When you think about eating disorders, the most common ones that come to mind are anorexia, bulimia and binge eating disorder. However, when the DSM-V was published, ‘ARFID’ was introduced as a new category of eating disorder.

What is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder. ARFID is characterised by the person avoiding certain foods or types of food. This may be due to their colour, texture or appearance. A person with ARFID may also have no or very little appetite, trouble digesting certain foods or may also be afraid to eat certain types of food. This fear may have stemmed from a previous adverse experience with certain foods, such as choking or being sick. The person may also have low interested in eating – it may seem like a chore to them.

ARFID must be distinguished from a medical condition that results in appetite loss or digestive difficulties. Also, ARFID is not the same as having an intolerance. Your GP should have excluded any underlying medical conditions and ARFID should be addressed by a mental health professional.

How is ARFID different from other eating disorders?

Stereotypically, eating disorders are seen as a significant reduction in the amount of food eaten, subsequently leading to significant weight loss and nutritional deficiency. Eating disorders are also commonly associated with being unhappy about your body weight or shape.

It may be difficult to recognise ARFID as it is not primarily about disliking of the body. Due to the person not expressing any distress or disliking around their body image, weight or shape, their eating behaviours may not be recognised as a disorder straight away. Also, those with ARFID may not actually consume any less food than required, again meaning it is difficult to identify this eating disorder straight away.

The signs of ARFID are more focussed around the reduced range of foods eaten. For example, a person may only eat beige foods of a certain texture. This will often lead to deficiencies and can interfere with psychological functioning. Certain deficiencies may mean a child fails to gain weight or grow in height.

It is important to remember:

1. ARFID is not about the person’s belief about their body weight or shape
2. Those with ARFID may even gain weight
3. ARFID is not always about a reduction in food intake, but rather a reduction in the variety of foods.

Possible signs of ARFID

• Feeling full after eating a small amount of food
• Avoiding food of a certain texture, smell or temperature
• Eating foods of one colour, commonly beige
• Difficulty recognising when they’re hungry
• Nutritional deficiencies
• Difficulty digesting certain foods
• Little interest in food or eating
• Avoiding social situations where food is a focus

Subtypes of ARFID

Norris et al. (2018) identified 3 subtypes of ARFID:

1. Limited intake – these people have little interest in eating or have physical difficulties with feeding. This may result in deficiencies or stunted growth.
2. Limited variety – these people have sensory issues around the texture or arrangement of food e.g. different food items cannot touch on a plate.
3. Aversive – these people avoid and fear certain food due to an adverse life event e.g. choking or pain as a result of eating.

The support required may depend on which subtype the person falls into.

How can those with ARFID be supported?

Due to eating difficulties, the person may find eating in social situations very difficult. For example, a child with ARFID may be unable to eat anything from the lunch menu at school.

Children at school who are following a meal plan, set up by a dietician, should have support following this. Time restrictions for eating should be implemented and staff should supervise this. Alternative food should not be offered as their meal plan needs to be followed strictly. It is also important for staff to recognise that children will probably be anxious around trying new foods or eating amongst large crowds of people. If possible, the child should be given the option to eat in less crowded areas, such as in a learning support room.

Those with ARFID should be given the opportunity to access support from professionals such as psychiatrists, dieticians and eating disorder therapists.

What support is available for those with ARFID?

• Beat
• Your GP
• CAMHS
• The Bridge
• MSEDS

ARFID or just picky eating?

Some people would say that ARFID is just extreme picky eating.

Picky eaters are also restrictive in the types of food eaten, however this often doesn't develop until mid-primary school age and often reduces in the teenage years. Those with ARFID may strongly protest certain food groups at very young ages.

In the majority of instances, picky eating does not does interfere with height or weight. Also, although picky eating may make social situations involving food difficult, it would not lead to as much distress and anxiety as ARFID would.

At some point, a lot of children will be a picky eater, however it is important to distinguish picky eating from ARFID. ARFID is a psychological disorder accompanied by high levels of distress and trauma around eating certain foods.