ARFID, which stands for avoidant restrictive food intake disorder, seems to be gaining more and more recognition as the years pass. Us dietitians at Courage to Nourish have been working more regularly with ARFID clients and have been fine tuning our skills to better work with this population. When a clinician is presented with a client who has ARFID, it would be completely understandable if they weren’t sure how to proceed. It’s also very possible that many clinicians out there do not know how to properly screen for or diagnose ARFID. This blog aims to discuss various ARFID signs and symptoms as well as general concepts in order to screen for and treat the disease appropriately. Keep reading to learn how therapists can recognize that a client may have ARFID.
Types of ARFID
First, it’s important to note there are three “types” of ARFID that fall into distinct categories. So, when we are screening for ARFID, it’s important we are aware of the various signs and symptoms. Let’s discuss the “types.”
Avoidant:
In the “avoidant” type, we find that clients may avoid food related to sensory issues. So, avoiding certain textures, tastes or smells. A client might be described – by themselves or by their family – as “picky.” And they also might have a small list of preferred foods or foods that they feel “safe” eating. The number of preferred foods can vary from person to person. Some people with ARFID might have 5 preferred foods, whereas others have 25.
Aversive:
Someone with “aversive” ARFID avoids certain foods based on their reaction to the food, like vomiting, choking or gagging. Some clients with ARFID do have a past history of vomiting, choking, or gagging on certain foods, while for others, the fear of this behavior is enough to avoid eating the food.
Restrictive:
Restrictive ARFID means that a person has no to little interest in food. They might forget to eat, have a low appetite, or become distracted during meals.
I’d also like to mention that even though there are three “types,” I have certainly seen people struggle with various symptoms across the type. For example, someone can have a lack of interest in food and can also have texture preferences. Or someone can have a fear of vomiting and also get distracted easily during meals. What people struggle with in terms of ARFID is certainly nuanced.
Common Things You Might Hear From a Client Suffering From ARFID
So, what are some things you’ll hear in a session with a client who has ARFID from either parents/caregiver or a client:
- “My child has always been picky, I’ve been told this is just a phase but it hasn’t stopped.”
- “My child eats a limited amount of foods, but they don’t make sense. For example, they will eat crabs but won’t eat yogurt with strawberries.”
- “Food just doesn’t taste good to me. Eating just feels like a chore.”
- “I want to eat, but I just can’t.”
- “My child has had trouble eating since infancy.”
- “X food just doesn’t feel right in my mouth.”
- “I just don’t think about food. If I could have a pill to meet all my nutrition needs, I’d rather take that than eat.”
Questions A Therapist Can Ask to Screen For ARFID
So how can you screen for ARFID? Here are a few questions you can ask:
Can you tell me more about what you eat during the day? And your food preferences?
A great basic screening question for ARFID, is to simply ask clients about what they eat throughout the day and their food preferences. You’ll want to look out for a client mentioning if they forget to eat, if they have highly specific preferences or if they describe themselves as picky. If a client mentions any of this you can ask more questions about their relationship with food.
Do you avoid certain foods because of their taste, texture and smell?
If this client answers yes, you may want to consider asking them to tell you more about the foods they avoid and why. Someone without ARFID of course has food preferences as well, we we may want to get more information about how severe these avoidances are and how sensitive they are to tastes, textures and smells.
Do you avoid social situations to avoid food?
We want to get an idea of to what degree a person’s relationship with food impacts their quality of life. Many individuals with ARFID might avoid social situations due to the different smells and the stimulation.
Some other questions to consider:
- Do you feel anxious about trying new foods because you are worried you won’t like them?
- Is mealtime stressful because of the foods presented at the table?
- Would you rather go hungry than eat foods that you don’t like?
What to do If You Suspect a Client Has ARFID?
If you suspect a client has ARFID, consider referring them to an ARFID dietitian. An ARFID dietitian can support clients in assuring they are eating enough throughout the day and can support a client in food exposures. An ARFID dietitian can educate clients and family members about the illness and discuss appropriate treatment options and recommendations. You can read more about Courage to Nourish’s ARFID treatment here!
Alex is the founder and owner of Courage to Nourish. She opened Courage to Nourish to create a practice that aligns with her values in eating disorder recovery. She is a Certified Eating Disorder Dietitian and Approved Supervisor through iaedp.