Avoidant Restrictive Feeding Intake Disorder (ARFID)

What is Avoidant/Restrictive Feeding Intake Disorder?

Avoidant/Restrictive Feeding Intake Disorder is a slightly different type of eating disorder, as there is rarely any body image disturbance. Eating is restricted, but not for weight or shape reasons. Instead, people may limit their food intake for other reasons including:

• struggling with the taste, texture or smell of certain foods

• fear of a trigger incident (e.g. choking or vomiting)

• a long-standing lack of interest in food or lack of appetite

ARFID is diagnosed when these difficulties are causing a significant impact on growth (e.g. people being at a low weight or experiencing nutritional deficiencies) or when there is a significant impact on day to day living and/or relationships.

Struggling with taste, textures or smells

It’s normal for people to have preferences over the tastes or textures they particularly like to eat. However, for some people this can have a devastating impact. Some people can have extremely strong disgust responses to foods that have different textures, smells or tastes. Sometimes this can lead to people avoiding entire food groups (e.g. fruit and veg or dairy) leading to nutritional deficiencies. Other people can be highly sensitive to differences, and will struggle to eat foods that are from a different brand as they will experience the differences as too difficult to tolerate. This type of restriction often occurs in the context of Autism Spectrum Disorders (ASD).

Fear of a trigger incident

A distressing incident (such as choking, seeing someone else have an allergic reaction, or having a vomiting bug) can cause people to avoid certain types of food. Whilst it is fairly common for people to want to avoid a food which has triggered a stomach bug or an episode of food poisoning for a little while, for some people this fear can grow. In these cases, people may avoid whole food groups, or may resort to only eating certain types of food (e.g. soft foods or long-life foods). For others, they may develop rules around how they eat, to try and avoid the feared consequence (for example chewing each mouthful numerous times or eating very slowly). This can result in restricted intake (with people not getting enough food or not getting the right nutrients) or can cause psychosocial difficulties (making it hard for people to eat with others, or interfering with work or school).

Lack of interest in food or lack of appetite

Some people appear to have little interest in food or a very poor appetite. If this is so chronic that it affects physical health, it is crucial that ways are found to address the lack of interest or lack of appetite, in order to help the person find a way of eating sufficient and balanced meals for their health.

What is the treatment for Avoidant/Restrictive Feeding Intake Disorder?

A specific treatment has been developed for the treatment of ARFID, called CBT-AR. This is based on CBT-E (a form of CBT for other eating disorders) but has been adapted specifically for the treatment of ARFID.