ARFID stands for Avoidant/Restrictive Food Intake Disorder. It is a feeding and eating disorder characterized by a persistent disturbance in eating or feeding that results in significant weight loss, nutritional deficiency, reliance on nutritional supplements, or interference with psychosocial functioning. Unlike other eating disorders like anorexia nervosa, ARFID is not driven by body image concerns but rather by an avoidance or restriction of certain foods based on sensory characteristics (such as texture or smell), fear of aversive consequences (like choking or vomiting), or lack of interest in eating. Individuals with ARFID may experience anxiety or distress around mealtimes and may have limited variety in their diet, which can impact their overall health and well-being. Treatment typically involves a multidisciplinary approach that addresses nutritional needs, behavioral interventions, and sometimes psychological therapy to help broaden the range of foods eaten and reduce anxiety related to eating.
Avoidant/Restrictive Food Intake Disorder (ARFID) encompasses several types based on the specific symptoms individuals experience:
1. Avoidant ARFID: Individuals with avoidant ARFID avoid certain foods due to sensory features that cause discomfort or overstimulation. This includes sensitivity to smells, textures (like soft foods or certain textures of fruits and vegetables), or the appearance of food (such as color).
2. Aversive ARFID: In aversive ARFID, food refusal is driven by fear-based reactions. Individuals may fear choking, nausea, vomiting, pain, or difficulty swallowing associated with certain foods, leading them to avoid those foods altogether.
3. Restrictive ARFID: Those with restrictive ARFID typically show little interest in food, forgetting to eat, having a low appetite, or becoming extremely distracted during meals. They may also exhibit extreme pickiness or selectivity about foods, resulting in a very limited diet.
4. ARFID “plus”: This type involves individuals who experience more than one aspect of ARFID and may also develop features similar to anorexia nervosa. This can include concerns about body weight and size, fear of weight gain, negative attitudes towards fatness, negative body image (without body image distortion), and a preference for less calorie-dense foods.
5. Adult ARFID: ARFID symptoms can persist into adulthood from adolescence. Adults with ARFID may exhibit avoidance, aversion, or restrictive patterns related to food. Symptoms may include selective or extremely picky eating, food aversions based on texture, color, or taste, and ongoing challenges with expanding their diet.
Each type of ARFID presents unique challenges and may require tailored interventions aimed at broadening food acceptance, addressing fears or aversions, and ensuring adequate nutrition and psychosocial support.
From our one of our owners and therapists, Christina Carson, MS CCC SLP, MA BCBA
In my view, true ARFID occurs when a child develops a fear of food, triggering a sensory response as if the food were poisonous due to its unfamiliarity to the child’s sensory system.
Key points to consider in feeding therapy:
Ensure you understand your therapist’s educational background and experience. Feeding therapy should ideally be conducted by speech therapists and occupational therapists. Some companies may allow occupational therapy assistants to participate in feeding therapy, but formal training in this area is often limited.
Feeding therapy is most effective when approached as a collaborative effort involving speech therapy, occupational therapy, physicians, psychologists, and occasionally ABA specialists. Psychologists are particularly recommended in ARFID cases to address anxiety and facilitate exposure to new foods.
ABA specialists should coordinate with speech or occupational therapy, as feeding issues are typically not purely behavioral. BCBAs are not trained to handle the medical aspects of feeding.
As a parent, it’s important to consistently complete assigned homework and expose your child to a variety of foods, tastes, textures, and brands.
A skilled feeding therapist will respect the child and parent’s comfort levels. Progress varies based on the child’s dynamics and family environment. Even non-verbal cues from the child indicate their comfort levels.
Pushing a child too hard can increase anxiety and make them more averse to food.
The cornerstone of successful feeding therapy is building trust and security. A competent feeding therapist establishes trust while ensuring the child feels safe. Once trust is compromised, it can be challenging to regain.
Consistency and repetition are critical in treating feeding disorders, as progress is gradual. Parents should remain patient and consistently expose their children to commonly available foods at home.
*Love & Co. feeding therapists are required to take extra feeding courses outside of their academic experience.
References
What is ARFID? Avoidant Restrictive Food Intake Disorder Symptoms & Treatment. (n.d.). Eating Recovery Center. https://www.eatingrecoverycenter.com/conditions/arfid#:~:text=The%20types%20of%20ARFID%20include,%E2%80%9Cplus%22%20and%20adult%20ARFID.
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