A voidant restrictive food intake disorder (ARFID) is a relatively new diagnosis of disordered eating, says physician Amy Middleman, chief of adolescent medicine at Oklahoma Children’s Hospital OU Health in OKC.
“It was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013,” she says. “While commonly reported among children and adolescents, adults can present with ARFID. ARFID refers to disordered eating, leading to significant weight loss, or failure to gain appropriately for children, significant nutritional deficiencies, reliance on oral or nasogastric tube supplementation, and disruption of psychosocial functioning.”
Middleman adds that those with ARFID do not have body image disturbance, and the disorder cannot be due to cultural food practices or food insecurity.
Valerie E. Grogan, a registered dietitian with the adolescent eating disorders program at Laureate Psychiatric Clinic and Hospital in Tulsa, describes ARFID as “picky eating in its most extreme manifestation.” But this doesn’t mean that every picky eater has ARFID.
“The hallmarks of ARFID include a lack of interest in eating, avoiding foods based on a sensory characteristic of the food, like taste, texture, color or smell, or worries about any perceived negative consequences of eating certain foods,” says Grogan. “This avoidant behavior can lead to an individual being persistently underweight – or if a child, not following appropriate weight or growth markers on growth charts.”
Grogan says that like other eating disorders, there is a biopsychosocial triad for developing ARFID.
“This means there is a range of biological (genetic), psychological (temperament) and social (environmental) factors that play into whether an individual will develop an eating disorder like ARFID,” she says. “Patients can have any combination of these three factors in varying degrees of severity, which means two people with the same diagnosis can have different etiologies in the development of their struggles and very different presentations.”
Grogan says the generally accepted co-occurring morbidities that increase the risk of developing ARFID include Autism spectrum disorders, ADHD, intellectual disabilities and other anxiety disorders, as well as children who do not outgrow developmentally appropriate ‘picky eating.’
According to Middleman, the treatment for ARFID depends on the patient and their concerns, and that management of all disordered eating is most effective with the help of an interdisciplinary team, including an experienced medical provider, mental health provider and registered dietitian.
“Disordered eating is often a response to psychological distress. However, the medical consequences can be quite severe,” she says. “It is critical to recognize and seek care if disordered eating patterns are suspected. Early diagnosis and treatment are associated with improved outcomes and health status.”
Behavioral and physical warning signs of ARFID:
Lack of interest in eating
Avoiding foods based on their sensory characteristics (taste, texture, acolor, smell)
Worries about perceived consequences of eating certain foods (vomiting, choking, etc.)
Sudden refusal to eat certain foods
Very slow eating
Difficulty eating in front of others
Lack of weight gain
Lack of or delayed growth
Grogan adds the reminder that individuals who struggle with eating disorders do not choose to develop eating pathology, just as someone with allergies does not choose to have hay fever.
“It is so important to accept and support those who struggle with these illnesses and recognize that the anxieties and fears they feel are real and significant enough to interfere with their lives,” she says. “It is very possible to have full recovery from eating disorders, including ARFID. Treatment, support from loved ones and hope are key in helping people overcome their struggles and lead the lives they were meant to live, without the burden of fear or worries about eating and food.”