ARFID, when food selection becomes a disorder
Avoidant/ Restrictive Food Intake Disorder ( ARFID ) is a disorder that falls under the diagnostic group of eating disorders and involves a refusal to eat food. People who are so selective about their food choices may be labeled "picky," "fussy," or "exhausting," and it is often mistaken for a mild and temporary problem, or even dismissed as a "fad."
In ARFID, severity levels range from moderate to severe. Severe cases require specialized care due to the disorder's impact on a person's overall functioning.
People with ARFID often refuse food due to a general lack of interest in eating, a specific fear (such as choking, vomiting, or pain), or a sensory characteristic (color, texture, smell, or taste) that repels them. They can become extremely selective, which can lead to serious consequences for their physical and mental health, as well as their psychosocial functioning. Some cases may require enteral feeding (nasogastric tube) or oral nutritional supplements.
Unlike other eating disorders:
- People with ARFID do not verbalize fear of weight gain (they may be underweight, normal weight or overweight) nor distortion of body image .
- They do not reject food because of its caloric content nor do they have persistent behaviors (vomiting, excessive physical exercise, use of laxatives, among others) that interfere with their weight gain.
- Although it can be diagnosed at any age, compared to other eating disorders, ARFID usually starts in childhood and is more common in boys than in girls.
- People with ARFID report a longer disease duration, which carries a higher risk of long-term chronicity.
ARFID alarm signals
The main warning sign is selective eating from childhood, and the following are also indicative:
- Having a lack of interest in food and eating from early childhood.
- Present weight loss and signs of malnutrition.
- Constantly verbalizing lack of appetite or gastrointestinal disturbances (abdominal pain, feeling of fullness, constipation, nausea, flatulence, among others).
- Eat very slowly and in small portions.
- Having specific fears of vomiting, suffocating, swallowing, choking, among others.
- Rejecting food because of its sensory characteristics (color, texture, smell or taste).
- Presenting family conflicts surrounding food and eating habits.
- Avoiding socialization due to food-related issues. For example, children who don't want to go to birthday parties, school outings, or who want to avoid the school cafeteria.
ARFID is a multifactorial disorder, meaning that biological, psychological, sociocultural, and familial factors can all influence its development. It is commonly associated with other illnesses (food allergies, congenital heart disease, gastrointestinal diseases, among others) or other mental health disorders such as anxiety, obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and learning disabilities.
How to support students with ARFID from school
What is the treatment for ARFID?
ARFID requires a multidisciplinary approach involving various disciplines: psychiatry, psychology, nursing, gastroenterology, social work, and speech therapy, among others.
Specialized mental health services offer treatment plans at the individual, group, and family levels, always adapted to the needs and situation of each person, taking into account that each case may require different levels of hospital facilities (the most serious cases require hospitalization) in terms of intensity and always depending on the level of severity.
The type of intervention used involves gradual in vivo exposure (a cognitive-behavioral technique) to aversive stimuli (rejected foods). The primary goal is for the individual to gradually expose themselves to the avoided stimuli and, through relaxation techniques, progressively reduce the anxiety they experience when faced with the feared food. The secondary goal of this procedure is to reduce coping difficulties and facilitate the generalization of the learned behavior to the home environment. This phase involves the individual gradually incorporating the foods they have been exposed to in their treatment plan into their daily diet, enabling them to achieve a varied and healthy eating plan. Throughout the process, guidance and coping strategies are provided.
It is important to emphasize that ARFID is an eating disorder with significant clinical severity and a strong impact on the overall development (physical, emotional, social, academic, and familial) of those affected. If ARFID is suspected, the primary care team should be consulted to determine the appropriate course of action based on each individual's clinical situation.
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