A very distinctive eating disorder, Avoidant Restrictive Food Intake Disorder (ARFID), made the headlines recently when a British teenager lost his sight as a result of malnutrition from his ARFID-induced diet. The boy was only able to eat chips, crisps, processed ham, sausages and white bread, because of the condition that limited the range of food he would eat without distress.

ARFID was previously known as ‘selective eating disorder’ but has now been renamed. It represents a very specific type of eating disorder – unlike conditions such as anorexia or bulimia, a patient with ARFID is not trying to lose weight or change their body shape. They simply cannot tolerate certain foods, either because of past experiences, phobias, a disinterest in eating, or a sensory issue.

Their eating habits become so restrictive that they cannot take in enough calories or nutrients to keep their body functioning at a basic level or, if they are a young person, to help them grow, which is where ARFID can sit alongside or coexist with other eating disorders.

ARFID can particularly affect children. You may notice they aren’t growing very much in height or weight, and that they are distinctly nervous around food or they take no interest in eating.

This nervousness is different from the common food journeys that all children go through, such as fads with certain types of food, and being unsure about new flavours until they are introduced gradually. Children can be picky eaters, but they will generally outgrow this – think of all the things you didn’t used to eat when you were young, and how your taste expanded over time.

Symptoms of ARFID

• Restricting the different textures of their food – for example, only crunchy or only soft foods.
• Their list of edible foods becomes shorter.
• Worries about choking on food, or a fear of being sick (emetophobia).
• Constant stomach pain – this can include cramps, constipation and acid reflux.
• Feeling cold all the time.
• Weight loss, and slowed or stunted growth in children.
• Low energy, and sleep issues.
• Feeling dizzy or faint on a regular basis.
• Poor immune system.
• Dry skin and nails.
• Thin hair on the head, sometimes with a fine layer of excess hair (lanugo) on the body.
• Women and girls may find their periods are irregular or that they stop altogether.

With ARFID, a child’s picky eating is much more ingrained, and it will intensify. Their condition can often coexist with a diagnosis of anxiety, or even with autism spectrum disorder. A restrictive diet is particularly common in children with autism, but this can persist into adulthood. In fact, as many as 20% of people with a diagnosable eating disorder (not just ARFID) could also be classed on the autistic spectrum.  

People with autism are affected by sensory disturbances and overstimulation. This is, of course, carried into eating and drinking, so flavour, textures, colour and packaging can all have an impact on the food and drink they enjoy. They may develop rituals and repetition around certain foods, and refuse others because of bad experiences.

Autistic people with ARFID tend to be drawn to either soft and smooth food or hard and crunchy food. Adding a new food into the mix, even if it has the same qualities, is not easy – it requires a lot of trial and error and support. As they get older, autistic people with ARFID may find it frustrating that their lack of food variety makes it harder for them to fit in with friends and in social situations.

Those with autism may also have pica, a condition that prompts them to eat non-food substances such as cigarettes, dirt, plastic bags, soap, or stones. Pica is seen as a challenging behaviour, but the reasons behind it are complex, and can include the body craving certain minerals or nutrients, the person enjoying the texture of the non-food substance, or the person being unable to tell whether something is edible or not.

Treatment for ARFID

There are many different treatment options available for ARFID – the most common are Cognitive Behavioural Therapy and Dialectical Behavioural Therapy, but an initial assessment and personalised treatment plan can determine the best approach for each patient. The therapist may also involve exposure therapy in the plan, helping the patient to gradually adjust to new foods through practical tasks.

When a patient is on the autistic spectrum, this requires an even more specialist approach, so it is important to pick a therapist with experience treating people with autism. If the person with ARFID has not yet been diagnosed for autism, an assessment can also be carried out at Christine Tizzard Psychology.

Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).