Most parents have dealt with their children being picky eaters at some time or another. With so much to think about when it comes to children’s diets, from allergies and food sensitivities to maturing taste buds, how do you know if a “picky eater” is struggling with an eating disorder – and which one? When should you get concerned and seek help? Knowing more could be the key to whether, when and how to offer support.
With that in mind, it’s worth exploring a commonly overlooked eating disorder called Avoidant Restrictive Food Intake Disorder (ARFID) and why it is sometimes confused with anorexia nervosa.
Since it was added to the American Psychiatric Association’s latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as an official diagnosis in 2015, it has been increasingly examined and discussed within the professional eating disorder community. Outside of that, many remain unaware about this illness.
ARFID is formally described as a feeding or eating disturbance that involves an inability to meet appropriate nutritional and/or energy needs (1,2). This can be due to a lack of interest in eating or food, avoidance of certain foods due to taste/texture or anxiety about health consequences or choking. ARFID typically presents in one of the following ways:
- Considerable weight loss
- Compromise in growth
- Dependence on nutritional supplements (like Ensure, Boost or similar products)
Kids and adults with ARFID also experience a noticeable “interference in psychosocial functioning” (1). Put plainly, this is when an individual’s thoughts influence their social behavior. For example, someone experiencing ARFID would struggle with eating the typical food served at restaurants, parties or even in the school cafeteria. Consequently, they may avoid social gatherings. Over time, this isolation and avoidance may naturally have a negative impact on mood, social relationships and daily functioning.
In a diagnosis of ARFID, it’s important to rule out that any of the behaviors or symptoms you’re noticing are driven by concern about body shape or weight as this may indicate a distinctly different diagnosis. Let’s take a closer look at anorexia nervosa to further distinguish the two.
Anorexia was included in the first edition of the DSM published in 1952. Awareness of the condition in the medical community dates back even further to 1873, when a British doctor presented a paper on it to the Royal College of Physicians (4).
Anorexia is characterized by the following:
- Strong fear of gaining weight or becoming fat, or a continuing behavior that interferes with weight gain, despite being at a noticeably lower weight (3)
- Body image or shape is not experienced in a normal manner, i.e. too much influence of body weight in how a person evaluates him or herself. There is also a persistent inability to recognize or address the seriousness of the low body weight (3).
These thought patterns lead the person to:
- Restrict the amount of food eaten, to the point where it becomes less than the amount of energy exerted (3).
Which can result in:
- Low body weight*, specifically when looked at regarding age, gender, the path of development, and overall physical health of the individual (3).
*It’s important to note that Atypical Anorexia can also develop in people are of normal or above average body weight and they are just as likely to suffer from the debilitating consequences, even more so in some cases because early identification is less likely when the physical signs of malnourishment are not visibly obvious to loved ones or medical professionals.
Similar but different…
Clearly, both anorexia and ARFID have some similarities in that they include food restriction and inability to eat enough food. Both conditions typically result in considerable weight loss, low body weight, malnutrition, and/or interference with normal growth and development. ARFID, however, is not associated with the negative or distorted body image thoughts. People who have ARFID do not fear weight gain and they do not have the “drive for thinness” that we see in anorexia nervosa (1). This is the key distinguishing factor between the two diagnoses.
It is important to be aware of and recognize the differences between ARFID and anorexia because they are two very different disorders that require different treatment protocols. If you recognize the signs and symptoms of ARFID or AN in your child – or yourself – plan a time to check in with a health provider who has expertise in treating these eating disorders. Additional descriptions of both eating disorders are available here.
If you’re not sure whether the behaviors you’re seeing are related to an eating disorder, our online self-assessment can help you evaluate specific risk factors and identify recommended next steps. Visit www.eatingdisorder.org/letscheckin to learn more.
Alexandra Hayden, Research Assistant
Alexandra just graduated from Loyola University Maryland, with honors, obtaining her Bachelors of Arts in psychology. In the fall she will be attending Johns Hopkins University to begin the Masters of Clinical Counseling program. She was an intern on The Center for Eating Disorders at Sheppard Pratt’s inpatient unit in the fall of 2016 and previously interned on the co-occurring disorders unit also at Sheppard Pratt. Past research projects include racial bias in the workplace, the effect of information source on leadership perceptions, and effects of mood and task difficulty on time perception.
Norris, M., Spettigue, W., & Katzman, D. (2016). Update on Eating Disorders: Current Perspectives on Avoidant/Restrictive Food Intake Disorder in Children and Youth. Neuropsychiatric Disease And Treatment. Vol 12, 213-218. Accessed 2/27/2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687
American Psychiatric Association. (2013). Feeding and Eating Disorders: Avoidant/Restrictive Food Intake Disorder. Diagnostic and Statistical Manual of Mental Disorders (5th) Accessed 2/27/2018. Available at: https://doi-org.proxyln.researchport.umd.edu/10.1176/appi.books.9780890425596.dsm10
American Psychiatric Association. (2013). Feeding and Eating Disorders: Anorexia Nervosa. Diagnostic and Statistical Manual of Mental Disorders (5th). Accessed 2/27/2018. Available at: https://doi-org.proxyln.researchport.umd.edu/10.1176/appi.books.9780890425596.dsm10
Plotkin, M. (2016). A Brief History of Eating Disorders & Binge Eating Disorder. Binge Eating Disorder Association. Accessed 2/27/2018. Available at: https://bedaonline.com/a-brief-history-of-eating-disorders-binge-eating-disorder/