What Is Avoidant Restrictive Food Intake Disorder ARFID

What Is Arfidavoidantrestrictive Food Intake Disorder Arfid Is Sus

WHAT IS arfid? Avoidant/Restrictive Food Intake Disorder (ARFID) is suspected if the patient has significant weight loss, low energy and experiences impaired sensory manifestations such as repelling the smell of food, texture or size. Adults with ARFID, may have had negative food related symptoms since childhood to adolescents which becomes even more restrictive with age (Norris et al., 2016). Some of these childhood behaviors generate restrictive eating habits, increase anxiety about food, facilitate food allergies and other patients may experience GI symptoms.

According to the DSM-5 criteria for diagnosing ARFID, the individual should have eating or feeding disturbance resulting in inadequate nutritional intake or weight loss, deterioration of psychological and physical health (American Psychiatric Association, 2013). These presentations must not be associated with the absence of food or cultural practices. The eating avoidance should occur separately from other diagnoses such as bulimia or anorexia nervosa, and additional past medical conditions should be evaluated. Persistent failure to gain weight or increase nutritional intake marks significant interference in growth and functioning, which is clinically assessed in ARFID (American Psychiatric Association, 2013).

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Avoidant/Restrictive Food Intake Disorder (ARFID) is a distinct eating disorder characterized by a persistent avoidance or restriction of food intake that leads to significant nutritional deficiencies, weight loss, and impairment in psychosocial functioning. Unlike other eating disorders such as anorexia nervosa or bulimia, ARFID is not driven by a desire for thinness or body image concerns but often stems from sensory sensitivities, fear of adverse consequences, or underlying medical or developmental conditions (Norris et al., 2016). This disorder can significantly impact the physical growth and psychological well-being of affected individuals, particularly during childhood and adolescence.

ARFID manifests through various symptoms and behaviors. Patients may avoid certain textures, smells, or sizes of food, leading to a limited diet. They often exhibit signs such as weight loss, nutritional deficiencies, dependence on oral or enteral nutritional supplements, and impaired social functioning related to eating situations (Ornstein et al., 2017). Specific symptoms can include constipation, abdominal pain, lethargy, cold intolerance, dizziness, dry skin, menstrual irregularities, and difficulties concentrating. These physical effects are compounded by psychological symptoms such as fear of weight gain, anxiety related to eating, and avoidance behaviors that further restrict their food intake.

The presentation of ARFID can be categorized into subtypes, each reflecting different underlying motivations or behaviors. The limited intake type is characterized by low appetite, small bites, and slow eating, often resulting in stunted growth and medical complications due to poor nutrition. The limited variety subtype involves a long-standing picky eating pattern, with aversions to specific food textures or types, often resulting in a monotonous diet. The aversive subtype involves fear or anxiety related to eating, which develops into a more profound avoidance of food (Norris et al., 2017). These distinctions are important for tailoring treatment interventions and understanding the complex etiology of the disorder.

Pathophysiologically, ARFID is associated with co-occurring psychiatric conditions such as anxiety disorders, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), and learning disorders. These comorbidities may exacerbate eating restrictions through internal fears or sensory sensitivities. Nutritional deficits, including iron deficiency and anemia, are common, particularly when restrictive behaviors lead to inadequate intake of essential vitamins and minerals. Sometimes, such behaviors are reinforced by cultural or social factors, or may be influenced by previous traumatic eating experiences or sensory processing issues.

Treatment strategies for ARFID are multifaceted and should be tailored to the individual. Laboratory screening is essential to assess nutritional adequacy and medical stability. Outpatient interventions often include individual and family therapy focusing on behavioral approaches such as exposure therapy to desensitize sensory sensitivities, cognitive-behavioral therapy (CBT) to address fears and anxieties, and nutritional counseling to restore healthy eating patterns (Lock & La Via, 2015). In severe cases, inpatient hospitalizations may be necessary to manage malnutrition, dehydration, or medical complications, providing intensive nutritional rehabilitation and psychological support.

Although there are no specific pharmacological treatments approved for ARFID, medications may be used to address underlying psychiatric conditions such as anxiety or obsessive-compulsive behaviors that contribute to food avoidance. For example, selective serotonin reuptake inhibitors (SSRIs) can be beneficial in managing anxiety symptoms, thereby reducing food-related fears and facilitating engagement in behavioral therapies (Dale & Drake, 2005). Importantly, treatment success hinges on collaboration among healthcare providers, patients, and families to develop a comprehensive management plan that addresses medical, psychological, and behavioral needs.

References

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