Every eating disorder is a complex psychiatric disorder, and as such tends to have equally complex causes that vary from individual to individual. ARFID (Avoidant Restrictive Food Intake Disorder) is no different. Like anorexia nervosa, bulimia nervosa, orthorexia nervosa, and others, it’s impossible to point to specific factors that will always cause the disorder. Instead, eating disorders are triggered by a combination of factors, each of which falls into a general category but is specific to the individual. These broad categories include psychological, social, and biological factors.
The biological factors have been the subject of some debate among clinicians specializing in eating disorder research. Almost every expert agrees that some biological factors such as sex influence a person’s risk of developing an eating disorder, but the question remains whether genetics play a major role. In some ways, the “nature vs nurture” debate comes up; a person whose parents have an eating disorder is generally more likely to develop one themselves, but is this because of learned behavior or due to a genetic predisposition? Some recent research into ARFID indicates that genetics may play a larger role than previously thought. Here we’ll take a look at this research and its implications in ARFID diagnosis, ARFID risk factors, and ARFID treatment.
What Is ARFID?
ARFID is a type of eating disorder in which a person compulsively avoids eating a certain food or food group. It can have detrimental effects on a person’s psychosocial and physical health; people with ARFID often experience great distress when their “fear food” is present, and the physical consequences can lead to malnutrition and extreme weight loss. ARFID affects people of all ages, genders, ethnicities, and cultural backgrounds. It most often begins during childhood or adolescence, and parents may have difficulty determining whether their child is just a picky eater or whether they are experiencing ARFID. According to the DSM-V, these are the diagnostic criteria for ARFD:
- 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.
- Marked interference with psychosocial functioning.
- The disturbance is not better explained by a lack of available food or by an associated culturally sanctioned practice.
- The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
- The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another mental disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Unlike many other eating disorders, body dysmorphia (a distorted sense of the body’s size or shape) is not considered to be a causative factor. As a comparison, a person with anorexia nervosa will continue to restrict food intake because they fear gaining weight or perceive themselves as overweight even when they are suffering from malnutrition. With ARFID, the individual doesn’t necessarily fear gaining weight but instead has a phobia about adverse health consequences from eating that food. The health risks they pose are the same, however. ARFID can be a life-threatening disorder that requires specialized, comprehensive treatment.
What Causes ARFID?
There is a difference between being a picky eater and having a psychiatric disorder like ARFID. As a disorder that often begins during childhood, it can be even more difficult to determine the difference, since children tend to be notoriously picky eaters. Who among us hasn’t seen a child steadfastly eat, say broccoli, or only eat chicken nuggets? The difference lies in the compulsive nature of the disorder. Whereas a picky eater may just dislike the flavor or texture of the food, they are not compelled by distress or fear to avoid eating that food.
Many times, the individual has a lack of interest in food in general and simply doesn’t want to eat. In many other cases, researchers have found that the triggering event is a traumatic experience with the avoided food. For example, choking on something as a child may naturally lead that child to avoid eating the same food again. Similar experiences might be food poisoning or gastric reflux caused by the food. Dislike of the food is not usually cause for an ARFID diagnosis unless the avoidance becomes a compulsion. Another important thing to note is that a person who avoids eating a type of food because of cultural or religious restriction (such as a kosher or halal adherent who will not eat pork) is not a candidate for an ARFID diagnosis unless they also display psychiatric compulsion to avoid that food.
Genetic Influence on the Development of ARFID
As mentioned, eating disorders rarely if ever have a single cause. A triggering experience no matter how traumatic is unlikely to spur the development of ARFID on its own. Because of this clinical researchers have delved into other possible contributing factors for ARFID. A study performed in 2021 by physiatrists from the University of Iowa and Penn State University, examined the influence of genetics on ARFID patients and came away with very interesting results. ARFID, the study indicates, shows strong connections to other disorders that indicate a genetic predisposition for developing disordered eating behavior.
The study founds that ARFID is highly comorbid with autism across a diverse spectrum of people with the latter disorders, at a rate 0f 21 percent after adjusting for control groups. In psychiatric terms, this is a staggeringly high rate of comorbidity. Further lining the two is the high prevalence of picky eating in autistic children, which tends to be even more commonplace than in non-autistic children. The study went on to suggest that there may be a link between the genetics that cause autism and the rate of ARFID among those individuals. Although this is a recent study and will be subject to further debate, the implication is that it may be possible to identify at-risk individuals for ARFID earlier than before and help parents discern between picky eating and risk factors for ARFID.
Treatment for ARFID
As with any psychiatric disorder, treatment for ARFID is a complex process consisting of varied therapeutic strategies. Most eating disorders will offer treatment at varying levels of care ranging from residential to intensive outpatient to day treatment. Talk therapy and behavioral therapy are key components of treatment, with CBT and DBT being frequent methodologies to help rehabilitate eating behaviors. Cognitive Processing Therapy (CPT), a form of CBT specifically designed to treat trauma response and PTSD, is also quite useful if a traumatic experience is a triggering cause of the individual’s ARFID symptoms. Exposure therapy is also frequently applied; gradually lessening an individual’s fear of a food by exposing them in controlled circumstances to that food is often the preferred method of counteracting ARFID.
ARFID also frequently requires a full continuum of care; many of the medical concerns brought about by the disorder require focused medical treatment. These might include malnutrition and dehydration, as well as disorders of the heart, bone density, and metabolism. Metabolic syndrome has also been linked to ARFID as a cause of the disorder. The 2021 study also indicated, that given the comorbidity with autism, specialized psychiatric treatment for autism may be required. In combination, any ARFID treatment plan must take the treated person’s unique and specific needs into account.
