Avoidant Restrictive Food Intake Disorders - An Overview

What Are Avoidant Restrictive Food Intake Disorders?

Avoidant restrictive food intake disorder (ARFID), which was previously known as "selective eating disorder," is an eating disorder where people are extremely choosy about their food, due to which they end up having less amount of proteins and calories required for normal functioning of their bodies. In children, ARFID can cause problems and affect the normal growth of a child, like delayed increase in height, weight gain, etc. Children with avoidant restrictive food intake disorders are extremely picky eaters and consume a very narrow variety of foods. ARFID is a rare disorder, and it is very similar to a selective eating disorder and thus is not very frequently diagnosed. Children with avoidant restrictive food intake disorder face difficulties in school as well due to delayed/ extended time to eat.

What Causes Avoidant Restrictive Food Intake Disorder?

When understanding avoidant restrictive food intake disorder in-depth, it is reflected that Avoidant restrictive food intake disorder is not caused by any specific or a single factor. It is an eating disorder caused due to genetic, sociocultural, and psychological factors, as food disorders are familial in many cases.

• Sociocultural plays an important role as children develop food habits right from childhood; during the same phase, they are exposed to the behavior of neat, clean, healthy eating there is a possibility a child becomes choosy about the food.

• The environment in which a child is brought up also is very important as a method of food preparation, observing the behavior of family members with the food.

• Most people with the disorder have a history where they had a bad experience with the food that causes choking and vomiting, which makes them taste sensitive, and due to the fear of incidence, they narrow the range of food they consume.

• Most children with avoidant restrictive food intake disorder are found to have a history of gastroesophageal reflux disorder (GERD).

• Healthy appearance pressure is another cause as people have a fantasy to be slim, maintain weight and avoid food, this is due to the misconception that being healthy means being slim.

What Are the Symptoms of Avoidant Restrictive Food Intake Disorder?

Symptoms of Avoidant restrictive food intake disorder can be divided into physical and mental.

Mental/Psychological Symptoms:

• Weight loss.

• Wearing multiple clothes one over another to hide weight loss.

• Complaints of frequent abdominal pain and stomach upset.

• Very picky about the type and amount of food consumed.

• Have only a certain texture of food.

• Fear of choking or vomiting.

• Picky eating progressively worsens.

• Fear of weight gain.

Physical Symptoms:

Physical symptoms of avoidant restrictive food intake disorder are similar to anorexia as both eating disorders have a similar presentation, which is as follows:

• Menstrual irregularities- These irregularities include missed periods or menses that occur only when a female is on oral contraceptives.

• Lack of concentration.

• Anemia, low thyroid and hormone levels, low potassium, low blood cell counts, and bradycardia are some of the common lab findings.

• Postpubertal menopause.

• Dizziness.

• Fainting or syncope.

• Cold intolerance.

• Sleep disturbances.

• Dry scaly skin.

• Dry and brittle nails.

• Fine hair on the body.

• Hair loss.

• Muscle weakness.

• Edema.

• Poor wound healing.

• Compromised immunity.

What Are Avoidant Restrictive Food Intake Disorder Health Risks?

As Avoidant restrictive food intake disorder is commonly seen in children, the health risks are most commonly associated with the growth of a child as the children with Avoidant restrictive food intake disorder are malnourished, present developmental delays, and have difficulty in gaining weight but above all this disorder can cause life-threatening medical emergencies due to electrolyte imbalance or sudden collapse due to dizziness, even when all the reports or laboratory findings are normal.

How Is Avoidant Restrictive Food Intake Disorder Diagnosed?

Avoidant restrictive food intake disorder is diagnosed based on DSM-5 criteria, which are as follows:

Disturbed eating must be associated with one or more of the following conditions.

• Nutritional deficiency as a result of loss of appetite and inadequate intake of food

• Weight loss

• Dependence on supplements to maintain nutritional health.

Restrictive is not because of external factors like food being unavailable.

The person has a normal physical appearance and is not overweight.

The disorder is not associated with other medical illnesses like flu or food poisoning.

What Are the Treatments Available?

Treatment modalities include medical surveillance followed by various therapies that include:

• Cognitive behavioral therapy (CBT).

• Family-based therapy (FBT)

• Occupational therapy

• Speech therapy.

All these therapies aim at improving food habits and increasing the food intake of children.

The main goal of the treatment is to

• Achieve healthy eating patterns and maintain a healthy weight.

• Add various varieties of food to the diet.

• Learn ways to eat without reluctance or with thoughts of choking.

Conclusion:

Avoidant restrictive food intake disorder is a selective food intake disorder that mainly is observed amongst children due to a bad experience, or exposure to the food. These children usually are very picky about the food and their food choices narrow over some time. These children with eating disorders are generally malnourished and present with delayed growth and development. Children with Avoidant restrictive food intake disorder also have reported a history of GERD. The treatment includes therapies like CBT, and FBT along with medicinal treatments. Some incidences of patients with Avoidant restrictive food intake disorder can be life-threatening due to electrolyte imbalance and cause sudden death. Thus medical help at the right moment is very necessary for such instances.