Almost everyone knows someone who, as a small child, refused to eat a certain food. Honestly, most of us were that child. Maybe broccoli was a no-go; maybe the hated food was eggs or seafood. Picky eating is a hallmark of childhood for many people, but in some cases, it’s a sign of a more serious situation: the eating disorder known as avoidant-restrictive food intake disorder (ARFID). This disorder is an outlier from other disorders like anorexia nervosa or bulimia nervosa because of its causative factors and age of onset, but it can be every bit as dangerous, psychologically and mentally.

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Characterized by an obsessive unwillingness to eat certain kinds of food or entire food groups, ARFID is not simply being a “picky eater” but instead is a psychological disorder that can cause severe physical problems like malnutrition, extreme weight loss, bone density, and dental issues, and more. It often arises during early childhood, as opposed to most other eating disorders (which tend to begin during adolescence and young adulthood). While most children outgrow food pickiness, teenagers and adults who continue eating only very few types of food may need to seek ARFID treatment at an eating disorder treatment center.

Currently, avoidant-restrictive food intake disorder (ARFID) is not a widely known eating disorder, but it is now listed in the Diagnostic and Statistical Manual of Mental Disorder as a separate type of eating disorder. Before 2013, it was listed as a subtype of OSFED (Other Specified Feeding and Eating Disorders), a kind of catchall category for “minor” eating disorders that weren’t deemed distinct or common enough to be their own category. 2013 was a big year for formal recognition of eating disorders in the psychiatric community; binge eating disorder was also added to the list of major eating disorders that year. It hadn’t been included even though it is the most common eating disorder in the United States.

Symptoms and Causes of ARFID in Teens and Adolescents

Previously called selective eating disorder, there are several clinical symptoms that must be met before an eating disorder therapist diagnoses someone with ARFID. Per the DSM-V:

• An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
  
  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
  • Significant nutritional deficiency.
  • Dependence on enteral feeding or oral nutritional supplements.
  • Marked interference with psychosocial functioning.A diagnosis of ARFID must not be related to cultural values or lack of access to different kinds of food
  • A diagnosis of ARFID cannot be explainable by another medical condition or mental illness

Unlike other eating disorders like binge eating disorder or anorexia nervosa, ARFID sufferers do not avoid or restrict food types because of a negative body image or compulsion to lose weight. Instead, the restriction is driven by an extreme dislike or phobia of a certain food or a fear of suffering damage or illness from the food. As an example, an ARFID sufferer might refuse to eat steak for fear of choking, which might be extended to pork and then all meats (please note refusing to eat pork as part of a cultural or religious practice is not considered to be ARFID). Alternatively, an experience of getting sick from a certain food in early childhood might prompt a person to avoid that food meticulously afterward.

ARFID is also associated with other mental health disorders, including anxiety disorders like OCD or phobias. People with one type of these disorders are more likely to have ARFID, and vice versa. For that reason, many of the treatment methods used to combat anxiety disorders are also applicable to ARFID treatment, although medication is not normally prescribed, especially in preadolescent children. As with most mental health and behavioral health disorders, ARFID is considered to be caused by a variety of genetic, environmental, biological, and psychiatric factors – there is no single cause that can be pinpointed in every circumstance.

How to Treat ARFID in Teens and Adolescents

Adolescent eating disorder treatment is a delicate process that requires specialized planning. Although many of the techniques used in adolescent treatment (in both residential and outpatient settings) are basically similar to those used on adults, they must be modified to fit adolescent needs. Psychosocial development is still continuing at this time, so it may be less necessary to break down barriers. Despite this, psychological treatments must be sensitive to the fact that these individuals are still children and have not formulated their psyches completely yet.

Adolescents have different nutritional needs than adults as well since their bodies are still growing and developing. Certain nutrients such as calcium are necessary for any adolescent eating disorder recovery program. Finally, although family involvement is necessary for virtually every treatment program, it’s even more important for adolescents, whose parents play a larger role in children’s lives than in adults’ lives.

Eating disorder treatment centers address ARFID in teens using cognitive behavioral therapy, dialectical behavioral therapy, nutritional counseling, and other methods that comprise an eating disorder recovery program for anorexia nervosa, bulimia nervosa, or binge-eating disorder. However, it is important to thoroughly assess someone suspected of having ARFID before treatment begins, since ARFID is sometimes due to unknown medical or sensory processing issues associated with autism spectrum disorders.

Cognitive Behavioral Therapy (CBT) for ARFID Treatment

CBT is a subtype of psychotherapy that teaches individuals how to recognize negative thought patterns so they view them objectively and eventually replace them with positive, more rational thoughts. Patients in an eating disorder recovery program suffer from ARFID or another eating disorder primarily due to holding onto cognitive distortions – distorted beliefs about their body shape, obsession with being “perfect” and low self-esteem. CBT shows eating disorder patients how powerful an impact their thoughts have on their emotions, attitudes, and beliefs. It also reveals the faultiness of their disordered thoughts through a variety of techniques like cognitive rehearsal and validity testing.

CBT and Cognitive Rehearsal

An eating disorder therapist will ask an ARFID patient to think about a problematic situation they once struggled to deal with productively. The client then works to find positive solutions to that problem by discussing other ways they could have better dealt with that problem with the therapist. By regularly “rehearsing” utilization of positive thoughts regarding past issues, cognitive rehearsal helps ARFID patients learn to use positive thoughts to deal with current issues related to their eating disorder.

CBT and Validity Testing

An eating disorder recovery program implemented at residential eating disorder treatment centers may include validity testing as a way to “test” a client’s beliefs. Clients are allowed to defend their viewpoint regarding their eating habits but must support beliefs with objective evidence. For example, if they believe that eating only a certain food won’t make them ill from nutritional deficiencies, the eating disorder therapist may ask them for proof of their health by bringing blood tests results or other lab reports to a counseling session.

Daily Exposure Therapy and ARFID Treatment

Also used to treat people with phobias, systemic desensitization involves exposing ARFID patients to new foods for short periods. If an individual refuses to eat dairy products, the therapist may have them take a sip of milk or eat a tiny piece of cheese every day. Or a small piece of cheese could be melted on a hamburger instead of eaten alone. The goal is to eventually get the individual used to the taste and texture of foods they previously avoided. The experience can be traumatic, so it should always start slowly and in controlled circumstances. Positive reinforcement is also used as part of exposure therapy; when a client successfully eats their “fear food,” program rewards like increased free time or excursions might be awarded, or they may move to the next level of the program’s level system.

Group and Family Therapy in ARFID Treatment

Of the various traditional “talk therapy” methods used in mental health settings, group therapy is among the most popular and effective. In group therapy sessions, clients are encouraged to share their personal experiences and emotions with a group of people with the same or similar conditions. It’s a judgment-free zone; clients are encouraged to share but normally not forced to. A feeling of shared experience provides a sense of support for many participants in group therapy; knowing that their problems aren’t unique also helps contextualize them and promotes motivation to continue recovery. Strong bonds between clients can also form, leading to lifelong friendships and providing a support system after treatment ends.

As mentioned, family therapy is also a key part of adolescent ARFID treatment. There are usually sessions that include the client and their immediate family, and sometimes there will be sessions for the family without their loved one present. These sessions can help unpack environmental factors that have contributed to the development of the disorder. They also provide nutritional and meal planning lessons which will help maintain recovery after the client returns home. The parents will also learn about effective ways to provide emotional support in these sessions.

How to Start ARFID Treatment for Your Child

Eating disorder treatment centers offer professional residential or outpatient help for adolescents and adults with ARFID, anorexia nervosa, bulimia nervosa, or other lesser-known eating disorders. Before admitting to one of these facilities, parents should speak gently but frankly with their child about their eating habits and assess the extent of the disorder. It’s worthwhile to set an appointment with a child psychologist or psychiatrist to see if they match the necessary criteria for an ARFID diagnosis. If they do, it’s time to research available ARFID treatment centers that can accommodate adolescents, like the experts here at Monte Nido.

ARFID in teens and children can be treated – and the sooner you start treatment, the better. Don’t wait; if you or a loved one is struggling with ARFID, give us a call and get started on a happier, healthier, recovered life.

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