Understanding ARFID: Effective Approaches for Dietitians

As dietitians, our role in supporting individuals with eating disorders extends beyond traditional conditions like anorexia nervosa and bulimia nervosa. One eating disorder that requires our specialized attention is Avoidant Restrictive Food Intake Disorder (ARFID). Unlike other eating disorders, ARFID does not involve body dysmorphia but presents unique challenges that necessitate a tailored approach. This blog aims to provide dietitians with an understanding of ARFID and effective strategies for treating clients who struggle with this disorder.

What Is ARFID?

ARFID stands for Avoidant Restrictive Food Intake Disorder. This eating disorder, recognized in the DSM-5, is characterized by an eating or feeding disturbance that leads to significant nutritional deficiency, weight loss, dependence on supplements, or interference with psychosocial functioning. ARFID replaced the previous diagnosis of “Feeding Disorder of Early Childhood and Infancy” in 2013 and has no age limitations.

Symptoms and Signs of ARFID

Distinguishing ARFID from typical picky eating can be challenging. According to the DSM-5, ARFID involves persistent failure to meet nutritional needs, accompanied by one or more of the following:

• Significant weight loss or failure to achieve expected weight gain
• Nutritional deficiencies
• Dependence on enteral feeding or dietary supplements
• Marked interference with psychosocial functioning

It’s crucial to note that ARFID is not related to a lack of available food, cultural practices, or body image disturbances. It also cannot be explained by another medical or mental health condition.

Common Characteristics of ARFID

In our practice, we often observe these common characteristics in clients with ARFID:

• High anxiety around new foods
• A dwindling list of acceptable foods, often fewer than 20
• Missing food groups and textures
• Heightened sensory sensitivity to the smell, taste, and texture of foods

The Sensory Factor

The sensory component is a critical aspect of ARFID. Clients with ARFID often have an enhanced sense of smell and taste and are highly sensitive to the tactile sensations of food. This sensitivity can be traced back to early sensory development, and there may be a genetic component, with some individuals being “super-tasters.”

Risks Associated with ARFID

Children and adults with ARFID can face severe nutritional deficiencies, which can lead to various physical health issues, including vitamin and mineral deficiencies. They may also experience significant social and emotional challenges, such as anxiety and depression, due to their limited diet and the resulting impact on their social interactions.

Effective Approaches for Treating ARFID

Identifying ARFID Sub-Groups

Clients with ARFID typically fall into one of three primary sub-groups:

1. Low appetite or lack of interest in eating
2. Avoidance based on the sensory characteristics of food
3. Concern about aversive consequences of eating, such as choking or vomiting

Treatment Strategies

For Younger Children

For children under seven years old, the foundation of treatment focuses on creating a positive feeding relationship and includes the following steps:

• Support Parents: Educate and support parents in creating a positive and anxiety-free mealtime environment.
• Remove Anxiety: Reduce pressure and anxiety around meals to encourage a more relaxed atmosphere.
• Structured Meals: Establish a consistent schedule for meals and snacks.
• Increase Exposures: Gradually increase food exposures at home, introducing new foods in a non-threatening manner.
• Food Chaining: Utilize food chaining techniques to transition from familiar to new foods.
• Nutritional Support: Monitor food intake and consider multivitamins to address deficiencies.
• Feeding Therapy: Consider referring to a pediatric occupational therapist specializing in feeding.

For Older Children, Teens, and Young Adults

Older children and teens may need more structured approaches involving:

• Daily Homework: Encourage participation in daily food exposure exercises.
• Hierarchy of Foods: Develop a hierarchy of foods to systematically introduce new items.
• Food Satisfaction: Use scales to gauge preferences and acceptability of new foods.
• Address Anxiety: Work on reducing anxiety around new foods and collaborate with pediatric therapists for additional support.

Conclusion

Treating ARFID requires patience and a tailored approach that considers the unique needs and characteristics of each client. Desensitization to new foods is a gradual process, but with persistence and support, significant progress can be made. By understanding and implementing effective strategies, dietitians can play a crucial role in helping clients with ARFID improve their nutritional intake and overall well-being.

Receiving supervision from an experienced clinician in ARFID can be one of the best ways to grow your skills and confidence in this area. KJ Dietitian Coaching offers supervision specifically for ARFID, providing you with the support and guidance needed to excel in your practice.

If you are a dietitian seeking to support clients with ARFID, consider incorporating these strategies into your practice. Together, we can make a meaningful difference in the lives of those struggling with this challenging disorder.