ARFID

ARFID is different from anorexia nervosa, bulimia nervosa and related conditions; in ARFID, beliefs about weight and shape do not contribute to the avoidance or restriction of food intake. A diagnosis of ARFID would not be given at the same time as one of these other eating disorders, although it could precede or follow. A diagnosis of ARFID would also not be given if there is another clear reason for the eating difficulty, such as a medical condition that results in appetite loss or digestive difficulties. 

Anyone of any age can have ARFID. It occurs in children, teenagers and adults. People with ARFID can lose weight and become very underweight, their weight may be in a “normal” range, or they may gain weight or have high weight (particularly if their diet is restricted to foods that are high in calories). ARFID can be present on its own, or it can co-occur with other conditions; those most commonly co-occurring with ARFID are anxiety disorders, autism, ADHD and a range of medical conditions. The eating difficulties someone with ARFID has, can have been present for a very long time, in some cases almost as long as they can remember. In other people, it might have a more recent onset.

Because ARFID includes a range of different types of difficulty that contribute to the avoidance or restriction of food intake, there is a wide range of possible signs and symptoms, not all of which would necessarily occur in one person. Possible signs of ARFID include: 

• Eating a reasonable range of foods but overall having much less food than is needed to stay healthy. 
• Finding it difficult to recognise when hungry. 
• Feeling full after only a few mouthfuls and struggling to eat more.
• Taking a long time over mealtimes/finding eating a ‘chore’.
• Missing meals completely, especially when busy with something else.
• Sensitivity to aspects of some foods, such as the texture, smell, or temperature. 
• Appearing to be a “picky eater”.
• Always having the same meals.
• Always eating something different to everyone else.
• Only eating food of a similar colour (e.g. beige).
• Attempting to avoid social events where food would be present.
• Being very anxious at mealtimes, chewing food very carefully, taking small sips and bites, etc.
• Weight loss (or in children, not gaining weight as expected).
• Developing nutritional deficiencies, such as anaemia through not having enough iron in the diet.
• Needing to take supplements to make sure nutritional and energy needs are met.

If you think you might have ARFID, you should make an appointment to discuss this with your GP. If you are concerned that a family member or friend has ARFID, it is important to talk with them to support and encourage them to seek the right help and support. It is usually best that this help and support is in place as soon as possible after the difficulties have been recognised. You may feel daunted by idea of trying to change your eating, or the person you care about may be scared or may not be as concerned about their eating as others. People with ARFID may not be able to see any possibility that they can ever change their eating behaviours. This may lead to them being reluctant to reach out for help, or saying that everything is okay. However, ARFID can lead to serious malnutrition and be associated with significant impairment to psychological wellbeing, so it is important that they receive this support. 

The first port of call when seeking help is through your GP or the GP of the person you care about. It could be helpful to go with someone close to you, or suggest that you go to this appointment together if you are concerned about someone else. It is often helpful to go prepared with notes about your concerns and to explain clearly why you think the difficulties are related to ARFID. If you are taking your child to see the GP, it is always best to explain to them why you are going and what you are concerned about, again taking some prompts or notes to the appointment. For example, think about how long things have been going on and any symptoms or behaviours that you are worried about. If going to the GP is something you are anxious about, you can speak to our Helpline about your worries.

Due to the varied forms ARFID may take, people may receive treatment in one or more of a number of different types of services from a range of different types of professionals. Currently, treatment for ARFID is not included in the NICE guidelines for eating disorders; however, this certainly does not mean it does not need to be taken seriously. The GP should still make a referral to the relevant service. Young people may be treated by their local community eating disorders service for children and young people, generic Child and Adolescent Mental Health Services (CAMHS), community paediatric services, in the local acute paediatric service, or by a range of private practitioners, including dietitians, speech and language therapists, psychologists and occupational therapists. Adults with ARFID may be treated by specialist eating disorders services, general mental health services (particularly those offering treatment for anxiety), as part of hospital-based liaison work when the ARFID occurs in the context of a chronic medical condition, or by private practitioners.

Treatment for ARFID is usually best tailored to the needs of the individual, based on the specific nature of the difficulties the person is experiencing and what is considered to be maintaining these. Most often, treatment can be delivered in an outpatient setting. Treatment commonly involves evidence-based treatments such as family-based treatment (for young people), cognitive behavioural therapy, behavioural interventions such as exposure work, and anxiety management training. Sometimes some medication may be suggested, most often to help with anxiety. The person’s physical health should also be monitored and managed, for instance by their GP or a physician or paediatrician. Treatment may also involve nutritional management through support from a dietician, and help with sensory problems.