Avoidant Restrictive Food Intake Disorder and its Treatments

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Food is the most vital and fundamental requirement of life. We can exist without shelter and clothing, but it is practically challenging to survive without food. Food gives us all the nutrients we need to stay healthy and establish a strong immune system.

However, there are some psychological conditions that cause unhealthy and altered eating habits called eating disorders. These disorders are characterized by a clinical presentation primarily focused on altered eating behavior.

These Eating Disorders are

1. Avoidant Restrictive Food Intake Disorder

 In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a newly introduced eating disorder causes people to undereat.

2. Anorexia Nervosa

Usually, females generally consider themselves overweight compared to people of similar age and personality, even if they are not. They have a distorted body image. Also, they have a very restricted eating pattern due to the fear of becoming obese.

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Source- By adrenalina/ Unlim photos

3. Bulimia Nervosa

Bulimics have an intense dread of being obese, but they also have an uncontrollable desire to eat. They have episodes where they eat a lot of food in a short length of time. Overeating leads to self-induced vomiting, long-term fasting, or the use of appetite-suppressing medicines.

4. Binge Eating Disorder 

 This is a disorder in which people eat enormous amounts of food in a brief period and regret it later.

5. Pica

 This is a disorder that involves eating things that are not foods. These non-food substances include soil, chalk, ice, soap, hair, clothes, or anything attracting the child’s mind.

6. Rumination Disorder

It is a disorder in which people bring recently eaten food from the stomach back into their mouth and either re-chew or spit it out.

In this article, we shall learn in detail about the newly introduced eating disorder, avoidant restrictive food intake disorder.

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder
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Avoidant Restrictive Food Intake Disorder, as the name suggests, is an eating disorder or feeding disturbance that is characterized by restricted food intake and highly selective eating habits. There is a persistent failure to meet the daily appropriate nutritional and energy needs.

ARFID is typically seen in infants and children, but some cases may persist until adulthood.

These children have picky eating habits. They avoid certain foods depending upon their sensory characteristics like color, texture, consistency, smell, and overall appearance.

As a result, they cannot consume enough nutrition and calories, causing stunted growth and delayed development.

What are the Characteristic Features of ARFID?

  • Some children may exhibit fussy eating behavior (restrictive behavior), while others may refuse to eat at all(avoidant behavior). These children have a limited variety of preferred foods. Sometimes, this list of preferred foods may get narrower, meaning that picky eating worsens progressively.
  • Low appetite.
  • Significant nutritional deficiency.
  • Food restriction leads to significant weight loss or failure to gain weight.
  • There is apprehension about choking, nausea, vomiting, and other illnesses or allergic reactions due to eating certain foods. These are known as aversive consequences of eating.
  • Significant nutritional deficiency and hence, requiring dietary supplements.
  • Struggling while passing stools or may feel pain while doing so (constipation).
  • The child seems irritable and cries frequently.
  • Abdominal pain and cramps.
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Source-By dul_ny/ Unlim photos
  •  Dizziness or fainting.
  •  The child lacks age-appropriate skills.
  •  Dry skin and hair.
  •  Brittle nails.
  •  Weak immune system.
  •  Sleep disturbance.
  •  Fine hair on the body is called lanugo.
  •  Electrolyte imbalance.
  •  The child appears tired and lethargic.
  • Difficulty concentrating.
  • Thyroid and iron deficiency.
  • Poor wound healing.
  • Feeling cold all the time.
  • Muscular weakness.
  • Other eating disorders such as anorexia nervosa or bulimia can be mistaken for avoidant restrictive food intake disorder. Patients with ARFID, on the other hand, do not have a distorted body image or the desire to lose weight, unlike anorexia or bulimia.
  • In severe conditions, there may be a marked interference with psychosocial functioning.
  • These patients may wear many layers of clothes to hide weight loss and to feel warm.

Causes of Avoidant Restrictive Food Intake Disorder

The exact cause of avoidant restrictive food intake disorder remains unknown.

Experts believe that the following reasons might be the possible reasons causing Avoidant restrictive food intake disorder:

  1. The child may have a reduced appetite or disinterest in eating.
  2. The child may be restrictive towards certain foods depending on their appearance and other sensory characteristics.
  3. The child may fear eating food, thinking that it may lead to side effects like vomiting, nausea, choking, and allergic reaction.
  4. It can also happen if a child has had a horrible previous feeding experience that resulted in severe vomiting and choking.
  5. Research studies also suggest that this condition can be caused by a complex interplay between psychological, genetic, biological, and sociocultural factors.
  6. The male gender, according to neuropsychiatric disease and treatment, is more prone to suffering from avoidant restrictive food intake disorder.
  7. ARFID is not caused by any medical condition or a mental disorder. It might occur secondary to a physical disorder like a gastro-intestinal disease.
  8. The presence of food allergies may also cause children to avoid food.

How is Avoidant Restrictive Food Intake Disorder Diagnosed?

To begin, ARFID must be distinguished from other eating disorders such as anorexia nervosa and bulimia nervosa, as ARFID symptoms may be identical to those of these illnesses. The absence of body image disturbance or fear of weight gain is distinctive.

The diagnosis is usually clinical. Consult the doctor as soon as you see symptoms like disinterest in food or food refusal.

Parents frequently refer to these children as ‘gazers,’ implying that they only observe food, or as ‘eating like a bird,’ suggesting they eat very little.

The mental health professionals will look for the symptoms, and the necessary investigations will indicate low nutritional levels. They will also ask for previous medical history and experience with food.

Avoidant restrictive food intake disorder frequently co-occurs with other mental illnesses like anxiety, attention deficit disorder, autism spectrum disorder, or obsessive-compulsive disorder.

Treatment of Avoidant Restrictive Food Intake Disorder

In general, it is simpler to treat eating disorders like ARFID or others if they are addressed as soon as symptoms appear. Still, if they are ignored, they can develop into major psychological or physiological issues, as well as stunted growth and weight loss.

Pediatric growth curves should be considered, and families and healthcare practitioners should use them to calculate the child’s optimal weight. This is a crucial stage in the evaluation and management of ARFID patients.

The main goals of treatment are to establish healthy eating patterns, meet nutritional needs, and maintain a healthy weight for that age. Also, care must be taken that this condition does not lead to any severe complications of body and mind.

Individual or combinations of these treatments are effective in ARFID.

1) Nutritional Counselling

A personalized and specified diet by a dietitian is a must. This diet should include all the essential nutrients in order to overcome the nutritional deficiency and achieve expected weight gain. Also, the child must be explained the importance of food.

2) Drug Prescriptions and Pharmacotherapy

Drugs that help with appetite and anxiety with minimal side effects can be made use of. These medications should be prescribed only by the child’s doctor, and no over-the-counter medicines should be made use of.

3) Cognitive Behavior Therapy

CBT plays an important role when it comes to treating ARFID. It helps the patients to normalize eating and feel less anxious about what they eat. The doctor or psychiatrist and the family members also have an essential role to play.

It is crucial for the doctors and the parents to address the fears of the kids. It helps the child to feel and do better.

  • Serve a variety of foods and take into account the food your child eats the most.
  • Reward the positive eating behaviors of your child.
  • Arrange regular family meals.
  • The mood at the table should be kept pleasant.
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Source- By National Cancer Institute/ Unsplash
  • Encourage spending time with friends or children of the same age where eating occurs.
  • Remember! Do not force your child to eat if they avoid food; only encourage them.
  • Try to keep the child engaged in other activities while they eat.
  • If the child is not very young, they can be taught yoga or take deep breaths. This might help with dealing the anxiety disorders if any.

4) Family-Based Therapy

The child’s family is educated about the dangers of malnutrition and low weight. The goal should be directed towards body weight gain and meeting nutritional requirements.

In severe cases, the child may require a feeding tube or depend on oral nutritional supplements and feeding via the mouth or stomach, known as enteral feeding.

In a nutshell, in avoidant restrictive food intake disorder, the body falls short of the essential nutrients necessary to function normally. Thus, the body slows down, conserving energy leading to severe medical consequences. In such extreme cases, death may occur without any warning signs.

Hence, it is indispensable to understand how eating disorders can affect one’s body.

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Content is medically reviewed periodically by professionals for accuracy and relevance. Reviewers include doctors, nurses, mental health professionals, and even medical students. 

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