Effective Treatments for Adults Living with ARFID

Avoidant restrictive food intake disorder (ARFID) is similar to anorexia. People with ARFID eat an extremely limited diet, and in some cases, they skip meals altogether.

But people with ARFID don’t have body concerns common in people with anorexia.[1] They don’t worry that they’re too fat or unshapely. Instead, they worry that eating the wrong foods will make them physically or mentally ill.

ARFID is common in childhood, and kids who don’t move out of the “picky eating” stage and into normal diets could get this diagnosis. But anyone, including adults, could develop ARFID symptoms.[2] And sometimes, adults with ARFID live with the problem for years before they’re diagnosed.

The longer a problem stays in place, the harder it can be to treat. But adults can benefit from programs that break negative food associations. Therapy could help people learn to tolerate (if not enjoy) the foods they once avoided altogether.

If left untreated, avoidant restrictive food intake disorder in adults can lead to weight loss, malnutrition, and severe mental suffering. If you think you have ARFID, it’s time to get help.

What Causes ARFID in Adults?

Sometimes, understanding the cause of a mental illness is key to treating it. ARFID is a little different. Eating disorders stem from a variety of issues all working together. Untangling the connections isn’t easy.

These are three common causes of avoidant restrictive food intake disorder in adults.

1. Genetic Factors

Researchers say that several genes could play a role in the development of eating disorders like ARFID. Those same genes could increase the risk of mental health issues like anxiety disorders.[3]

If your parents developed restrictive eating habits as adults or you remember another close family member dealing with this issue, genetics could be at play.

2. Traumatic Incidents

A sudden food aversion in adults could stem from a frightening, food-related problem, such as these:

• Choking
• Bloating
• Diarrhea
• Gastrointestinal pain
• Food poisoning

Some people remain so upset at the memory of these incidents that they’ll put entire categories of food in the “never again” category. Choking on a carrot, for example, could lead some adults to skip all vegetables for life.

3. Restrictive Eating

Researchers found a link between undiagnosed ARFID and people limiting their meals due to celiac disease.[4] They found no link between significant celiac symptoms and very limited eating.

Grouping foods into good or bad categories can cause a shift in your mind, and you may begin to eliminate almost all foods due to concerns about your health. A diet that once seemed healthy could push you into disordered eating.

ARFID Symptoms in Adults

Avoidant restrictive food intake disorder presentations can be variable, and it’s rare for two people to express the very same feelings about their eating patterns. Experts recognize three common presentations of ARFID.[5]

1. Sensory Food Aversion in Adults

Most food groups have a distinctive smell, mouth feel, and taste. Adults often avoid meats, fruits, and vegetables due to these concerns.

2. Lack of Appetite in Adults

Some people with ARFID dislike eating almost any type of food, no matter how it’s prepared. They may skip meals altogether, as they just don’t enjoy the experience of eating.

3. Food Fears in Adults

These people avoid specific foods after an event involving choking, vomiting, or gastrointestinal problems. Even thinking about trying this type of food again can fill them with distress.

Related Reading

• What is ARFID?
• Treatment Options for ARFID

Avoidant Restrictive Food Intake Disorder Treatment in Adults

It’s easy for experts to overlook ARFID symptoms in adults. In one study, close to 24% of people had ARFID symptoms, but only one patient had ever been diagnosed with it (and that person waited 1.5 years for the diagnosis).[6]

Controlling long-standing habits isn’t easy, but treatment can help.

Your treatment team may choose from these treatment options:

Exposure Therapy

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, addressing negative thoughts, and life practice sessions to sensitize clients to various situations and foods.

Cognitive Behavioral Therapy

Often, a food may remind a client of being “forced” to eat certain foods when young, having a negative reaction, or experiencing 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, going from picky eating to ARFID.

In CBT sessions, people learn how to identify negative thoughts (“I will choke if I eat this.”) and cope with them (“I will take a deep breath in and out. Then, I will take a tiny bite. I will enjoy this bite.”).

In one study of CBT effectiveness in ARFID, 93% of patients said they were very satisfied with the help they got in their sessions, and 80% of the therapists said their patients improved.[7]

Dialectical Behavior Therapy

With dialectical behavior therapy, a person learns mindfulness within the moment, distress tolerance skills to manage high anxiety-provoking situations, and emotional identification.

With these tools, a person is able to understand better what their body is trying to say to them.

Group Therapy

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 and learn how to manage situations with the backing of a member of their treatment team.

ARFID Treatment Settings

There are various levels of treatment for an individual struggling with ARFID.

Many individuals who struggle with avoidant restrictive food intake disorder attend an eating disorder facility that addresses concurrently both the eating disturbances and anxiety. Currently, there are no facilities that address just the ARFID diagnosis.

Residential Therapy

Residential therapy allows the person 24-hour support and treatment, such as individual therapy, family therapy, nutritional support, group therapy, and skills-based groups.

Intensive Outpatient Therapy

The individual attends sessions three to seven 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

The person attends therapy up to three to four days per week for individual support. Often, this is the last level of a step-down approach when coming out of a higher level of care or the first level of support when assessing what type of treatment would work best.

ARFID Is Treatable

Avoidant restrictive food intake disorder can be a struggle for many adults, but there are effective treatments available to help individuals have a higher quality of life. People do not have to suffer alone with this diagnosis. Know that treatment and support are available.

References

1. Avoidant Restrictive Food Intake Disorder. National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid. Accessed July 2022.
2. Avoidant/Restrictive Food Intake Disorder (ARFID). National Eating Disorders Collaboration. https://nedc.com.au/eating-disorders/eating-disorders-explained/types/arfid/. Accessed July 2022.
3. How Genetic Analysis May Contribute to the Understanding of Avoidant/Restrictive Food Intake Disorder (ARFID). Journal of Eating Disorders. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00578-x. April 2022. Accessed July 2022.
4. Avoidant/Restrictive Food Intake Disorder Characteristics and Prevalence in Adult Celiac Disease Patients. Gastro Hep Advances. https://www.sciencedirect.com/science/article/pii/S2772572322000036. March 2022. Accessed July 2022.
5. Avoidant/Restrictive Food Intake Disorder: A Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281436/. December 2018. Accessed July 2022.
6. Avoidant/Restrictive Food Intake Disorder Very Common with Neurogastroenterology Symptoms. Clinical Gastroenterology and Hepatology. https://advances.massgeneral.org/digestive-health/journal.aspx?id=1736. November 2020. Accessed July 2022.
7. Cognitive-Behavioral Therapy for Adults with Avoidant/Restrictive Food Intake Disorder. Journal of Behavioral and Cognitive Therapy. https://www.sciencedirect.com/science/article/pii/S2589979120300470. March 2021. Accessed July 2022.