Avoidant / Restrictive Food Intake Disorder (ARFID) & Substance Abuse in a Dual Diagnosis

Avoidant / Restrictive Food Intake Disorder (ARFID) is distinct from other eating disorders, marked by food intake avoidance not linked to body image concerns but driven by lack of interest, sensory aversions, or fear of adverse effects.

ARFID is primarily about the act of eating itself and does not involve concerns about body weight or shape, making it distinct from the other eating disorders that include significant distress about body image and weight control behaviors.

Avoidant/Restrictive Food Intake Disorder (ARFID): A DSM-5 Overview

Avoidant/Restrictive Food Intake Disorder (ARFID), as detailed in the DSM-5, is a feeding or eating disorder characterized by a pattern of eating that avoids certain foods or limits intake, leading to significant nutritional deficiencies, weight loss, or developmental stunting.

Unlike anorexia nervosa or bulimia nervosa, ARFID does not involve distress about body shape, size or an explicit desire to lose weight. Instead, it’s driven by a lack of interest in eating or food, avoidance based on sensory characteristics, or concern about aversive consequences of eating, such as choking or vomiting.

Common Features and Symptoms of ARFID

Significant weight loss or failure to achieve expected weight gain or growth in children.

Significant nutritional deficiency attributable to the avoidance or restriction of food.

Dependence on enteral feeding or oral nutritional supplements.

Marked interference with psychosocial functioning.

What makes ARFID distinct?

ARFID is distinct from more common picky eating in childhood, as it involves more severe dietary restrictions and significant impacts on health or functioning. The disorder can manifest at any age but is more commonly identified in children and adolescents.

Known Facts and Research: Understanding ARFID

Prevalence: Research suggests that ARFID is less common than other eating disorders but still represents a significant portion of individuals seeking treatment for eating disorders. Its prevalence is not well-defined due to its relatively recent classification in the DSM-5.
Comorbidities: ARFID often co-occurs with other mental health disorders, including anxiety disorders, obsessive-compulsive disorder (OCD), and autism spectrum disorder (ASD). These comorbid conditions can complicate treatment and may require integrated approaches to address both ARFID and the co-occurring disorder(s).
Treatment: Treatment typically involves a multidisciplinary approach, including nutritional counseling, psychotherapy (especially cognitive-behavioral therapy), and family therapy. The goals are to address the underlying anxiety or sensory issues, expand the range of foods eaten, and ensure adequate nutrition and growth.
Risk Factors: While the exact cause of ARFID is unknown, it’s believed to involve a combination of genetic, psychological, and environmental factors. Sensory sensitivities, past negative experiences with food, and a family history of eating disorders can contribute to its development.
Treatment: Treatment typically involves a multidisciplinary approach, including nutritional counseling, psychotherapy (especially cognitive-behavioral therapy), and family therapy. The goals are to address the underlying anxiety or sensory issues, expand the range of foods eaten, and ensure adequate nutrition and growth.
Risk Factors: While the exact cause of ARFID is unknown, it’s believed to involve a combination of genetic, psychological, and environmental factors. Sensory sensitivities, past negative experiences with food, and a family history of eating disorders can contribute to its development.

Identifying Key Differences: ARFID vs. Other Eating Disorders

Differentiating Avoidant/Restrictive Food Intake Disorder (ARFID) from Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder can be achieved by understanding the core motivations and behaviors associated with each disorder. Here’s a straightforward way to distinguish ARFID from the others:

ARFID

Core Feature: Avoidance or restriction of food intake not related to concerns about body weight, shape, or size. The avoidance may be due to lack of interest in eating, aversion to textures or smells of foods, or fear of negative consequences (like choking or vomiting).
Lack of Body Image Disturbance: Individuals with ARFID do not express a desire to lose weight or fear of gaining weight as a primary concern.

Anorexia Nervosa

Core Feature: Restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, or persistent behavior that interferes with weight gain, even at a significantly low weight.
Body Image Disturbance: A distorted view of body weight or shape, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Bulimia Nervosa

Core Feature: Recurrent episodes of binge eating (eating large amounts of food in a short period) followed by inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, excessive exercise, or misuse of laxatives.
Body Image Concerns: Self-evaluation is unduly influenced by body shape and weight.

Binge-Eating Disorder

Core Feature: Recurrent episodes of binge eating without the regular use of compensatory behaviors characteristic of bulimia nervosa. These episodes include eating much more rapidly than normal, until uncomfortably full, large amounts of food when not physically hungry, and feeling disgusted with oneself, depressed, or very guilty afterward.
No Purging Behaviors: Unlike Bulimia Nervosa, individuals with Binge-Eating Disorder do not regularly engage in purging behaviors after binge eating.

In summary, the easiest way to differentiate ARFID from Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder is by focusing on the individual’s relationship with food and body image. ARFID is primarily about the act of eating itself and does not involve concerns about body weight or shape, making it distinct from the other eating disorders that include significant distress about body image and weight control behaviors.

Prevalence Amongst Groups: Avoidant / Restrictive Food Intake Disorder

Prevalence by Sex

Initial studies and clinical observations suggest that ARFID may not have as pronounced a gender disparity as seen in other eating disorders like anorexia nervosa and bulimia nervosa, which are more common in females. ARFID appears to affect males and females more equally compared to these disorders. Some studies even suggest a slightly higher prevalence in males, especially in pediatric and adolescent populations.

Prevalence by Age

Children and Adolescents: ARFID is more frequently diagnosed in children and adolescents. This age group often presents with feeding difficulties, limited range of food preferences, or fear of aversive consequences related to eating, which significantly impacts their nutritional intake and growth.
Adults: While less studied, ARFID does occur in adults and can be a continuation of childhood feeding issues or emerge due to other factors such as trauma or medical conditions affecting eating. The prevalence in adults is less well-documented, but the disorder is recognized as impacting adults’ nutritional status and quality of life.

Disproportionate Effects

While ARFID can affect individuals of any age or sex, certain populations may experience the disorder differently based on the context of diagnosis and the presence of comorbid conditions. For example, individuals with autism spectrum disorder (ASD) or those with a history of severe food neophobia (fear of trying new foods) may be at higher risk for developing ARFID.

The impact of ARFID may also vary with age. In children, the disorder can significantly affect growth and development, while in adults, it may lead to social isolation or exacerbate other mental health disorders.

In conclusion, ARFID does not seem to disproportionately affect one specific gender but does have a higher incidence in younger populations, particularly children and adolescents. Continuous research is needed to further understand the prevalence and impact of ARFID across different demographics, as well as to develop targeted interventions that address the unique needs of affected individuals.

Nutritional, Psychological, & Sensory Challenges

Final Words for Families Considering Long-Term Treatment

ARFID stands distinct from other eating disorders, marked by food intake avoidance not linked to body image concerns but driven by lack of interest, sensory aversions, or fear of adverse effects. Its manifestation across ages necessitates tailored treatment approaches, addressing nutritional, psychological, and sensory challenges, underscoring the importance of comprehensive care for those affected.