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Avoidant Restrictive Food Intake Disorder (ARFID) Treatment

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Man working on reducing his ARFID symptoms through ARFID treatment by pouring himself a cup of coffee and eating a meal in Burlington, Vermont
Avoidant Restrictive Food Intake Disorder (ARFID) is a type of eating disorder in which a person doesn't feel hungry or is repulsed by the taste, texture, smell, or color of food. Some people with ARFID feel afraid of choking or vomiting when they eat. Individuals suffering from ARFID don't consume enough calories to grow and develop properly, or to maintain basic bodily functions, making this disorder so dangerous.
The Kahm Center for Eating Disorders in Burlington, Vermont, offers ARFID outpatient treatment. Outpatient treatment can help individuals struggling with ARFID find coping mechanisms to reduce ARFID behaviors and develop a new relationship with food.

What is ARFID?

Avoidant Restrictive Food Intake Disorder—ARFID, for short—is an eating disorder characterized by a limited quantity and variety of food intake. A person suffering from ARFID may have an extreme lack of interest in eating, or they may feel a heightened sensitivity and aversion to the taste, smell, texture, or color of food. They may also fear becoming sick, choking, or vomiting if they eat.
Many children and some adults go through phases of being picky eaters. However, people with ARFID do not consume enough calories to meet the basic nutritional needs of their bodies. For kids, this can result in delayed or stunted growth. Adults with ARFID may experience dramatic weight loss.
Similar to anorexia nervosa, ARFID involves limitations in the quantity or types of food consumed. Where it differs from anorexia is in the absence of any emotional distress or obsession with body size, shape, or weight.

Risk Factors of ARFID

Experts are still exploring what puts people at risk of developing ARFID, and the causes and conditions can vary widely from one person to the next.
Risk factors for ARFID that have been observed include:
  • Children who don't outgrow normal picky eating, or whose picky eating is particularly severe, are more likely to develop ARFID.
  • Unlike anorexia and bulimia, which are more common in girls, boys are more likely to have ARFID.
  • Having autism spectrum disorders
  • Having ADHD or intellectual disabilities
  • Having an anxiety disorder
  • Having obsessive-compulsive disorder (OCD)

Warning Signs & Symptoms of ARFID

Some of the physical, psychological, and behavioral signs and symptoms of ARFID to be on the lookout for include the following.

Behavioral and Psychological Signs of ARFID

  • Consistent lack of appetite or interest in food
  • Dramatic restriction in the amount or kinds of food eaten
  • Will only eat food with certain colors or textures
  • Fears of choking or vomiting
  • Dressing in layers to hide weight loss or stay warm
  • Reports of vague gastrointestinal problems around mealtimes
  • A range of preferred foods that becomes more and more limited over time

Physical Symptoms of ARFID

  • Dramatic weight loss
  • Stomach cramps, constipation, acid reflux, and other gastrointestinal issues
  • Cold intolerance or feeling cold all the time
  • Lethargy and/or excess energy
  • Menstrual irregularities, for instance, a post-puberty female losing her menstrual period
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
  • Difficulty concentrating
  • Dizziness or fainting
  • Sleep problems
  • Dry skin
  • Fine hair on the body
  • Thinning of hair on the head, or dry and brittle hair
  • Muscle weakness
  • Cold, mottled hands and feet or swelling of feet
  • Poor wound healing
  • Impaired immune functioning

Diagnostic Criteria for ARFID

Psychiatrists and other mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose ARFID. The ARFID diagnosis is a relatively new one, and was previously referred to as a "Selective Eating Disorder."
According to the DSM-5, ARFID is an eating or feeding disturbance defined primarily by (1) an apparent lack of interest in eating or food; (2) avoidance based on the sensory characteristics of food; and (3) concern about aversive consequences of eating.
ARFID comes with a persistent failure to meet appropriate nutritional and/or energy needs, and is 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
In addition, to be diagnosed as ARFID, the disturbance must not be better explained by a lack of available food or by an associated culturally sanctioned practice. There must not be a disturbance in the way in which the person's body weight or shape is experienced. The eating disturbance must not be attributable to a concurrent medical condition and not be better explained by another mental disorder.

Health Risks Commonly Seen with ARFID

When a person suffers from ARFID, their body is denied the essential nutrients that it needs to function normally. As a result, their body's metabolism slows down to conserve energy, which can lead to serious medical consequences.
  • Stunted growth and/or delayed puberty
  • Excessive and unhealthy weight loss
  • Malnutrition: not getting enough vitamins, minerals, healthy fats, and protein to sustain the body
  • Not getting enough electrolytes to support the heart's conduction system
  • The need for tube feeding and nutritional supplements
  • Dizziness and fainting due to low blood pressure
  • A slow pulse
  • Dehydration
  • Weakened bones (osteoporosis) and muscles
  • Delayed or halted menstrual periods (amenorrhea)

Treatment for ARFID

At the Kahm Center, ARFID is treated by a team that includes a medical doctor, a dietitian, and a therapist who specializes in eating disorders. Metabolic Testing and Body Composition Analysis are also utilized to help aid in the treatment of ARFID.
Metabolic Testing at the Kahm Center for Eating Disorders is used to provide an accurate depiction of what the caloric needs are of each individual patient. Body Composition Analyisis can show how well the client is adhering to the meal plan and where they are at in the recovery process. Utilizing both of these tools helps us have meal oversight like an inpatient facility. When the brain is better nourished, treatment methods work better which improves the recovery process.

PHP (Partial Hospitalization Program) Treatment for ARFID

The Kahm Center for Eating Disorder’s partial hospitalization program (PHP)—aka "day treatment"—is a level of treatment that allows patients to recover from ARFID under close medical supervision but without completely disrupting their everyday life. It combines the best of inpatient and outpatient recovery programs.

Patients who participate in a day treatment program spends five hours five days per week undergoing treatment. The rest of their week is spent at home or work. PHP patients also have access to continuous support and weekly check-ins with specialized professionals such as dietitians.

IOP (Intensive Outpatient Program) Treatment for ARFID

The Kahm Center for Eating Disorder’s intensive outpatient program (IOP) is a good option for ARFID patients who don't require the kind of 24-hour monitoring that comes with an inpatient program but need more than a single weekly session with a therapist. IOP involves the patient visting the Kahm Center for three hours, five days per week to work with a therapist or dietitian.

For someone recovering from ARFID, the main goals of treatment are to:
  • Increase the variety of foods eaten.
  • Achieve and maintain a healthy weight along with healthy eating patterns.
  • Learn ways of eating without any fear of pain, choking, or vomiting.
  • Learn healthy ways to relate to anxiety or worries about food.

Outpatient Treatment for ARFID in Burlington, Vermont

Avoidant restrictive food intake disorder, ARFID, is a type of eating disorder that is characterized by an individual limiting the quantity and variety of food due to aversion with texture, taste, smell, or color. ARFID is associated with many physical and mental health risks. Treatment for ARFID can help reduce risk factors, reduce symptoms, and provide a better relationship with food.
The Kahm Center for Eating Disorders is an outpatient treatment center for eating disorders located in Burlington, Vermont, that provides treatment for ARFID. The Kahm Center offers metabolic testing and body composition analysis as part of its ARFID treatment—in addition to traditional methods such as therapy, meal plans, and meetings with a dietitian. The client group sizes at the Kahm Center are kept small so that treatments can be tailored to each person's unique needs, and real community is nurtured and enjoyed.

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