ARFID

What is ARFID?

Avoidant/restrictive food intake disorder (ARFID) as it is known is actually a fairly recent term that was introduced in 2013. Before this date, it was simply known as feeding disorder, selective eating disorder or 'picky eater'.

ARFID is when a person will avoid certain foods and limit how much they eat. ARFID is not seen as a body image disorder, unlike anorexia nervosa, indeed, those presenting with signs of ARFID are less likely to be worried about their body shape, image or weight. There are three main subtypes of ARFID - sensory, lack of interest and the fear of consequences.

In this video, counsellor Maggie Learoyd explains what ARFID (avoidant restrictive food intake disorder) is and how counselling can help.

Below are some of the reasons a person may be diagnosed with ARFID:

• avoids smells, textures and tastes
• going from previously 'a little fussy' to developing a more severe avoidance of a wide variety of foods
• no interest or low interest in trying new foods
• presenting with anxiety around eating or the fear of eating after having had a negative experience; this can be from a one-off event such as choking or sickness

Why would someone avoid and/or restrict their food intake?

There are several different reasons why a person would avoid or restrict food intake. Some of the most common signs or reasons are:

• sensitivity regarding the taste, smell, texture or appearance of certain foods
  only being able to eat foods at a determined temperature
• previous negative experiences with food, such as choking, food poisoning, etc. leading to increased phobias
• fear or anxiety around food or general eating, resulting in the avoidance of trigger foods
• worries about the consequences of eating, such as putting on weight leading to body-focused food restrictions 

These reasons above can start as relatively insignificant issues, but if they carry on over a long period, they can manifest into more serious issues, leading to sensory-based avoidance or restriction, or avoidance based on a more heightened concern about the consequences of eating.

Not all those who experience ARFID know they are avoiding or restricting their food. It may be someone close to them, such as a friend or family member who notices a change in their behaviour or eating habits. Equally, the person experiencing issues may not even notice that they are hungry in the way others would. For many ARFID sufferers, eating is a chore and is feared, not the enjoyable act that many of us feel. This can lead to avoidance or restriction due to a lack of interest in eating.

It goes without saying that we are all individuals and ARFID is no different. No two people will present the same and as such, a person could have one or many of the above-mentioned reasons. ARFID is often referred to as an umbrella term, as it includes a whole range of issues that a person may be experiencing. However, the one thing that links all ARFID sufferers is the avoidance or restriction of their food intake, whether this is the quantity consumed, range of food eaten, or both.

When does ARFID first start to present?

Although ARFID can appear at any point in a person's life, the early signs often present as a young child. It can often be classed as picky eating in the beginning and it may even be seen as normal when it presents at an early age, as this is when many children start to refuse greens, new tastes and smells, etc. 

It can be difficult to diagnose at this young age and the issue then evolves into a more serious case of ARFID. It also appears to present itself, quite often, along with sensory-based disorders, such as ADHD, autism and SPD (sensory processing disorder). I must add that the two are not mutual, but in my experience are often seen together. 

When do I know I need help?

Simply put, when ARFID has a negative impact on your physical health and your psychological well-being, it is recommended that you seek help.

Our bodies need a certain number of calories to maintain weight. A restrictive diet or general avoidance of food could lead to a loss of weight, or in a child, stunted growth and/or development. An inadequate diet due to eating a narrow range of foods may also lead to a lack of essential nutrients needed for your health. In turn, your body's development and ability to function on a day-to-day basis can become severely affected, perhaps leading to serious weight loss or nutritional deficiencies. 

Being limited in terms of what you can eat can also present significant difficulties at home, at school or college, at work and when with friends. Your mood and day-to-day functioning can equally be negatively affected. You may find it difficult to go out or to go on holiday and your eating difficulties may make social occasions difficult to manage. You might also find it difficult to make new friends or establish close relationships as social eating occasions are often part of this process. If any of this sounds familiar, then please do think about talking to someone.

How can counselling help with ARFID?

From personal experience, I would say counselling can bring about a wide range of positive benefits. When we look at ARFID, the ability to understand where the issues first arose can lead to the person understanding and ultimately managing their disorder. It can be used to bring to the surface the fear and anxiety attached to certain foods.

For some people, it's hard to begin unpicking unhealthy thoughts and behaviour patterns, but through counselling with an ARFID-trained specialist, this becomes a safe place to explore these feelings, enabling them to find the root cause of their eating disorder. ARFID treatment may include cognitive-behavioural therapy as well as talking therapy that helps individuals identify self-destructive patterns of thoughts and behaviours.

Counselling isn't just for the person presenting with ARFID, it is also a great way for parents, guardians or carers to understand more about ARFID, whilst equipping them with tools and strategies to be able to help support the person with ARFID. It can help to empower parents, guardians or carers with a level of support and freedom, where they may have felt powerless before.

What can you expect from a therapist?

It can be very daunting for many people to take that first step, to choose a therapist and book that first session. It can highlight the issue as it's an admission in a way, to yourself, that you need help. But help is good! So many people don't seek help and so nothing changes for them, their lives continue down the same path. Others do seek help and give themselves the opportunity to change their lives for the better.

With the right therapist, there will be a sense of relief, being able to share things in a safe, non-judgmental environment where you will receive empathy and understanding. There should be absolutely no pressure on you to change. When the time is right and with the correct support and encouragement from your therapist, any change will occur naturally. Ultimately, it's the client that is in charge and if you feel things aren't working, please don't give up.

The most important ingredient in your counselling journey will be the therapeutic relationship with your therapist, so if this isn't working, try a different therapist! In our everyday lives, we all connect with each other in different ways and therapy is the same, so don't be afraid to make a change. 

If you feel after reading this article that anything has resonated with you and that you would like to explore this further, you can find me and other specialist ARFID counsellors on the Counselling Directory website.

Further help

• Beat Eating Disorder charity

This page was written by Counsellor Maggie Learoyd MNCS Accredited & Dip. Counselling Practice (March 2023).

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