ARFID: When picky eating becomes a serious disorder

Avoidant/restrictive food intake disorder, commonly known as ARFID, is a relatively new diagnosis in the field of eating disorders. 

“Unlike better-known eating disorders such as anorexia or bulimia, ARFID doesn’t involve body image concerns or fear of weight gain,” says Dr Anita Parbhoo, a paediatrician at Mediclinic Louis Leipoldt. “Instead, it represents a complex relationship with food that goes far beyond typical ‘picky eating.’”

Mike, a 35-year-old man who lives with ARFID, explains: “For a long time, I ate only white bread and chips. I had no vegetables or fruit in my diet. I couldn’t even eat bland pasta or rice, let alone any sauce or flavouring. If a plate of food had been blemished by the presence of a ‘non-safe’ food, I couldn’t eat it. Going to a restaurant was a nightmare, so I just didn’t do it.”

With intensive therapy, Mike is learning to try new foods. “The sensation of my mouth drying up and not being able to swallow remains sometimes, but I feel like I’m making progress,” he says. I am optimistic for the future.”

How is ARFID diagnosed?

People with ARFID may have a lack of interest in eating or choose to avoid certain foods because of a particular texture, smell, taste or appearance, or they have concerns about choking or vomiting when eating because of a previous bad reaction.

This disorder can lead to serious health issues because people who suffer from it are unlikely to get proper nutrition.

“Children with ARFID might not gain the weight necessary for healthy development,” says Dr Parbhoo. “They may also develop serious nutritional deficiencies. Adult sufferers may limit their social activities because of ARFID.”

ARFID versus picky eating

Many parents worry about their child’s selective eating habits, but it’s important to distinguish between normal developmental picky eating and ARFID:

• Picky eating could mean your child rejects certain food groups like fruit or vegetables. “It’s usually temporary and often improves with age,” says Dr Parbhoo. “It rarely causes significant nutritional deficiencies and doesn’t usually result in weight loss.”
• ARFID, on the other hand, is an ongoing condition that often gets worse if left untreated. “ARFID can lead to unhealthy weight loss or stunted growth and significantly affect daily life and social functioning. Those who live with it may also restrict their diet to a few items of food – and will often eat the same meals every day for years to avoid any uncomfortable sensations.

Who does ARFID affect

“ARFID often emerges during infancy or childhood. It sometimes develops from what at first appears to be extreme fussy eating,” says Dr Parbhoo. “Traumatic food-related experiences like choking or vomiting could make the person fearful of certain foods and trigger the development of ARFID.”  

Doctors believe ARFID occurs more frequently in individuals with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). “These connections suggest underlying neurobiological mechanisms that affect food acceptance and eating behaviours,” explains Dr Parbhoo. Anxiety disorders can also co-occur with ARFID.

Dr Parbhoo adds that family eating patterns, a parent’s relationship to food and cultural food norms can all influence a child’s feelings about eating. “Pressure to eat certain foods or emotional conflict around mealtimes can also reinforce avoidant behaviours,” she says.

Treatment for ARFID

Successful treatment for ARFID usually involves a multidisciplinary approach:

• Psychologist – can help with strong anxiety about food by using cognitive behavioural therapy (CBT). This therapy helps people slowly get used to trying different foods. The psychologist can also work with families to make mealtimes feel safe and supportive, not stressful or scary.
• Dietitian – can help plan meals to make sure you or your child is getting the right nutrition.
• Paediatrician or family doctor – can give supplements if needed.

“With proper treatment, people with ARFID can significantly improve their relationship with food,” Dr Parbhoo assures. “But this requires ongoing support and management, particularly during times of stress when symptoms may worsen.”

If you, your child, or someone you know is struggling with severely limited food intake, significant weight loss, or extreme anxiety around eating, your Mediclinic doctor can help. Book an appointment