ARFID & OTHER DISORDERS
Whilst for some children and young people, their eating difficulty is limited to a restricted diet and a fearful response to new foods, for others, ARFID is accompanied by other challenges. The following are conditions that may present alongside ARFID with, or without autism.
Although ARFID and Anorexia are very different from each other, there has been some research into possible links between anorexia and autism. Research has also shown that it is possible for autistic girls, in particular, to have elements of more than one type of eating difficulty, and for ARFID and anorexia to co-exist in adolescence.
Many young children with ARFID would say that they are happy with their eating pattern and do not want, or feel the need, to change it. This however can change with puberty as a child with ARFID becomes a teenager, and their eating pattern makes it difficult to fit in with their friends and participate 'normally' in society. It is at this point that for many young people with ARFID, their anxiety which had previously been limited to food, generalises and leads to a social anxiety about eating away from home. If this leads to withdrawing from social occasions , it can have an additional negative impact. Without support, this state of chronic anxiety and low moods can turn into depression.
Obsessive-compulsive disorder (OCD) is a chronic and long-lasting disorder in which a person has uncontrollable, re-occurring thoughts (obsessions) and behaviours (compulsions) that he or she feels the urge to repeat over and over. Research into adult 'picky eating' has shown that those who are 'picky eaters' display a higher incidence OCD symptoms compared with those who are considered to be 'non-picky eaters. Furthermore, there is one form of OCD that involves a persistent fear about 'contamination,' so there are some parallels between contamination fears and more generalized 'fear around food' in people with ARFID with both being related to sensory sensitivities and the disgust response. Also, whilst obsessive behaviour is something which is often present in autism, this doesn't always mean that OCD is present.
PATHOLOGICAL DEMAND AVOIDANCE
Although not universally accepted as a behaviour profile, Pathological Demand Avoidance (PDA) is something that is associated with the autism spectrum. People with PDA are driven to avoid everyday demands and expectations to an extreme extent. Caused by an anxiety-based need to be in control, some people with PDA see eating as being a 'demand.' This can cause them to employ or require highly controlled and specific rituals about food and mealtimes including how food is chosen, prepared and eaten. In extreme instances, PDA can result in the complete avoidance of mealtimes entirely.
Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value. This items will vary depending on the age of the individual, but may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice. Pica can be associated with other mental health disorders including intellectual disability, autism spectrum disorder and schizophrenia, and it is sometimes present in children and young people with ARFID regardless of whether they are neurotypical or not.
SENSORY PROCESSING DISORDER
This occurs when the brain has difficulty receiving and responding to information that comes through the sensory system.
It can manifest as over- or under- sensitivity to things in the environment, for example, noise, bright lights, tastes, textures or smells. It can also affect a person’s co-ordination, awareness of their body in space and in relation to other objects and people. The impact of sensory processing can be very significant as the child or adult can easily become distressed and overwhelmed by their surroundings. They will then be unable to attend to tasks in hand, take in information and learn.
It is commonly associated with autism and other developmental conditions.
If you are a concerned parent or individual, it is best to seek a specialist assessment and advice from your local GP, Paediatrician or Child and Adolescent Mental Health Service (CAMHS).