What is ARFID?: Understanding the Misunderstood Eating Disorder

Julia Actis, Assistant Clinical Manager, LMSW, CSW-I • October 16, 2024

What is ARFID?: Understanding the Often Misunderstood Eating Disorder

Amongst eating disorders, Avoidant/Restrictive Food Intake Disorder (ARFID) is lesser known and often misunderstood. Unlike disorders like anorexia or bulimia, ARFID isn't motivated by body image or weight. Instead, it's characterized by a persistent avoidance or restriction of certain foods due to various reasons, leading to nutritional deficiencies and serious health issues. As ARFID gains more awareness, it's essential we explore what this condition entails to provide understanding and reach those in need of support.

Avoidant/Restrictive Food Intake Disorder (ARFID)

What is Avoidant/Restrictive Food Intake Disorder (ARFID)?

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder marked by extreme food restriction or avoidance. Unlike other eating disorders driven by body image concerns, ARFID emerges from sensory sensitivities, fear of adverse effects from eating, or negative experiences related to food. These behaviors can significantly impact nutritional intake, leading to weight loss, negative effects on health, and in children, inhibited growth. Many people with ARFID struggle with meeting basic dietary needs, impacting healthy development and functioning. Although often initially diagnosed in children, ARFID can last into adulthood.

The causes and severity of ARFID can vary from person to person. Understanding these factors is critical for diagnosis and treatment:

Sensory Sensitivities: Aversions to specific textures, smells, or colors of food.

Fear of Negative Effects: Anxiety about choking, vomiting, or allergic reactions.

Traumatic Food Experiences: Past incidents that induce fear or avoidance.

Recognizing ARFID's unique triggers can facilitate accurate diagnosis and effective therapies.

Is Avoidant/Restrictive Food Intake Disorder (ARFID) the Same As Picky Eating?

A common misconception about ARFID is that it is "just picky eating". However, the two are different in their severity and impact. Picky eating is often a harmless phase in childhood that people typically outgrow without serious health implications. In contrast, ARFID involves intense aversions, leading to a restrictive eating pattern that can impact nutrition and development. Those with ARFID may avoid certain food groups all together and often experience severe anxiety around mealtimes.

The distinction between picky eating and ARFID lies in the degree and consequences of food avoidance. Unlike picky eaters, those with ARFID face significant obstacles that affect their social lives and overall well-being. The psychological component is real, causing complications that extend beyond mere preference in foods.

How Common is Avoidant/Restrictive Food Intake Disorder (ARFID)?

Though ARFID is a relatively new classification (first added to the DSM-5 in 2013), its recognition is steadily increasing in various clinical settings. This condition is more prevalent in younger populations, with up to 15.5% of children and adolescents being affected by ARFID (NIH). While seemingly rare amongst adults, increased awareness has led to more frequent diagnoses.

Although it is not as commonly known as other eating disorders, ARFID’s growing rate of diagnoses underscores the importance of awareness and education. With increased understanding, healthcare professionals are more frequently recognizing and diagnosing ARFID, a crucial step in providing necessary interventions.

Symptoms and Causes

What are the Signs and Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Lack of appetite, disinterest in food, notable weight loss, and a failure to gain weight mark the disorder’s physical symptoms, affecting overall health and development. ARFID can affect people in a variety of ways, but understanding common signs is the first step towards effective treatment. These signs can include:

Limited Food Range: Preference for certain foods, often based on sensory features like taste, smell and texture. These specific foods are termed as "safe foods."

Psychosocial Difficulties: Anxiety at social events involving food, impacting daily interactions. People with ARFID may feel uncomfortable eating or trusting food that they did not source from their home, like at restaurants or school.

Recognizing these symptoms can facilitate early diagnosis and treatment, promoting better health outcomes for someone living with ARFID.

What are the Risk Factors for Avoidant/Restrictive Food Intake Disorder (ARFID)?

Several risk factors contribute to the development of ARFID, originating from both biological predispositions and lived experiences. Understanding these risks aids in early identification and potential prevention strategies, tailored to those predisposed to the disorder:

Genetic Predisposition: Someone with a family history of anxiety or other mental health conditions may be more susceptible to developing ARFID.

Traumatic Feeding Experiences: Traumatic experiences with food, like choking or vomiting, can instill long-lasting aversions to certain foods.

Neurodivergence: Neurodevelopmental differences like ADHD and autism spectrum disorder can lead to hypersensitivity around food texture, taste, and smell, resulting in co-occurring ARFID.

Diagnosis and Tests

How is Avoidant/Restrictive Food Intake Disorder (ARFID) Diagnosed?

Diagnosing ARFID involves a thorough assessment by healthcare specialists, including evaluating eating habits, medical history, and nutritional intake. Clinicians utilize screening tools and assessments to gather details about patients' eating patterns and associated distress. The diagnostic criteria are detailed in the DSM-5, highlighting nutritional deficiencies or physical health issues as a result of limited food intake. A common screener used for diagnosing ARFID is the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS).

Proper screening is crucial for distinguishing ARFID from other possible conditions. Diagnosis among healthcare providers often includes:

Questionnaires and Interviews: Collect data on eating behaviors and anxieties.

Nutritional Assessments: Identify any deficiencies or health issues.

Psychological Evaluations: Reveal any contributing mental health issues or fears.

Engaging a multidisciplinary approach ensures correct diagnosis and helps inform an effective treatment plan, paving the way for improvements in symptoms.

Management and Treatment

How is Avoidant/Restrictive Food Intake Disorder (ARFID) Treated?

Treating ARFID requires a comprehensive, multidisciplinary strategy that includes psychological, nutritional, and medical components. In severe cases, medical supervision or residential treatment may be employed to resolve health complications and restore weight. Here are some key strategies in treating ARFID:

Cognitive-behavioral Therapy: Used to tackle the negative associations or fears related to food.

Exposure Response Prevention Therapy: Supervised exposures to new foods can be effective in lowering the anxiety response around feared foods and outcomes.

Nutritional Counseling: Meal plans tailored to address and overcome deficits while expanding the diet.

Family Involvement: Family-based therapy, particularly in children and adolescents, can bolster familial support and improve dynamics around eating.

A targeted and integrated treatment fosters a supportive environment for those living with ARFID, facilitating recovery, restoration of weight and improved health.

Who Treats Avoidant/Restrictive Food Intake Disorder (ARFID)?

ARFID is usually treated by a team of healthcare professionals collaborating to address both its psychological and physical aspects. Each professional plays a vital role:

Psychologists/Therapists: Psychologists or therapists who specialize in treating eating disorders focus on cognitive and behavioral interventions to lessen anxiety around eating.

Dietitians: Design and implement personalized meal plans addressing deficiencies and guiding nutritional changes for patients and their families.

Medical Providers: Physicians or pediatricians monitor broad health impacts and support treatment continuity, ensuring health issues do not worsen.

Occupational Therapists: Assist with sensory processing challenges tied to food

Together, this multidisciplinary team provides comprehensive care that addresses each facet of ARFID.

What if my Child has ARFID?

ARFID can be challenging for both children and their families. If your child has been diagnosed with ARFID, the first step is to seek professional support from a pediatrician, therapist, dietitian, and possibly an occupational therapist. These professionals can work together to create a comprehensive treatment plan tailored to your child's needs. Engaging in family-based therapy can also be beneficial, where parents and siblings learn how to support the child around mealtimes. Incorporating gradual exposures to new foods through exposure response prevention therapy can also be helpful. Additionally, finding online resources and support groups for parents dealing with ARFID can provide further guidance and emotional support. Remember, patience and understanding are key as recovery will take time.

Living with ARFID

Living with ARFID can deeply impact someone's daily life. People's anxiety around eating and mealtimes can negatively affect comfort around social engagements involving food, leading to isolation and depression.

Identifying and addressing the disorder’s psychological and physical aspects can allow those affected to live more functional and full lives. Through intervention and a strong support system, individuals with ARFID can better manage their disorder and overcome anxieties, improving their overall quality of life.

When Should I See a Healthcare Provider?

If your eating patterns are negatively affecting your physical health or social life, it's time to seek professional guidance from a healthcare provider. Notable weight loss and nutritional deficiencies linked to food avoidance and restriction also warrant an evaluation. If anxiety around eating deprives you of a balanced diet, or symptoms influence your ability to complete daily tasks and result in emotional distress, pursue professional intervention. Proactively seeking a diagnosis and care can improve treatment outcomes and increase the odds of recovery from ARFID.

What Questions Should I Ask My Doctor?

When speaking with a healthcare provider about ARFID, it’s important to cover all aspects to ensure there is complete understanding and effective treatment in place. When asking questions about ARFID, make sure to focus on:

- Understanding Symptoms: Confirm how ARFID differs from other eating disorders.

- Exploring Treatment Options: Discuss the best strategies for your case.

- Engaging Support Services: Reach out to local or online resources for additional support.

Asking thorough questions allows you to work together with your healthcare providers to navigate ARFID's challenges. Find more important questions to ask your healthcare provider here.

Moving Forward with ARFID Awareness

The journey of understanding and diagnosing Avoidant/Restrictive Food Intake Disorder (ARFID) can be complex, given its differences from other more well-known eating disorders. By raising awareness and educating people about ARFID, opportunities for accurate diagnosis and effective treatment increase, offering real hope for those affected. A multi-disciplinary treatment approach remains essential in achieving recovery and building a healthy relationship with food. As ARFID becomes more widely recognized, increased awareness and effective treatment approaches will continue to open doors for people to access needed support, find recovery, and live fuller lives.

If you or someone you know is experiencing symptoms of ARFID, don't wait to seek help. You can find specialized treatment for ARFID at Thrive Wellness.

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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.