Avoidant/Restrictive Food Intake Disorder (ARFID)
Facts to Know:
- Individuals with ARFID limit food variety and/or quantity for different reasons that are unrelated to body image
- ARFID may cause serious medical consequences as well as and social impairments.
- Behavioral interventions are the cornerstone of treatment.
What is ARFID?
ARFID is an eating disorder characterized by food avoidance or restriction that fails to meet an individual’s nutritional or energy needs that may be related to sensory concerns or fear of unpleasant experiences such as choking or vomiting but not related to body image concerns. There is limited epidemiological data available as this diagnosis was newly defined in the most recent diagnostic manual (DSM-5). This diagnosis captures a heterogeneous group of individuals with varying symptoms and likely many different causes. Other psychiatric disorders including autism spectrum disorder, obsessive-compulsive disorder, and attention deficit/hyperactivity disorder may increase an individual’s risk for ARFID.
An individual meets criteria for ARFID if the following are present:
- Low weight or failure to achieve expected weight gain or faltering growth (in children and adolescents)
- Significant nutritional deficiency
- Dependence on enteral feeding or nutritional supplements OR
- Eating behavior interferes with psychosocial functioning
If in the context of another mental disorder (e.g. autism spectrum or anxiety disorder), symptoms are severe enough to warrant specific clinical attention, the diagnosis may apply.
If in the context of a medical condition (e.g. gastrointestinal illness or food allergy), symptoms are beyond what is directly attributable to the medical illness or symptoms may persist after the medical condition has resolved, the diagnosis may apply.
A diagnosis of ARFID is best made by clinical assessment by a doctor or mental health professional and should include a diagnostic psychiatric interview. A medical assessment is also necessary to assess for malnutrition, low weight and growth delay.
At ColumbiaDoctors, we provide evidence informed treatments for ARFID:
To date, no evidence-based treatments have been established; however, treatment plans are developed relying on evidence established in eating and anxiety disorders. Specifically, treatment data from Cognitive Behavioral Therapy (CBT) for anxiety disorders and specific phobia, as well as Family Based Therapy for anorexia nervosa and are likely applicable to the treatment of ARFID. Treatment goals are to restore and maintain weight, normalize eating and normalize psychological and family function. Behavioral treatments include exposures to challenging foods, establishing a regular eating schedule and in some cases increasing caloric intake. For children and adolescents, parent work is also often indicated including meal supervision, contingency planning and reduction of accommodation of food avoidance.
Psychopharmacology (Medication Management)
Medication has not been established to be effective for ARFID; however, treatment of comorbid anxiety treatments may include psychopharmacological interventions.
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