ARFID is a form of disordered eating where an individual restricts their food intake, and thus their nutrient intake, to such an extent that their nutritional status and micronutrient levels are affected. This can include vitamins A, C, B12, thiamine, folate and D, minerals such as calcium, iron and potassium, and trace elements such as zinc. All of these nutrients have key functions in growth, development and function.
Sufferers do not restrict their intake for a purpose associated with pursuit of a low body weight. Many report distress that they are unable to manage more nutrients. Weight loss is common but some may also have a higher body mass index (BMI), which may mask deficiencies.
DSM-5 & ICD-11
Added to the Diagnostic and Statistical Manual of Mental disorders (DSM-5; American Psychiatric Association) in 2013, and potentially soon to be added to the International Classification of Diseases (ICD)-11.
Individuals suffering with ARFID allow a very narrow range of foods and drinks providing few nutrients. As an example a dietary recall may look something like this:
- Breakfast) bowl of dry coco pops
- Snack) avoided as dislikes
- Lunch) 2 from 6 different packets of crisps – to ensure something is consumed
- After school) dry coco pops and popcorn
- Evening meal) chips, pudding) bowl of dry coco pops
It is not uncommon for individuals to prefer eating alone and not in-front of others. Sufferers can can also experience bowel issues such as constipation due to low fibre and low food volume.
The causes of ARFID are not fully understood but are often associated with fear. Fear of new things, fear of sensory overload, fear of negative consequences or a lack of interest in food, especially when other things are occurring in life. A choking trauma may also be a trigger for some individuals. When discussing the introduction of new foods with an individual suffering with ARFID, they can report that the thought of introducing new foods is ‘painful’ and can experience severe nausea and even vomiting
The following factors can increase the risk of developing ARFID:
- autism spectrum disorder
- History of picky eating in infancy
- Anxiety disorders
Treatment will ideally include an MDT (medic, psychologist, dietitian, speech and language therapist if available). Currently paediatric care pathways are more established but potentially overwhelmed by the number of patients requiring services. Adult services are less established and not always managed by eating disorder teams. A combination of therapies have proved to be effective in helping individuals to improve their nutritional intake.
What should I do?
If you suspect your child or an adult known to you maybe experiencing restrictive intake to a level affecting their quality of life then contact us for more information.
Links for support and more information:
ARFID Awareness uk – www.arfidawarenessuk.org/
BEAT eating disorders uk – ARFID