Is ARFID an eating disorder?
Avoidant Restrictive Food Intake Disorder (ARFID) has been recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an eating disorder since 2013.
It is described as an eating or feeding disturbance and inability to meet energy needs associated with one (or more) of the following:
- Significant weight loss (or slowed weight gain in youth)
- Significant nutritional deficiency
- Dependence on oral nutritional supplements
- Marked interference with psychosocial functioning
How do I tell if my child has ARFID?
Those with ARFID often have significant concerns with the texture, taste, or smell of foods, leading them to severely restrict their diets based on these sensory factors. Some researchers suggest that these individuals are born with the susceptibility to experience food more intensely.
Some people with ARFID avoid certain foods or eating in general due to a fear of choking, vomiting, getting sick or other negative consequences. This fear often stems from past negative experiences, such as choking or gastrointestinal distress, which they associate with the food at that time.
Individuals with ARFID often show no interest in food and might even forget to eat. They do not actively avoid food but have a general disinterest in feeding themselves. Researchers suggest that these individuals experience a "low homeostatic appetite", or in other words, minimal hunger cues.
Risk factors for the development of ARFID
ARFID affects individuals of all ages but is more commonly detected in children and adolescents. It is equally common in males and females during infancy and early childhood. However, a male predominance in middle childhood has been shown in the literature, especially with ARFID and autism. ARFID often occurs alongside other conditions such as obsessive-compulsive disorder (OCD), generalized anxiety disorder, autism spectrum disorder, learning disorders, and cognitive impairments.
This is a significant intersection of ARFID and neurodivergence due to sensory processing challenges and other factors. ADHD can also play a role in ARFID, particularly in relation to inattentiveness and "lack of interest" driving factor. The combination of anxiety and sensory sensitivities significantly contributes to the development and persistence ARFID as well.
ARFID often persists into adulthood in the absence of treatment. As awareness of ARFID increases across society, more adults are seeking treatment after living with the condition undetected for years. Advances in research, advocacy, and the inclusion of ARFID in the DSM-5 has improved detection and treatment of the condition.
Signs and symptoms of ARFID
ARFID can often fly under the radar for years, discounted as eating behaviours we will "grow out of" or "get over". However, ARFID is a serious health condition that can lead to long-term and sometimes permanent negative health outcomes. Generally, the ARFID diagnostic criteria in adults are similar to those in children. However, in children, ARFID often presents as a failure to gain weight or grow as expected, accompanied by nutritional deficiencies. In adults, it appears as chronic low weight status, nutritional deficiencies, and social isolation due to the inability to eat with others. Adults may not have realized that extreme picky eating can be diagnosed as a disorder - they may have wondered if they were the odd one out or thought never really fit in because of their extreme picky eating.
ARFID vs. picky eating
While some may consider ARFID as extreme picky eating, it is much more complex. The difference between picky eating and ARFID lies in the severity and impact on our health and daily life. Picky eating is a common behaviour, especially among young children, where they prefer a limited variety of foods and avoid trying new ones. Despite their limited diet, picky eaters usually get enough nutrients and grow without major social or psychological issues. They might refuse certain foods because of their taste, texture, or appearance but do not feel significant distress or anxiety about eating.
In contrast, individuals with ARFID do not meet their nutritional needs, leading to significant weight loss (or lack of weight gain in youth), nutritional deficiencies, and/or dependence on oral nutritional supplements. ARFID can cause severe social and psychological issues, including anxiety about eating and avoiding social situations involving food. This avoidance becomes so intense that it disrupts daily life and causes considerable distress.
Canadian statistics for ARFID
ARFID is estimated to affect about 3% of children and young adolescents, and 0.3% of older adolescents and adults in Canada.
Research indicates that 32.6% of individuals with ARFID also have Attention Deficit Hyperactivity Disorder (ADHD), and 19.8% have Autism Spectrum Disorder (ASD).
Studies suggest that ARFID affects approximately 1.5% of children and adolescents who are seen in specialized pediatric gastroenterology clinics.
ARFID is a new diagnosis, first established in the The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), in 2013.
Our team provides ARFID treatment in Ontario and all across Canada.
ARFID is much more complex than picky eating and can continue into adulthood if it is not treated properly. Our team works with each client to collaborate on a treatment approach that best fits with the needs and wishes of the affected individual. Book a free consultation call below to learn more.
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