Struggling with Food: A Serious Matter Far Beyond Picky Eating—Introducing Avoidant-Restrictive Food Intake Disorder
Severe Food Selectivity Disorder, or Arfid, is a significant condition that restricts an individual's food intake, rather than being a casual pickiness about food.
For many individuals, food is a source of pleasure and nourishment. However, for Mara, a woman in her mid-30s, eating has become a burden due to her Avoidant-Restrictive Food Intake Disorder (ARFID). She finds it challenging to consume solid fruits, vegetables, and cold cooked meats. Despite the obstacles, she is gradually expanding her diet and hopes not to pass her struggles onto her daughter.
"No, not even strawberries," Mara often needs to explain the limitations of her diet. Her avoidance encompasses oranges and most other solid fruits and vegetables, along with cold cooked meats. Before attending the company's Christmas dinner, she would already experience sweaty palms. "For about 30 years, I believed I was simply a food fool, behaving like a toddler," she confessed.
However, upon seeing a child with similar eating habits on Instagram, Mara discovered the term "Arfid." Recognizing herself in the behavior, she was relieved to find a name for her condition. Arfid, or avoidant-restrictive eating disorder, is not merely being picky about food. "There's a difference between disliking something and not being able to eat it," Mara elucidated.
This disorder is characterized by the rejection of food based on its smell, taste, consistency, or appearance. Many affected individuals feel no hunger, have eating fears, or have a low appetite. "Eating is a burden, not a delight," notes Ricarda Schmidt, a psychosomatic medicine and psychotherapy expert at Leipzig University. In some cases, the rejection of food is so fierce that children develop malnutrition or weight loss.
First recognized as a separate disorder in a diagnostic manual in the USA in 2013, Arfid was recently included in the International Classification of Diseases (ICD-11) of the World Health Organization. Currently, it is not yet recognized in Germany, where doctors list appointments as "Other Eating Disorders." The exact number of people affected is unknown, but a self-help association based in Münster exists.
In Germany, anorexia is often assumed in sick adolescents. However, people with ARFID do not restrict their food intake to lose weight. They may, however, consume foods like fries, noodles, or chocolate chip cookies. These individuals can be of normal or overweight, but due to their restricted dietary habits, they may suffer from malnutrition.
The causes of ARFID are not well understood, but a genetic predisposition may be a factor for those who are sensitive to smells, textures, or tastes, or have a disgust for many foods. Additionally, fear of food or other symptoms of ARFID can stem from early traumatic experiences, such as severe choking episodes, allergic reactions, or diseases with swallowing difficulties.
An analysis of 77 studies offers initial insights into potential therapeutic approaches. These include family-based therapy, cognitive behavioral therapy, and the use of psychotropic drugs, although further research is required. The therapy should be individually tailored based on the main problem and severity.
"ARFID is incredibly stressful for the entire family," says Schmidt. Early symptoms of abnormal eating patterns, such as those observable during breastfeeding or the introduction of solid foods, should prompt a visit to the pediatrician. The doctor can assess the physical consequences, rule out stomach problems or food allergies, and may identify ARFID if warranted.
A relaxed atmosphere at mealtime, offering refused food on the table, and gradually introducing new foods are some practical approaches. Success is essential, as Mara, who can now eat dried tomatoes and olives, demonstrates. She ensures that her daughter, who currently eats a wide variety of foods, does not inherit her ARFID.
[Enrichment Data: ARFID patients often experience anxiety and fear related to food intake, causing significant nutritional deficiencies and health risks. Traumatic experiences, genetic factors, and psychological issues such as anxiety disorders, depression, OCD, and ADHD may contribute to its development. Treatment typically involves a multidisciplinary approach, including nutritional support, therapy, and addressing the underlying psychological causes. CBT, CBT-AR, family-based treatments, and Feeling and Body Investigators are common therapeutic approaches.]
Source: ntv.de, Simone Humml, dpa
"Mara, in her research to understand and manage her ARFID, mightbenefit from exploring vocational training programs in health-and-wellness or mental-health sectors, as her experience could contribute to the development of community policies addressing food-related anxiety and eating disorders."
"Given the relationship between ARFID and mental health conditions such as anxiety disorders, depression, OCD, and ADHD, it's important for Mara to consider enrolling in a vocational training program in psychology or counseling, where she could gain the knowledge and skills to help others struggling with ARFID and related issues."
