The Differences Between Avoidant Restrictive Food Intake Disorder (ARFID) and Pediatric Feeding Disorder (PFD) and the Role of Occupational Therapy in Treatment

Thrive • April 19, 2022

By Thrive Reno Occupational Therapist Dr. Meadow Deason, OTD, OTR/L

Both avoidant restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) involve a disturbance in the way individuals eat and typically affect youths. Both conditions can be dangerous, as individuals experiencing either disorder will often eat a limited amount and variety of food. Those with ARFID avoid eating foods due to their sensory elements, general lack of interest in food, or fear of adverse consequences of eating, while those with PFD limit their intake of food because of medical conditions or deficits in motor skills.

Occupational therapists help individuals of all ages overcome obstacles that interfere with their ability to carry out daily activities, including eating. Integrating occupational therapy into the treatment of ARFID and PFD can empower individuals with skills and strategies to make eating more accessible and enjoyable.

WHAT IS AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID)?

ARFID is a kind of eating disorder that most often develops in children and adolescents. Individuals with ARFID may avoid foods due to lack of interest in eating. They may also have an aversion to certain sensory characteristics of food, meaning they may be highly sensitive to the color, taste, temperature, or texture of particular foods. Additionally, individuals with ARFID may have fears about experiencing pain or discomfort while eating, such as choking. Unlike many other eating disorders, ARFID does not typically involve a disturbance in one’s body image.

Signs and symptoms of ARFID include:

Extremely limiting the intake of food of certain types or textures, and often becoming more so over time
Fear of choking or vomiting
Low weight or dramatic weight loss
Failure to achieve age-appropriate weight or height benchmarks
Nutrient deficiency or malnutrition
Reliance on a feeding tube or nutritional supplements
Cold intolerance, dressing in layers to stay warm despite comfortable environmental temperatures
Digestive issues including constipation, abdominal pain, and constant stomach upset
Lethargy
Interference in carrying out daily activities
No body image disturbance, meaning there is no distortion of perception related to body weight, size, or shape
No fear of weight gain

Risk factors for ARFID include:

Autism spectrum disorder (ASD)
Attention-deficit/hyperactivity disorder (ADHD)
Intellectual disabilities
Anxiety disorders
Picky eating at a young age
History of choking or food trauma

OCCUPATIONAL THERAPY FOR ARFID

When a person is struggling with ARFID, an occupational therapist may use the following interventions to help them learn to embrace eating without fear.

Sensory modulation strategies: These strategies guide individuals in processing their sensory perception, which can help clients with ARFID to perceive food in a more open and accepting way.
Non-nutritive food exposures: Exposures to food that don’t involve eating the food can promote a more neutral sensory response to the food, increasing tolerance to the sensory elements of food.
Graded exposure to non-preferred foods: Slowly and progressively exposing children to non-preferred foods can help integrate a wider range of foods into their diets.
Parent and caregiver training for mealtime success: Educating parents and caregivers on ARFID and strategies for helping their children overcome food aversion can provide children with the support they need.

WHAT IS PEDIATRIC FEEDING DISORDER (PFD)?

A relatively new clinical diagnosis, PFD occurs when a child’s ability to intake nutrients orally is impaired in a way that doesn’t align with the abilities characteristic of others of the same age. PFD is associated with medical, nutritional, feeding skills, and/or psychosocial dysfunction.

Medical conditions that impact various body systems are risk factors for PFD. These systems include:

The gastrointestinal system
The cardiovascular system
The respiratory system
The neuromuscular system

Signs and symptoms of PFD include:

Age-inappropriate disturbance in the oral intake of nutrients lasting at least two weeks, associated with medical, nutritional, or feeding skills dysfunction
- Medical dysfunction includes:
  - Cardiorespiratory dysfunction during feeding
  - Aspiration
  - Recurrent aspiration pneumonitis, which can occur after the inhalation of regurgitated gastric contents
- Nutritional dysfunction includes:
  - Malnutrition
  - Specific nutrient deficiency
  - Decreased dietary diversity resulting in the restricted intake of one or more nutrients
  - Reliance on enteral feeds, also known as tube feeding, or oral supplements to sustain nutrition and/ or hydration
- Feeding skill dysfunction includes:
  - Need for texture modification of liquid or food
  - Use of modified feeding position or equipment
  - Use of modified feeding strategies
- Psychosocial dysfunction includes:
  - Active or passive avoidance behaviors by individual when feeding or being fed
  - Inappropriate caregiver management of child’s nutrition needs
  - Disruption of social functioning within a feeding context
  - Disruption of caregiver-child relationship associated with feeding
Absence of the cognitive processes consistent with eating disorders and pattern of oral intake isn’t due to a lack of food or congruent with cultural norms

For more on the signs, symptoms, and diagnostic criteria of PFD, you may consider referring to the Journal of Pediatric Gastroenterology and Nutrition’s (JPGN) article on the topic.

OCCUPATIONAL THERAPY FOR PFD

Because PFD involves medical, nutritional, feeding skills, and psychosocial components, the condition requires an integrated approach and multidisciplinary treatment team. Occupational therapists play an important role in treating PFD and may implement the following tactics as part of clients’ treatment:

Feeding skill development: Occupational therapists work with children to help develop their feeding skills by improving their upper extremity and oral motor skills, finding effective mealtime positioning, and carrying out basic swallow training.
Parent and caregiver training for mealtime success : As with ARFID, the education of parents and caregivers can be vital in overcoming any psychosocial factors.
Coordination of care with other providers: Occupational therapists typically work with their clients’ other health care providers to ensure the entire treatment team is efficiently working towards promoting clients’ independence in self-feeding, eating, and swallowing.

DIAGNOSING ARFID AND PFD

Since PFD is a new diagnosis, the medical community is still understanding how the signs and symptoms of ARFID and PFD differ, so misdiagnosis can occur at times. Both ARFID and PFD have nutritional and psychosocial components, but ARFID doesn’t necessarily have a medical cause or involve a deficit in feeding skills.

An individual could be diagnosed with ARFID due to limited food intake, however, multiple medical and feeding skills factors can contribute to limited food intake and may even point to PFD as a diagnosis.

If you believe your loved one might be experiencing ARFID or PFD, it is encouraged to explore the symptoms and circumstances with their pediatrician who can then refer specialized care as appropriate.

THRIVE HERE

Thrive’s multidisciplinary team specializes in eating disorder treatment that involves occupational therapy in addition to medical, psychiatric, therapeutic, and nutritional support. Our experts collaborate on each clients’ care to ensure treatment is effective, integrative, and targeted to the individual. Additionally, Thrive currently offers outpatient occupational therapy for both ARFID and PFD. Reach out to learn more about our eating disorder treatment programs.

About the Author

Thrive Reno Occupational Therapist Dr. Meadow Deason, OTD, OTR/L

Dr. Meadow Deason earned her doctorate of occupational therapy at Huntington University and is a licensed doctor of occupational therapy (OTD). As an occupational therapist, she has extensive clinical experience in neurological and physical rehabilitation, fall prevention education, community-based services, home health, and mental health. Dr. Deason is also trained in oral motor function assessment, feeding therapy, therapeutic pain education, home modification, aging in place, brain injury rehabilitation, sensory integration, integration of primitive reflexes, neuromuscular rehabilitation, upper extremity rehabilitation, behavioral management, ergonomics, and mindfulness. She partners with individuals and their loved ones to overcome emotional, physical, and social barriers to holistic health through meaningful activities designed to develop, recover, modify, or maintain skills for thriving in everyday life.

Prior to becoming an occupational therapist, Dr. Deason gained years of experience in early childhood intervention, social services, treatment, foster care, special education, and business.

The post The Differences Between Avoidant Restrictive Food Intake Disorder (ARFID) and Pediatric Feeding Disorder (PFD) and the Role of Occupational Therapy in Treatment first appeared on Thrive Wellness.

< Older Post

Newer Post >

Breaking Down Barriers: Debunking the Most Common Eating Disorder Myths

By Sage Tippie • February 14, 2025

This Eating Disorders Awareness Month, we’re focusing on fighting the misinformation and stereotypes surrounding eating disorders that so often create barriers to diagnosis and treatment. Myths about eating disorders can perpetuate harmful stereotypes and keep people from receiving effective and timely treatment when they need it. It’s no secret that the field of eating disorders is riddled with misinformation, leading to confusion, stigma, and shame for those struggling. In this blog post, we'll explore the common myths about eating disorders and fight them with concrete facts in the hopes of building a more informed and educated community when it comes to these serious mental health conditions. Eating Disorder Myths Versus Facts Myth: Only those who are medically underweight have an eating disorder. Fact: Someone can have an eating disorder at any weight. In fact, less than 6% of those diagnosed with an eating disorder are medically underweight. There is even a specific diagnosis for those who are not underweight showing the symptoms of anorexia called atypical anorexia. People of all sizes are at risk for serious complications from an eating disorder, not just those that are underweight. Myth: Only women have eating disorders Fact: Although often associated with teen girls, eating disorders can affect those of any gender and age. While stereotypes and stigma surrounding eating disorders may tell us that men are not commonly affected by them, research has found that nearly 25% of those who present for eating disorder treatment are male. Keeping an open mind around who can be affected by eating disorders allows for more accurate and timely diagnosis and treatment for those who need it. Myth: Eating disorders are just about food. Facts: While eating disorders always involve an unhealthy relationship with food or body image, they also are rooted in biological, psychological and sociocultural aspects. Eating disorders cannot be treated just by changing eating behaviors, but by addressing the mental aspect of the illness as well. This is why integrated treatment involving a team of social workers, primary care specialists, therapists, and in some cases occupational therapists or psychiatrists is so crucial: a holistic approach is needed to treat all aspects of an eating disorder. Myth: Eating disorders aren’t that serious. Fact: Eating disorders are extremely serious and life-threatening mental disorders that require dedicated treatment. In fact, anorexia nervosa has the second highest mortality rate of any psychiatric disorder. By taking eating disorders and their diagnosis and treatment seriously, we can save lives. Myth: Eating disorders are a choice. Fact: Just like any other illness, eating disorders are not a choice or a phase, nor is recovery from an eating disorder just a simple decision to start eating more or less. Recovery is not dependent on willpower, but on ongoing professional treatment and long-term support. The recovery process can be lengthy and challenging, requiring patience and a supportive environment and team on your side. It is a gradual, step-by-step journey, rather than an instantaneous decision made on one person’s part. Myth: Eating disorders always involve negative body image. Fact: Avoidant/restrictive food intake disorder (ARFID) does not have to do with body image. Those with ARFID may avoid many foods because of texture, taste, color, or smell, or feared outcomes of eating like choking or vomiting. Like any other eating disorder, ARFID is serious and requires specialized treatment like exposure-response prevention therapy. Myth: Eating disorders only affect White people. Fact: Although Black, Latina/o/x/e, Indigenous/Native, and Asian people are historically underrepresented in studies of eating disorders, large-scale studies have found that rates of eating disorders are the same or higher in all racial and ethnic groups as compared to white individuals (NEDA). Removing racial stereotypes around eating disorders can help to remove barriers that BIPOC individuals commonly face when seeking treatment. Dispelling the Myths: A Path Towards Understanding By addressing and dispelling these myths, we can create a safe space that promotes understanding and empathy. Eating disorders are not choices or phases, but debilitating mental health issues that can affect anyone. Recognizing the seriousness of these disorders is so important in reducing stigma and ensuring that those who are struggling receive the care and support they require. This month and every month, we encourage you to fight misinformation and stick up for those experiencing eating disorders, because knowledge and education can be one of the greatest assets to recovery for those who need it. If you or someone you know is in need of eating disorder support, don’t be afraid to reach out , our team of healthcare professionals are here for you. To learn more about eating disorders and the journey to recovery, download our free eating disorders guide .

Why Eating Disorder Awareness Matters

By Sage Tippie • February 6, 2025

Did you know that February is Eating Disorder Awareness month? Here at Thrive, we're passionate about educating our community and providing tools for eating disorder recognition while offering the specialized support and treatment that those with eating disorders deserve. Join us this month in the conversation around eating disorders and putting an end to harmful stereotypes and misinformation. Let's cover six reasons why building awareness around eating disorders is so crucial. 6 reasons why eating disorder awareness is important 1. Eating disorders are serious. Despite often being termed as a "choice" or a "phase," eating disorders are an incredibly serious psychological condition that require specialized treatment and support. Anorexia Nervosa has the second highest mortality rate of any psychiatric diagnosis in the United States, and every 52 minutes, 1 person dies as a direct consequence of an eating disorder (NEDA) . By spreading awareness and providing early intervention in eating disorder treatment, we can not only change lives, but save them. 2. Eating disorders are more common than you think. 9% of the US population will have an eating disorder at some point in their lives and 22% of children and adolescents worldwide show symptoms of disordered eating (NEDA). Since eating disorders can be challenging to detect, many go undiagnosed. Raising awareness for eating disorders and educating our community partners about their symptoms can allow us to catch eating disorders as early as possible and bring these statistics down. 3. Fight harmful eating disorder stereotypes. A common stereotype in association with eating disorders is that of the "thin, white, affluent female," however, anyone is at risk of an eating disorder despite their appearance or background. Stereotypes associated with eating disorders around weight, gender, age and race can create serious barriers to seeking care and major disparities in treatment. People experiencing an eating disorder can face challenges in seeking and receiving treatment or may feel unworthy of recovery when they don’t fit a stereotype, preventing them from gaining needed support and treatment. Promoting diversity and representation through awareness and education can help to break down the harmful stereotypes that have historically surrounded eating disorders. 4. Eating disorder recovery is not a one person job. Family and loved ones’ involvement in eating disorder treatment is crucial for recovery. Family-based therapy (FBT) has proven to be effective in 50% of patients being treated for anorexia nervosa, and is effective in the treatment of other eating disorders as well. A strong support system and steadfast relationships through the struggles associated with eating disorders can lead to more effective and long-lasting recovery. With more awareness and education, people will be better equipped to provide assistance to their loved ones in recovery. 5. You’re not alone. Eating disorders can be an isolating and painful disorder, making those experiencing it feel like they’re the only ones, or that no one understands what they’re going through. Building an informed community through awareness and education can be the first step towards diagnosis and treatment for those who need it. 6. Recovery is Real. Those with eating disorders are capable of long-term recovery through appropriate treatment. Research has found that the earlier intervention takes place in the treatment of eating disorders, the better the odds of long-term recovery are. Awareness and education around eating disorders helps the people that need support find it sooner, resulting in a repaired relationship with food and the body and a fuller life. How can I get involved in eating disorder awareness efforts? To get involved in eating disorder awareness efforts, start by educating yourself about the complexities and different types of eating disorders. By gaining a deeper understanding, you can become a more effective advocate. You can also consider participating in local or national events such as walks, trainings, or online webinars that aim to raise awareness, provide support to those affected, and offer education around eating disorders and their diagnosis. Another simple step for building awareness can be using your social media platform to share factual information, personal stories, or relevant resources that can help demystify eating disorders and reduce stigma. Additionally, supporting legislative efforts that promote mental health education and funding for eating disorder research can help in creating systemic change. By taking these steps, you can contribute to this important movement and work alongside us to foster acceptance, encourage early intervention, and ultimately save lives. Eating Disorder Treatment and Support Thrive offers a free eating disorder guide with more information about eating disorder symptoms and recovery. If you or someone you know is struggling with eating or body image, don’t be afraid to reach out to professionals for support. At Thrive Wellness, we offer a number of treatment options for all ages and genders, including a partial hospitalization program, an intensive outpatient program, outpatient therapy, occupational therapy, nutrition services, and more. Don’t wait to get started on treatment, contact us for a free eating disorder assessment today.

Alcohol and Mental Health: How Alcohol Effects Anxiety and Depression

By Thrive • January 24, 2025

You’ve probably heard of “Dry January” or are even participating yourself. More and more people seem to be experimenting with or embracing sobriety from alcohol, but what benefits are there from abstaining? In this article, we’ll explore alcohol’s effects on mental health, the symptoms of alcohol use disorder (AUD), and the benefits of cutting back on drinking. Alcohol's Effects on Mental Health Commonly consumed as a way to relax after a long day or to lighten up in social interactions, alcohol is a widely used and culturally accepted drug despite warnings of its dangers by health experts . When a person regularly drinks, it can result in a slew of complications for their physical and mental health. Although often consumed in an attempt to escape stress, sadness, or other unpleasant emotions, alcohol itself is a depressant that can contribute to negative feelings and exacerbate existing mental health conditions, especially with prolonged use. Alcohol influences thoughts, mood, and behaviors by impacting the central nervous system in a way that slows the communication between the brain and the body. Without the ability to process information effectively, the brain isn't able to regulate emotions and consider consequences effectively which may promote unhealthy behaviors, including drinking to excess. Ways that alcohol can affect cognitive functioning include: Lowering inhibitions Contributing to poor judgment Causing confusion Causing lapses in memory Disrupting sleep Contributing to shifts in mood Alcohol and Mental Disorders According to the Journal of the American Medical Association, 37% of people with alcohol use disorders also have at least one serious mental illness. Furthermore, alcohol abuse commonly occurs alongside depression and anxiety . Research has shown that those with major depressive disorder and those with generalized anxiety disorder were more likely to report life‐time moderate to severe alcohol use disorder than those without these conditions. Frequently, individuals struggling with depression or anxiety self-medicate by drinking alcohol. Although alcohol may provide temporary relief, it expends the chemicals in the brain which help ward off anxiety and depression. When the initial effects of the drug fade, individuals are typically left feeling more depressed or anxious than they did before they began drinking. Related: Eating Disorders, Substance Abuse, and Substance Abuse Disorders Alcohol Use and Depression The slowed functioning of the brain caused by alcohol can allow individuals to numb to their suffering. As such, those experiencing depression may be inclined to drink to avoid the sadness, pain, and hopelessness associated with depression. This maladaptive coping behavior is so prevalent that research shows a clear relationship between alcohol use disorder (AUD) and major depression. Using alcohol while depressed can be extremely dangerous. Not only can alcohol negatively interact with antidepressants, but it can also place individuals experiencing depression at an increased risk for suicidal thoughts and behavior . If you're experiencing suicidal thoughts or behaviors , you can reach the National Suicide Prevention Hotline at 1-800-273-TALK (8255). Alcohol Use and Anxiety According to a study on anxiety and AUD , a person with an anxiety disorder is two to three times more likely to develop an alcohol abuse disorder. When individuals with anxiety drink alcohol, they may feel an initial alleviation of their symptoms as well as a sense of euphoria. However, the symptoms of hangovers and alcohol withdrawal following heavy drinking can heighten feelings of anxiousness and interfere with ones daily obligations, contributing to even more agitation. This feeling of dread and anxiety associated with a hangover is commonly referred to as " hangxiety ," but for those with existing anxiety conditions, this side effect of drinking can feel unbearable. Individuals with anxiety may be driven to drink more to tamper their stress and re-establish the sense of euphoria, resulting in a dangerous cycle of alcohol abuse. Unhealthy Drinking Behaviors and Alcohol Use Disorder (AUD) Most who regularly drink alcohol don't have AUD, which develops when addiction is present. However, alcohol-related side-effects on mental health are still common, and they may still benefit from mental health support . Signs of unhealthy alcohol use include: Feeling a need to consume alcohol to make it through the day Feeling unable to stop consuming alcohol Progressively feeling a need to increase consumption of alcohol Drinking to prevent or alleviate symptoms of hangover or withdrawal Feeling ashamed of ones alcohol consumption Having loved ones express concern over drinking habits AUD is a condition that is often driven by genetics, abuse, trauma, or unhealthy family dynamics. Healing from AUD is possible and it can be treated with the help of mental health professionals and a dedicated treatment plan. Signs of AUD include: Alcohol use that interferes with the ability to carry out daily activities Drinking despite the behaviors adverse effects on their life Often drinking more or for a longer period of time than intended Persistent desire and unsuccessful attempts to curb alcohol use Revolving their schedule around drinking Experiencing strong cravings for alcohol Continuing to drink despite experiencing recurring illness or social issues as a result of alcohol use Giving up activities one used to enjoy in favor of drinking Using alcohol during situations where its physically hazardous to be impaired Continuing to use alcohol despite knowing that it exacerbates a known existing health condition Developing a tolerance for alcohol, or needing more alcohol to feel the same effects Experiencing alcohol withdrawal or drinking more to avoid withdrawal What are the Mental Health Benefits of Going Sober or Drinking Less Alcohol? Reducing or eliminating your alcohol consumption can lead to a variety of mental health benefits, improving your overall quality of life. When going sober or cutting back on your alcohol consumption, some of the benefits you can look forward to are: Improved mood stability, including reduced feelings of depression and anxiety Improved sleep quality Enhanced cognitive function Increased energy levels Improved concentration and productivity Increased self-esteem More authentic social interactions Improved relationships Limiting your alcohol consumption has the capability to change your life for the better, as it can help you establish a healthier mental environment, build better connections, and improve your physical health. Support for Alcohol Abuse and its Mental Health Impacts As humans, it can be uncomfortable for us to process difficult experiences and feel intense emotions. Therapy can help heal the source of your struggles driving alcohol abuse, while also guiding you in implementing healthy strategies for processing painful emotions. Through professional mental health support, you can be empowered to embrace life without having to rely on alcohol. Thrive offers outpatient therapy for substance abuse struggles in addition to other mental and behavioral health conditions. Reach out to learn more. Additional Resources SAMHSAs National Helpline : A free, confidential, and 24/7 service for individuals and families facing mental health conditions and/or substance use disorders, reachable by calling 1-800-662-HELP (4357) or texting 435748 (HELP4U). National Institute on Alcohol Abuse and Alcoholisms (NIAAA) Treatment for Alcohol Problems : A guide for individuals and their loved ones who are looking for options to address struggles with alcohol use.