Picky eating, as established in the previous article, is clinically described as the consumption of an inadequate variety of food. It is common in children but can carry over into adulthood; for some picky adults, a great deal of change and determination can help ease their particularities. But for the adults with ARFID, that potential lifestyle change is hindered due to mental, emotional, and physical limitations.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard for classifying mental disorders, used by healthcare professionals in the United States and most of the world. In 2013, the DSM’s Fifth Edition added a new diagnosis: Avoidant Restrictive Food Intake Disorder (ARFID). ARFID, formerly known as “Selective Eating Disorder,” is defined as “an eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs.” According to the National Eating Disorder Association, ARFID is similar to anorexia as both disorders involve nutritional limitations, but unlike anorexia, ARFID does not involve distress about body shape (1). Basically, people who have ARFID avoid most foods due to its appearance, taste, smell, texture, etc. and possible negative past experiences. Figure 1 shows the differences between picky eating and ARFID.
The causes of ARFID are still poorly understood. According to the Eating Recovery Center, ARFID develops from genetic, psychological, and sociocultural factors (2):
Genetic: genetic makeup or predispositions to selective eating are strong risk factors. People with autism spectrum disorders and those with ADHD and intellectual disabilities are more likely to develop ARFID.
Psychological: Obsessive Compulsive Disorder (OCD), anxiety, and mood disorders are likely to accompany ARFID and most other eating disorders. Past negative experiences with food, such as trauma, may also leave a lasting impact.
Sociocultural: cultural and societal pressures to “eat healthy,” paired with increased processed food production, can influence nutritional decisions. There is often very minimal empathy for adult picky eaters, and due to the general public’s unawareness of the newly classified ARFID, the same regard likely extends to ARFID.
A main warning sign of ARFID is, of course, eating behavior interfering with psychosocial functioning. Other signs include, but are not limited to, dramatic weight loss, limited range of preferred foods that become narrower over time (paired with no body image disturbance or fear of weight gain), stomach cramps, other non-specific gastrointestinal complaints, and abnormal laboratory findings. A diagnosis of ARFID is made by mental health professionals through psychiatric interviews and guidance through medical assessments.
As previously stated, picky eating can be overcome through determination and lifestyle-change planning. On the other hand, professional treatment for ARFID is still being researched. Currently, methods of treatment include behavioral and psychological interventions. Columbia University Medical Center conducts Cognitive Behavioral Therapy, which aims at improving patients’ mental health (3). Treatment goals include restoring and maintaining weight, normalizing eating, and normalizing psychological and family function. Behavioral treatments include exposures to challenging foods, establishing a regular eating schedule and in some cases, increasing caloric intake.
Avoidant Restrictive Food Intake Disorder is a real, yet misunderstood disorder. Like all disorders, its victims do not choose to have them. Research and dedication to comprehending ARFID are imperative, but in order for people to manage and potentially overcome it, patience, and encouragement will always be key.
(1) “Avoidant Restrictive Food Intake Disorder (ARFID).” National Eating Disorders Association, 22 Feb. 2018, www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid.
(2) “Causes of Avoidant/Restrictive Food Intake Disorder (ARFID).” Eating Disorder Treatment at Eating Recovery Center, www.eatingrecoverycenter.com/conditions/arfid/causes.
(3) Friedl, MD, Eve K. “Avoidant/Restrictive Food Intake Disorder (ARFID).” ColumbiaDoctors, 19 Apr. 2018, www.columbiadoctors.org/condition/avoidant-restrictive-food-intake-disorder-arfid.
(4) “Picky Eating vs. Selective Eating Disorder.” Mealtime Hostage, 9 June 2015, https://mealtimehostage.com/2012/12/13/picky-eating-vs-selective-eating-disorder/.
(5) Featured Image of Woman and Salad. “Are You a Picky Eater? You Could Be Suffering from ARFID.” Willow Place, 10 Jan. 2017, willowplaceforwomen.com/picky-eater-suffering-arfid/.