WHAT IS ARFID?
Avoidant/restrictive food intake disorder (ARFID) is a relatively new term, that was introduced in 2013 when it first appeared in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). It has also previously been known as Selective Eating Disorder.
It is anticipated that it will similarly, make its debut in the World Health Organisation’s next edition of its equivalent (the ICD). Favoured by European countries, the next edition of the ICD (ICD-11) will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022.
The entry of ARFID into the DSM-5 was significant in that it had previously existed under an umbrella term used to encompass all ‘other infant and early childhood’ feeding disorders.
MORE THAN JUST 'PICKY EATING'
ARFID is characterised by a pattern of eating that avoids certain foods or food groups entirely and/or is restricted in quantity (eating small amounts). Avoidant and restrictive eating cannot be due to lack of available food, or cultural norms (e.g. someone who is fasting or chooses not to eat certain foods for religious or cultural reasons alone).
ARFID is different to other restrictive eating disorders in that:
ARFID isn't affected by a person’s beliefs about the size and shape of their body.
Someone with ARFID doesn't restrict their food intake for the specific purpose of losing weight.
ARFID doesn’t feature some of the other behaviours that can be associated with anorexia, bulimia, or OSFED, such as over-exercising.
The difference between a 'picky eater' and a child with ARFID,
is that a picky eater won't starve themselves to death. A child with ARFID will.
Dr. Gillian Harris, Clinical Psychologist. BA, MSc.PhD, CPsychol, AFBPsS
Whilst the exact causes of ARFID are unknown, it is thought that people who develop ARFID do so because of sensory sensitivity, fear of negative consequences or a lack of interest in eating. For example, they might be very sensitive to the taste, texture or appearance of certain types of food, or have had a distressing experience with food, such as choking, vomiting, infant acid reflux or other gastrointestinal conditions – this may cause the person to develop feelings of fear and anxiety around food, and lead to them to avoiding food.
ARFID doesn’t discriminate and can affect anyone of any age, including babies, and can be diagnosed in children as young as 2 years-old.
Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:
People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.