Avoidant/restrictive food intake disorder (ARFID)

What is avoidant/restrictive food intake disorder?

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that occurs when a child or teen doesn’t eat enough to meet their energy or nutritional needs. People with ARFID are not concerned about their body weight, shape or size.

Instead, they avoid foods due to worries about vomiting or choking; or dislike of certain food textures, smells or tastes; or because they are not interested in eating or food. Because of their problems with eating, they may lose weight or not grow as expected.

What the signs and symptoms of ARFID?

Physical signs of ARFID

• losing weight or no longer gaining weight
• poor growth in height
• showing signs of malnutrition such as:
  • feeling cold all the time
  • dizziness
  • low energy
  • changes in how the heart works
  • dehydration
  • in people assigned female at birth, menstrual periods stop

Behavioural signs of ARFID

• suddenly refusing to eat foods that they once enjoyed
• fear of choking, vomiting or other concerns associated with eating
• losing appetite for no known reason
• eating very slowly
• difficulty eating meals with family or friends
• lack of interest in eating or food
• are more likely to have an anxiety disorder

Someone with ARFID does not usually worry about calories or specific food groups. Once better, they can eat the foods they have always eaten.

What if I think I may have ARFID?

Tell someone. Tell a trusted adult such as a parent, caregiver, teacher, coach or therapist. Explain your concerns and ask for their help.

Don’t feel alone. It can be hard to tell someone about your eating disorder thoughts and behaviors. You might be concerned about how they will react. However, it can help to have an open and honest conversation about your eating disorder with those you trust. It will help you feel less alone.

Get help early. It is important for you to see your health-care provider as soon as possible. Your health-care provider can help to determine whether you have an eating disorder and can also assess how serious the situation is. The sooner a diagnosis is made, the quicker you can start treatment, and the better chance for recovery.

It’s important to see a doctor if you:

• have stopped growing
• are losing weight and finding it hard to eat enough food
• have any signs or symptoms of ARFID as outlined above

What does a health-care provider do during an assessment for ARFID?

A health-care provider will do a complete history (medical, nutritional and psychosocial history) and a thorough physical examination including:

• weight and height (plotting measurement on a growth curve)
• blood pressure and heart rate, both lying and standing
• temperature
• assess pubertal growth development

They may also do some initial tests including laboratory studies to check the blood and urine for abnormalities and an electrocardiogram to check how the heart is functioning.

How is ARFID treated?

If the health-care provider determines that a person has ARFID, they will arrange for appropriate care. Eating disorder care is usually done with multiple health-care professionals including a paediatrician or adolescent medicine doctor or family doctor or nurse practitioner, nurses, dietitians, psychologists, psychiatrists, and social workers who specialize in treating children and teens with eating disorders. In children and adolescents with ARFID, there may need to be a speech-language pathologist and occupational therapist involved the young person’s care. In children and adolescents with ARFID, there may need to be a speech-language pathologist and occupational therapist involved the young person’s care.

Most adolescents with ARFID can be treated as an outpatient. This can be done in an outpatient clinic or in a specialized eating disorder program.

The main goals of treatment include:

• achieve and maintain a healthy weight and height
• achieve healthy eating patterns
• increase the variety of foods eaten
• learn ways to eat without fear of pain or choking

Because ARFID is a relatively new eating disorder, health-care providers are just learning more about the best treatments. Currently, one of the first treatments recommended for young people with ARFID is an outpatient treatment program called family-based treatment, which focuses on recovery of the eating disorder. Parents/caregivers play an essential role in the treatment and recovery of their child. Family-based treatment includes 3 treatment phases.

• Phase 1 focuses on weight restoration. Parents, supported by the therapist, take responsibility for making sure that the adolescent is eating sufficiently and also takes on all meal planning and preparation.  
• Phase 2 is when substantial weight recovery has occurred and the adolescent gradually assumes responsibility for their own eating.  
• Phase 3 is when weight is restored and the focus is on general issues of adolescent development.

Another treatment that is currently being studied for patients with ARFID ages 10 through older adults is cognitive behavioural therapy (CBT). CBT involves working with a therapist and addressing relationships among thought, feelings and behaviors. CBT for patient with ARFID is most often family-supported for children and adolescent and involves psychoeducation, treatment planning, addressing the eating issues and preventing relapse.

The treatment can also involve using methods such as exposure therapy, in which a therapist will work with the adolescent and family to reintroduce foods they fear or have been avoiding.

If the health-care provider finds that the patient is too sick for outpatient treatment, they may refer the patient for urgent hospitalization.

If the adolescent is experiencing depression or anxiety in addition to ARFID, the health-care team may suggest other therapy for these conditions once the eating disorder is under control. Sometimes, the health-care team may also suggest medication. Antidepressants can help with depression or anxiety. If the adolescent’s thoughts about food are really strong, their doctor may suggest other medications.

SickKids has an eating disorder program that treats children and teens who are struggling with symptoms of anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder. For more information on our program visit: https://www.sickkids.ca/en/care-services/clinical-departments/adolescent-medicine/

NEDIC – National Eating Disorder Information Centre (Canada)

NEDA – National Eating Disorder Association (United States)

B-EAT – Beating Eating Disorders (United Kingdom)

Kelty Eating Disorders (Kelty Mental Health Resource Centre, BC Children's Hospital)

ANAD - National Association of Anorexia Nervosa and Associated Disorders (United States)