When Hannah was seven years old, she confided in her parents about her intense fear of food. This fear kept her from attending Girl Scouts, birthday parties, restaurants, family gatherings, and even the dinner table. Her anxiety around food was overwhelming, said her mother, Michelle, who chose not to disclose their last name for privacy reasons.
Michelle first noticed the issue when Hannah was transitioning from formula to milk and solid foods. Baby Hannah would often pucker her lips shut or spit out any food given to her. As she grew older, her diet narrowed to about five specific foods, including green sour cream and onion Pringles, but only from the small packs, not the larger containers.
Now eight years old, Hannah is undergoing treatment for Avoidant/Restrictive Food Intake Disorder (ARFID). Unlike anorexia or bulimia nervosa, ARFID is not concerned with body image. Instead, individuals with ARFID have a very limited range of foods they feel safe eating, explained Kate Dansie, clinical director of the Eating Disorder Center in Rockville, Maryland. This disorder is more than just being “picky”; it can be debilitating and lead to long-term health issues.
ARFID was officially recognized in 2013 with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although an estimated 9% of the US population will experience an eating disorder, studies suggest that between 0.5% and 5% of people have ARFID, according to the National Eating Disorders Association.
Dr. Stuart Murray, associate professor of psychiatry and behavioral sciences at the University of Southern California, refers to ARFID as “the silent eating disorder” due to its prevalence, lack of study, and minimal funding at the federal research level.
What is ARFID?
People with ARFID often limit their food intake based on sensory or textural preferences rather than calories or nutritional content, explained Murray. “They restrict the variety and volume of food due to debilitating beliefs about the food’s composition,” he said. This could mean avoiding foods of a certain texture, smell, flavor, or even brand.
Traumatic experiences with food, such as choking, can also trigger ARFID, leading to heightened vigilance around eating. Additionally, individuals with low appetite and high anxiety about food, as well as those with rigid or change-averse personality types, may be more susceptible to ARFID.
Is It Like Picky Eating?
While many children are picky eaters, ARFID is much more severe. A key difference is the level of impairment and anxiety when faced with new foods. Picky eaters might manage to eat around disliked foods, but those with ARFID might refuse to eat anything if an unacceptable food is present. Furthermore, people with ARFID often have a very limited list of acceptable foods and can detect small differences, such as changes in the brand of pasta sauce, which can be very challenging for parents.
The Importance of a Good Relationship with Food
ARFID often begins in childhood but can affect people of all ages. Without treatment, children can quickly fall behind on growth and become nutritionally imbalanced, as Hannah did before receiving specialist help. Severe cases can lead to weight loss or hospitalization.
The social impact of ARFID is significant, often causing anxiety around social events involving food, further isolating affected individuals. “A good relationship with food is fundamental to well-being,” said Dansie. ARFID is not something children outgrow, and it requires a compassionate approach.
What You Can Do
Early intervention is crucial, as the list of avoided foods can grow exponentially. While medication data is limited, cognitive behavioral therapy (CBT) has shown promise. Therapy often involves guided exposure to feared foods to help individuals reframe their associations.
At home, families can support a child with ARFID by ensuring they receive enough calories before expanding their food variety. Tools like timers, visual reminders, and food chaining (combining new foods with familiar ones) can be helpful.
It is vital for families to remember that children with ARFID are not being difficult on purpose. Punishing them can be damaging; instead, a supportive stance is essential.
Five months into treatment, Hannah is making progress. She is trying new foods, increasing her confidence, and expanding her list of “safe foods” by 11 items. “Our goal is to equip her with the tools she needs as she grows older,” said Michelle.
Understanding and addressing ARFID with empathy and early intervention can help those affected build a healthier relationship with food and improve their overall well-being.
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