Struggling with Food: Understanding ARFID, a Serious Eating Disorder
Eating disorder known as ARFID, distinguished from common dietary issues
In an interview, Mara — a sufferer of Avoidant/Restrictive Food Intake Disorder (ARFID) — shares her daily struggle to consume a balanced diet. The condition prevents her from consuming various solid fruits, vegetables, and cold cooked meat, making eating a challenge. Despite the challenges, she remains hopeful, slowly expanding her diet and aiming to avoid burdening her daughter with her eating habits.
"Not even strawberries," she often explains when discussing her food limitations. Before company events like the Christmas dinner, she would experience anxiety, with sweaty palms. Previously, she believed she was simply inept when it came to food and behaved like a toddler. However, after seeing a child with similar eating habits on Instagram, she learned about ARFID — a term she immediately recognized as fitting her situation.
ARFID, or Avoidant-restrictive eating disorder, is a distinct condition that goes beyond simple pickiness. While she dislikes marzipan, Mara is unable to swallow cooked ham. The difference, she explains, is akin to the challenges faced by participants on survival shows when confronted with unpalatable offal.
Eating has become a burden, not a pleasure, for Mara. She is of normal weight but is considering seeking professional help, either from a psychotherapist or a speech therapist, both recommended for individuals who have an aversion to certain solid foods.
Both children and adults can be impacted by ARFID, according to Ricarda Schmidt from Leipzig University's Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy. They may reject food based on its smell, taste, texture, or appearance. These individuals may experience no hunger, fear eating, or have little appetite, regarding eating as a chore rather than a pleasure. In severe cases, malnutrition or weight loss can occur.
ARFID was first recognized as a distinct condition in a 2013 diagnostic guideline in the USA. It was included in the World Health Organization's International Classification of Diseases (ICD-11) in 2022, although it is not yet in use in Germany. Doctors currently code it under "Other Eating Disorders." The number of affected individuals is unknown, but there is a self-help association based in Münster.
In Germany, anorexia is often assumed in sick adolescents. However, ARFID patients do not restrict their eating for the purpose of losing weight. They may consume foods like fries, noodles, or chocolate croissants, and can range from underweight to overweight, but are generally malnourished due to their restrictive diet. A genetic predisposition may contribute to ARFID in individuals sensitive to smells, textures, or tastes, or who have a strong aversion to many foods.
Early traumatic experiences, including choking incidents, allergic reactions, intubation, or swallowing difficulties, may also trigger ARFID symptoms. An analysis of 77 studies provides initial indications of potential therapeutic approaches, including family-based therapy, cognitive-behavioral therapy, and sometimes the addition of psychotropic drugs. Therapy should be individualized based on the main problem and severity.
ARFID can already be evident during breastfeeding or while introducing solid foods in infancy. Parents should consult their pediatrician to evaluate the physical consequences, rule out stomach problems or food allergies, and learn about ARFID. It's crucial to remember that doctors may not be familiar with the condition.
Practical approaches include maintaining a relaxed atmosphere at mealtime, offering rejected food in bowls, and trying new foods at least ten times to become accustomed to them. However, pressuring someone to eat isn't helpful.
Through long-term therapy — often around 60 sessions — families can learn techniques to cope with ARFID and continue working towards a balanced diet with variety, even after professional intervention. Starting with small steps, such as trying different pasta shapes or brands, can help achieve success and encourage the child to broaden their diet.
Mara's diet has gradually improved over time. She's been able to eat dried tomatoes and olives for five years, as well as enjoy pumpkin and tomato soup and orange juice without pulp. She's taken steps to ensure her child doesn't develop ARFID, opting for soft, graspable pieces instead of pureed food when introducing solids, and implementing the Baby-led weaning method, which allows the child to choose what to eat from available options.
Contact ntv.de or dpa for more information on ARFID.
Relevant Background Information:
- ARFID is characterized by a persistent failure to meet appropriate nutritional needs due to lack of interest in eating or avoidance of certain foods[1].
- Common therapies for ARFID include Cognitive Behavioral Therapy for ARFID (CBT-AR), Family-Based Therapy (FBT), Feeling and Body Investigators, Cognitive Behavioral Therapy (CBT), Nutritional Guidance, Exposure Therapy, and a multidisciplinary team approach, involving psychologists, occupational therapists, dietitians, and speech and language therapists[2].
- Sensory sensitivities and issues with food texture, smell, or taste may contribute to the development of ARFID[3].
- The treatment of ARFID emphasizes a supportive and non-judgmental approach, tailored to the individual's needs and responses[4].
- Recovery from ARFID is possible with timely professional intervention, although it's essential to approach treatment as a long-term process and be aware of potential nutritional deficiencies and health complications if the condition is left untreated[5].
- In her pursuit towards a balanced diet, Mara could potentially benefit from vocational training related to health-and-wellness and mental health, which could help her better understand and manage her Avoidant/Restrictive Food Intake Disorder (ARFID).
- Given the importance of proper nutrition in overall health and well-being, community policies might consider incorporating vocational training programs focused on food preparation, cooking techniques, and understanding various dietary needs as a means to support individuals like Mara who are battling eating disorders such as ARFID.
