Avoidant Restrictive Food Intake Disorder (ARFID) is a newly recognized diagnosis in the DSM-5, and it is distinct from other eating disorders such as anorexia nervosa and bulimia nervosa. While anorexia involves fears of body shape and size, ARFID focuses on limitations in the amount and types of food consumed without distress about body image. ARFID can affect both children and adults, resulting in stunted growth, weight loss, and difficulties with psychosocial functioning. The diagnostic criteria for ARFID include persistent failure to meet appropriate nutritional and energy needs, significant weight loss or nutritional deficiencies, dependency on enteral feeding or oral nutritional supplements, and marked interference with psychosocial functioning. Individuals with autism spectrum conditions, ADHD, and intellectual disabilities are at a higher risk of developing ARFID, as are those who don’t outgrow normal picky eating. The disorder can have serious health consequences, including electrolyte imbalances and cardiac arrest. It is crucial to understand the impact of ARFID on the body and provide proper diagnosis and support to those affected.
DIAGNOSIS CRITERIA
Manifestation of eating or feeding disturbance
The first criteria for diagnosing Avoidant Restrictive Food Intake Disorder (ARFID) involves the manifestation of eating or feeding disturbance. This can include a lack of interest in eating or food, avoidance based on sensory characteristics of food, or concerns about aversive consequences of eating.
Failure to meet appropriate nutritional and/or energy needs
The second criteria for diagnosing ARFID is the persistent failure to meet appropriate nutritional and/or energy needs. This can be demonstrated by a significant weight loss or failure to achieve expected weight gain or growth in children, as well as significant nutritional deficiencies or dependence on enteral feeding or oral nutritional supplements.
Interference with psychosocial functioning
ARFID must also result in marked interference with psychosocial functioning to meet the diagnostic criteria. This means that the eating or feeding disturbance is causing problems at school or work, due to difficulties eating with others and extended times needed to eat.
Exclusion of other explanations
To diagnose ARFID, it is important to exclude other explanations for the eating or feeding disturbance. This means ruling out factors such as lack of available food or associated culturally sanctioned practices. The disturbance should not be better explained by these factors.
Severity exceeding that associated with other conditions
The final criteria for diagnosing ARFID is that the severity of the eating disturbance exceeds that associated with other conditions or disorders. This means that the severity of the disturbance warrants additional clinical attention and is not simply a result of another condition or disorder.
RISK FACTORS
Autism spectrum conditions
People with autism spectrum conditions are at a higher risk for developing ARFID. The reasons for this are not entirely understood, but individuals with autism may have sensory sensitivities that impact their ability to tolerate certain foods or textures.
ADHD and intellectual disabilities
ADHD and intellectual disabilities are also risk factors for ARFID. It is believed that individuals with these conditions may have difficulties with impulse control and cognitive processing, which can impact their eating behaviors.
Persistent picky eating
Children who do not outgrow normal picky eating or who have severe picky eating are more likely to develop ARFID. Picky eating that worsens over time and involves a limited range of preferred foods can be a warning sign of ARFID.
Co-occurring anxiety disorders
Many individuals with ARFID also have co-occurring anxiety disorders. Anxiety can contribute to the avoidance of certain foods or eating situations, further exacerbating the eating disturbance.
High risk for other psychiatric disorders
ARFID is associated with a higher risk for other psychiatric disorders. This means that individuals with ARFID may be more likely to experience conditions such as depression, anxiety disorders, and obsessive-compulsive disorder.
WARNING SIGNS & SYMPTOMS
Behavioral and psychological signs
There are several behavioral and psychological signs that may indicate the presence of ARFID. These can include dramatic weight loss, dressing in layers to hide weight loss or stay warm, reports of constipation or other gastrointestinal issues, and a dramatic restriction in types or amounts of food eaten. Other signs may include fears of choking or vomiting, a lack of appetite or interest in food, and a limited range of preferred foods that becomes narrower over time.
Physical signs
ARFID can also have physical signs and symptoms that can be observed. Some of these physical signs may overlap with those of other eating disorders. Physical signs of ARFID can include stomach cramps, gastrointestinal complaints such as constipation or acid reflux, menstrual irregularities, difficulties concentrating, abnormal laboratory findings such as anemia or low thyroid and hormone levels, dizziness, fainting, feeling cold all the time, sleep problems, dry skin, brittle nails, fine hair on the body (lanugo), thinning hair on the head, muscle weakness, cold and mottled hands and feet, poor wound healing, and impaired immune functioning.
HEALTH CONSEQUENCES
Denial of essential nutrients
One of the primary health consequences of ARFID is the denial of essential nutrients. When a person with ARFID does not consume enough calories or a variety of foods, their body is not receiving the nutrients it needs to function properly. This can lead to deficiencies in vitamins, minerals, and other essential nutrients that are necessary for growth, development, and overall health.
Slowing down of body processes
In order to conserve energy, the body of someone with ARFID may slow down its processes. This means that various bodily functions may be affected, including digestion, metabolism, and hormone production. As a result, individuals with ARFID may experience issues such as constipation, slowed heart rate, and difficulties with temperature regulation.
Serious medical consequences
Without proper nutrition, ARFID can lead to serious medical consequences. Some of these consequences can include anemia, weakened immune system, poor wound healing, bone loss, organ damage, and hormonal imbalances. These medical complications can have long-term effects on a person’s health and well-being, making it essential to diagnose and treat ARFID as early as possible.
In conclusion, ARFID is a complex eating disorder characterized by an eating or feeding disturbance, failure to meet appropriate nutritional and energy needs, interference with psychosocial functioning, exclusion of other explanations, and severity exceeding that associated with other conditions. Risk factors for ARFID include autism spectrum conditions, ADHD and intellectual disabilities, persistent picky eating, co-occurring anxiety disorders, and a high risk for other psychiatric disorders. Warning signs and symptoms of ARFID can be both behavioral and psychological, as well as physical. Denial of essential nutrients, slowing down of body processes, and serious medical consequences are among the health consequences of ARFID. It is crucial to recognize the signs and symptoms of ARFID, as early intervention and treatment can greatly improve outcomes for individuals with this disorder.
