant success.
ARFID can be a struggle for many adults, but there are effective treatments available to help individuals have a higher level quality of living. People do not have to suffer alone with this diagnosis and know that there are treatment and support available.
About the author: As a Dialectical Behavior Therapy Specialist, Emily supports residents within their recovery learning the principles of Dialectical Behavior Therapy and application of skills into daily life to help residents create their meaningful life while living in recovery.
Emily started at Timberline Knolls of March 2015 as a Behavior Health Specialist before transitioning to DBT Specialist in June 2015. Emily earned a Bachelors of Arts in Psychology as well as a Graduate Certificate in Eating Disorders and Obesity from Northern Illinois University. She was awarded a Master’s of Education in Community Counseling from DePaul University and became a Licensed Professional Counselor in August 2015.
References: Zickgraf, H. F., Franklin, M. E., & Rozin, P. (2016, October 29). Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms. Retrieved November 08, 2017, from https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-016-0110-6
 Avoidant/Restrictive Food Intake Disorder (ARFID) . (n.d.). Retrieved November 08, 2017, from https://eatingdisorder.org/eating-disorder-information/avoidantrestrictive-food-intake-disorder-arfid/
 A. (n.d.). Treatment for ARFID. Retrieved November 08, 2017, from http://www.arfidresource.com/?page_id=34
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on December 27, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on December 27, 2017.
Published on EatingDisorderHope.com