What is ARFID and why is it so hard to get treatment for it that works?
Does your child or teen eat only a small selection of foods, and the list has been getting smaller and smaller over time?
Are you an adult who is so bothered by the smells, textures and tastes of certain foods, or the fear they will make you sick, you have limited your food choices so much you have trouble staying at a healthy weight?
Have you tried to get your child or teen to eat a wider variety of foods without success, resulting in constant stress and fighting that effects the entire family?
Frowning when presented with a plate of broccoli is a widespread experience among children. Being selective about your meals is normal to some degree.
But what if you or someone you know is exceptionally picky about the foods they eat to the extent that they avoid certain food groups entirely, even if it leads to nutrition deficiencies?
Avoidant/restrictive food intake disorder (ARFID) is a relatively new term that was introduced in 2013. Previously, it was more commonly known as selective eating disorder. Avoidant/restrictive food intake disorder effects hundreds of thousands of people worldwide, especially children, but it may appear in adults as well.
In ARFID, one displays highly selective eating habits or “extremely picky eating” where they only rely on certain foods for dietary needs and completely ignore other important food groups, which can cause nutrition complications and may even require medical attention.
Picky eaters may avoid eating certain foods due to different factors such as being sensitive to their taste, smell, texture, appearance, or even temperature.
Picky eating is somewhat expected in the early years, but as children grow, most develop more flexibility about their food choices and naturally develop a broader intake range. But, in some cases, this pickiness does not go away and can become a severe problem taking the form of an eating disorder.
For some people, this extreme selectiveness and avoidance of certain food groups altogether may continue into adulthood, causing physical and even social problems. For example, if a person with ARFID does not believe they will be able to order their limited food selection from a restaurant menu, they can avoid going entirely and losing their social network over time.
ARFID can cause isolation, loneliness and stress in both adults and children, and their loved ones.
Resorting to only a selected group of foods for your diet needs may cause nutrition or energy deficiencies and may turn into a disorder and require treatment.
What are the symptoms of Avoidant/restrictive food intake disorder?
Common symptoms include:
⦁Dramatic weight loss due to malnutrition
⦁Digestive issues such as constipation
⦁Only eating foods with certain textures
⦁No appetite for no known reason
⦁Fear of choking or vomiting when eating certain foods
⦁Feeling full or sick around mealtimes
⦁Difficulty eating food with friends or family
⦁Restricting or refusing to eat certain types of foods
⦁Weakness or excessive energy
⦁Always feeling cold, faint, or dizzy
⦁Having dry skin or brittle nails.
⦁Difficulty chewing or swallowing certain foods
⦁Prolonged chewing of foods
⦁For children, delayed growth or no longer gaining weight
⦁In extreme cases, dependence on external feeding tubes or nutritional supplements
How is ARFID different from other eating disorders such as Anorexia or Bulimia?
ARFID is vastly different from bulimia and anorexia. A person avoids eating with these other disorders because they have concerns about their body’s weight or shape. However, in ARFID, the problem lies primarily with the food itself.
A person undergoing ARFID usually does not have such self-image concerns that lead them to avoid certain foods. Someone with ARFID usually does not skip food for specific purposes of losing weight or maintaining body image.
In bulimia, anorexia, or any other specified feeding or eating disorder, a person may display symptoms such as excessive exercising or go without food for long periods. In ARFID, people typically do not show such signs.
ARFID may seem like anorexia nervosa because both disorders involve limitations in the amount of intake of food. But unlike anorexia, ARFID does not primarily involve any distress about your body shape, size, or fear of fatness.
Since it is a different kind of eating disorder, ARFID treatments also differ significantly from the treatments used for usual eating disorders such as bulimia, anorexia, or binge eating disorder, because with these disorders, the person is mainly concerned about the impact food has on their body and how they look. They also may have underlying issues of trauma which need to be addressed. But in the case of ARFID, the problem is almost totally centered around discomfort with certain foods and not taking in adequate nutrients that are essential for physical wellbeing.
ARFID is often misunderstood, even by counselors and medical professionals. For this reason, families can become extremely disillusioned and frustrated, referred to provider after provider, none of whom can effectively solve the problem. Luckily, there IS a highly effective treatment for ARFID, and it can cause a healthy turnaround in behaviors, often in a matter of months rather than years.
How can applied behavioral analysis help treat avoidant/restrictive food intake disorder?
Eating disorders should never be taken lightly, as they are severe conditions that can affect both the physical and emotional wellbeing of a person. If left untreated, ARFID is rare to resolve on its own. If you or someone you know suffers
from AFRID, it is never too late to seek treatment.
The earlier you decide to get proper treatment, the sooner you will recover.
One of the best ways to overcome Avoidant/restrictive
food intake disorder is by using Applied Behavioral Analysis (ABA).
ABA clinicians are well trained to understand and effectively treat ARFID. They can quickly formulate a recovery
plan that aids the clients in the best possible way.
It focuses on understanding the chain of behaviors shown by respondents associated with ARFID and then troubleshooting them.
The behavioral analyst assesses the client’s behavior and the emotional responses towards food and how they react towards a specific food group.
For example, when food is at the table, the person experiences unpleasant thoughts associated with the texture, smell, appearance, or food temperature.
These thoughts relate to feelings of anxiety and discomfort, such as fear of vomiting or getting sick. This helps to identify the primary source of psychological distress.
Then the focus then shifts to the client’s actual eating behaviors and the different ways they act while eating. It is very logical that by not eating the foods that cause distress, unpleasant thoughts will decrease.
After that, ABA seeks to find derived relational behaviors. These are the clients’ behaviors associated with their food, such as disgust, fear, or any other stimuli responsible for their food avoidance.
Once a proper analysis has been made, the applied behavior analyst will better understand how environmental factors affect the client’s behavior.
Focus then shifts to creating specific treatment goals, repeated engagement activities, and strategies that work to remove these reinforcements.
These strategies can include attention from the family when the person talks about skipping or not eating. Such reinforcers will discourage troublesome eating behaviors. This also helps with increasing the frequency of desired behavior that is the target of eating more.
Positive reinforcements may also include providing clients with privileges or even praising them. Applied behavior analysts may also motivate their patients by making them realize how good they feel after eating.
Such consistent and immediate positive reinforcement can help people rapidly get on track towards healthier eating.
It is also important to note that, unlike conventional talk therapies, ABA does not require a detailed history of the past to help you overcome your disorder.
In talk therapy, you focus on the events that led you to your current position and unfold your past experiences to make sense of those behaviors, which can be very time-consuming.
In ABA, you focus directly on the current issues associated with your dysfunctional eating patterns.
This means you do not spend extensive hours talking about your past or what could have led you to this point. You primarily focus on the current issue, making it a very straightforward and robust approach for treating eating disorders. It works great for both adults, and especially children, who tend to respond well to rewards and praise.
A bonus is that ABA often stops stress and fighting in the family over food that may have been going on for months or years. Parents are no longer worried sick and engaging in useless power struggles with their children. They know there is a solid plan that works, and with the guidance of the therapist, they can successfully implement it and get lasting results.
For both adults and children, ABA therapy increases flexibility when presented with unlikable foods. This helps increase the variety of foods they eat and fulfills the nutritional needs to maintain a healthy lifestyle. Clients become less fearful and more social, so overall quality of life is improved.
Applied behavioral analysis is an ideal approach for overcoming AFRID. Working with qualified professionals can help you get proper therapy. At The Body Image Counseling Center, we have licensed, experienced and caring behavioral analysts on staff that can help you or your child quickly and effectively recover from Avoidant/Restrictive Food Intake Disorder and lead a healthier and more balanced life.