Everyone is picky with their food sometimes — some people love cilantro, while others hate it. Some people don’t let food mix on their plate and prefer their dressing on the side.
But when do these food preferences go from simply picky eating to being an eating disorder?
WHAT IS AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER?
While many people avoid and restrict their consumption of certain foods, these behaviors are not considered unless the person is experiencing clinically significant struggles with eating and food. This is known as avoidant/restrictive food intake disorder (ARFID) (also known as selective eating disorder).
Symptoms of ARFID frequently show up in infancy or childhood, but they can also arise and continue throughout adulthood. According to the Center for Eating Disorders at Sheppard Pratt, some eating problems that could warrant an ARFID diagnosis include “difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite or being afraid to eat after a frightening episode of choking or vomiting.”
People suffering from ARFID may lose weight because they are not eating enough calories, and children with ARFID may simply not gain weight or grow as they are expected to. Those with ARFID may also face challenges such as avoiding social situations where food is present, or being unable to finish work due to the excessive amount of time they spend eating (The Center for Eating Disorders).
HOW IS ARFID DIFFERENT FROM FOOD NEOPHOBIA?
ARFID in children refers to extreme selectiveness in food, while food neophobia is the fear of trying new foods. Children with ARFID may also have food neophobia, to an extent. While ARFID and food neophobia are separate issues, in children, they can be treated in similar ways—through a combination of therapy and relaxation techniques at home surrounding food.
Occupational therapy can aid children with oral texture sensitivity, and behavioral modification can encourage children to eat a broader range of food. Children with food neophobia should be shown positive mealtime dynamics in order to reduce their fear of food. For example, they should sit where they feel comfortable and watch their family members eat a range of food, calmly, with light, pleasant conversation.
This will help make eating seem more enjoyable, especially if the child has a negative association with eating, such as a history of being scolded or forced to eat something he or she did not want to, as is common within frustrated households dealing with a child who will not eat (Gavi, 2011).
Children with eating issues in general should also be encouraged not to snack in order to ensure they arrive at mealtime hungry, which may break them out of their comfort zones and sway them to eat more than they would have before. Additionally, it is important to consider supplemental vitamins for children not eating properly, to maintain healthy growth. High calorie, high protein drinks may also be an effective way to keep children healthy while working through food anxieties.
Once positive associations with eating are created, children should make progress in their food consumption, though it might be slow. They may start by simply remaining at the table throughout the entirety of the meal, or putting food on their plate but not eating it, or claiming to enjoy a new food even if they have not eaten it yet. Any positive change is a step in the right direction, no matter how small.
HOW IS ARFID TREATED IN ADULTS?
According to the Eating Disorders Review, little is known about effective treatment interventions for adults with ARFID, but “given the prominent avoidance behaviors, it seems likely that behavioral interventions, such as forms of exposure therapy, will play an important role. For someone with an emotional disturbance such as depression or anxiety that affects feeding, cognitive behavioral therapy and other treatments for the underlying condition may be an effective approach for treatment of the eating disorder.”
ARFID in adults can be more complicated than in children, as mental health issues can come into play. These issues should all be addressed in treatment, especially because adults with ARFID sometimes develop related eating disorders such as anorexia or bulimia, as well as depression and anxiety.
While ARFID can affect people of all ages, it manifests itself differently among different age populations. But with appropriate treatment, it can be outgrown and overcome, and allow people to develop a healthy relationship with food.