Effective Treatments for Co-Occurring ARFID and Autism

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Avoidant/Restrictive Food Intake Disorder (ARFID) is a diagnosable feeding disorder recognized in the DSM-5.

ARFID involves rigidity around eating and avoiding certain food types, which results in insufficient calorie intake. This disorder can occur throughout the lifespan in all ages.

Food avoidance may be based on inaccurate information or incorrect beliefs about food intolerance and nutrition, which are rigidly held beliefs that conflict with empirical evidence.

There may be an aversion to the smell, taste, temperature, or texture of foods and ARFID can result from traumatic avoidance related to food, such as choking or painful esophageal spasms due to dysphagia [1, 2].

The diagnostic category of ARFID replaced the previous term of Childhood Feeding Disorders, and the many terms used to describe individuals with certain common characteristics in their eating and drinking [6].

Anorexia is an entirely separate eating disorder with different diagnostic criteria, characterized as a restriction of calorie intake and a desire to control weight with intense fear of becoming weight gain.

Autism is a developmental disorder that affects the way individuals think and interact with others [7]. Individuals who have autism may have repetitive or very focused behaviors, interests, and high sensitivity to sensory experiences.

Connection Between ARFID and Autism

ARFID is a pattern of eating that is common in individuals with autism and is combined with sensory sensitivity. Researchers have found links between autism and eating disorders, especially in thinking profiles [6].

Both disorder patterns overlap with eating and restriction of food intake and potential for significant weight loss. Depending on the severity of the autism and symptoms, sensory experiences, such as smells, tastes, textures, noises, and body sensations, may be uncomfortable and perceived as harmful.

Woman struggling with autismWhen a person avoids consistently aversive sensory experiences, they tend to consume a limited variety of foods. This can cause low energy, malnutrition, arrested growth, and weight loss [7]. This leads to the development of ARFID.  This disorder is similar to anorexia because of significant weight loss, and those with autism and ARFID are often misdiagnosed with anorexia.

A key difference in ARFID is that there is no drive for thinness or fear of becoming fat, as there is with individuals struggling with anorexia.

When those with ARFID lose a significant amount of weight or fail to achieve expected weight gains, it is dangerous and may require hospitalization.

Effective Treatment for ARFID and Autism

Cognitive Behavioral Therapy (CBT) is a highly effective, empirically-based therapy for ARFID that can help challenge rigid beliefs around food, including fear of choking. Psychoeducational information from scientific literature on nutrition could also be beneficial for those with ARFID due to food avoidance.

ARFID is often also treated through anxiety management and systematic desensitization, gradually rewarding the introduction of new foods. Relaxation therapy can also be used to minimize stress.

It is essential to have a safe environment where fear foods are slowly integrated into the eating plan. Consuming a meal together with meal processing, visualization, art therapy, and psychotherapy can be extremely useful in treatment.

Janet Treasure, a psychiatrist at King’s College London and Director of Eating Disorder Program at Maudsley Hospital, states that she feels autism and anorexia are more similar than anyone previously believed [4]. She states that many aspects of eating disorders and autism, such as thinking styles and emotional states, are very similar.

Woman sitting on stump

Emerging research shows that people with either condition have difficulty understanding and interpreting social cues, and tend to fixate on tiny details that make it difficult to see the big picture [4].

Both groups of people often seek out rules, routines, and rituals. Genetic studies also have shown overlaps between autism and anorexia. Some studies show that as many as 20 percent of individuals with anorexia also have autism [4].

ARFID can cause some children and teens to lose a significant amount of weight due to restrictive food intake. If an individual is at an extremely low weight or medically unstable, hospitalization may be the first step in treatment.

If hospitalization is not needed then outpatient treatment can be extremely effective. A full treatment team is recommended, including a psychiatrist, psychologist, dietician, adolescent medicine doctor, nurse or social worker. Together a treatment plan can be created to help best address the patient’s needs [5].

Further treatment can include exposure therapy for nutritional recovery [7]. A core component in exposure therapy for ARFID is exposing the individual to varied textures, smells, tastes, and sensations.

Proper nutrition and exposure can provide nourishment to the brain and permit habituation to the anxiety-provoking stimuli. A nourished brain is more flexible in treatment than a malnourished one, so improved nutrition is central to treatment for those with co-occurring ARFID and autism.

It can be difficult to distinguish early onset anorexia from ARFID in children under 12, particularly when an individual also falls on the autism spectrum. If you are noticing warning signs in your child, know that treatment is available and reach out for support today.

 


Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


References:

[1] https://www.theravive.com/therapedia/Avoidant-Restrictive-Food-Intake-Disorder-DSM–5-307.59
[2] https://eatingdisorder.org/eating-disorder-information/avoidantrestrictive-food-intake-disorder-arfid/
[3] http://www.todaysdietitian.com/newarchives/1015p70.shtml
[4] https://spectrumnews.org/features/deep-dive/the-invisible-link-between-autism-and-anorexia/
[5] http://www.aboutkidshealth.ca/en/healthaz/conditionsanddiseases/behaviouralandemotionalproblems/pages/arfid-treatments.aspx
[6] http://network.autism.org.uk/good-practice/case-studies/eating-disorder-or-disordered-eating-eating-patterns-autism
[7] https://www.eatingrecoverycenter.com/blog/2016/05/26/must-know-eating-disorders-autism-spectrum-lisa-geraud


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 May 4, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on May 3, 2017.
Published on EatingDisorderHope.com