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Avoidant Restrictive Food Intake Disorder in Children (AFRID)

As an eating or feeding disturbance, avoidant/restrictive food intake disorder (ARFID), also known as "extreme picky eating," is a new diagnosis in the DSM-5. It was previously referred to as "Selective Eating Disorder" (e.g. apparent lack of interest in eating, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating). It frequently causes severe nutritional and energy deficiencies in children, as well as failure to gain weight.

Diagnosis is associated with at least one of the following:

  • Significant weight loss or failure to achieve expected weight gain

  •  Significant nutritional deficiency

  •  Dependence on enteral feeding or oral nutritional supplements

  •  Marked interference on an individual’s psychosocial functioning


According to Neuropsychiatric Disease and Treatment at Physciatric Times,  ARFID is most common in infants and children, as it is the second most common eating disorder in children aged 12 and under, with boys being more likely to develop ARFID.


ARFID is sometimes referred to as an "umbrella" term because it encompasses a wide range of difficulties. Nonetheless, all people who develop ARFID have one thing in common: they avoid or restrict their food intake in terms of overall amount, variety of foods eaten, or both.


Types of ARFID:

Like other eating disorder conditions, there are several different types of ARFID, depending on the symptoms that children are experiencing. The types of ARFID include

  1. Fear of consequences associated with: eating/feeding, such as choking, a phobia of a particular foods, nausea and allergies

  2. Sensory Avoidance, such as avoiding fruit and vegetables, crunchy foods because of have issues with food tastes, textures, temperature and smells.

  3. Genuine Lack of interest in eating or food, for example forgetting to eat, not feeling hungry, lack of pleasure in eating


Children can limit or prevent certain foods based on factors such as their appearance (e.g. color, size, shape), structure, smell, temperature, or groups of foods (e.g., all vegetables after a bad experience choking on a vegetable). It is critical to note that food avoidance or restriction does not always result in weight loss. ARFID affects people of all weights, depending on their food intake (type and amount) and reliance on tube feeding/oral supplements.

Since their bodies aren't getting enough nutrients, ARFID can make a person seriously sick. Children, for example, can experience medical or mental health issues such as stunted development, diabetes, weakness, low self-esteem, family mealtime conflict, and academic and relationship difficulties.


Causes and Risk Factors 

ARFID has a number of potential contributing factors, including biological, psychological and socio-cultural issues, investigated by researchers and clinicians. A child who is predisposed to ARFID due to biological or genetic makeup may be triggered by environmental or psychosocial situations, such as a traumatic event.


ARFID vs anorexia nervosa

While ARFID is similar to anorexia nervosa in that it involves restricting one's food intake, the intent or reason for doing so differs between the two eating disorders. People with ARFID do not restrict their food intake in order to lose weight or change their body size/shape. ARFID is not linked to weight or shape concerns.


Signs and symptoms of ARFID 

  • ARFID may have a negative impact on a person's physical and mental health. When a person's diet is inadequate and they can only consume a small variety of foods, they can miss out on important nutrients for their health and are more likely to lose weight. The following are some of the more common ARFID signs and symptoms, as well as complications:


  • Fear of consequences associated with eating/feeding

  • A short list of acceptable foods, or has a phobia of certain foods

  • Avoiding events where food will be served or becomes distressed when preferred foods aren’t available

  • May feel prematurely full while eating or skipping meals entirely

  • Preferences for particular food preparation methods

  • Poor weight gain, malnutrition and needing to take nutritional supplements

  • Lack of interest in eating or forgetting to eat

  • Decline in psychosocial function with developmental delays


Physical signs and effects of ARFID

  • Neurologic– preoccupation with food, headaches, fainting, dizziness, mood swings, anxiety, depression and difficulty concentrating

  • Gastrointestinal (digestive) system– constipated, diarrhea, bloating, abdominal pain

  • Cardiovascular system – poor circulation, irregular or slow heartbeat and hypotension 

  • Skin and Hair – growth of thin white hair all over body (called lanugo), dry skin, brittle nails, hair loss and thin hair, bruises easily, 

  • Endocrine (hormonal) system– irregular  periods, loss of libido, infertility

  • Bones and muscles – loss of bone calcium (osteopenia), osteoporosis, muscle  weakness, fatigue

  • Kidneys – dehydration, kidney failure

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts)

If you think your child may have an eating disorder such as AFRID you can schedule a consultation with one of our therapists here.

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