How to Diagnose Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder (ARFID)—sometimes called Food Neophobia or Selective Eating Disorder (SED)—is an eating disorder where the consumption of food is severely limited. With children, this can be a problem for feeding that begins in early childhood or even in infancy.[1] Limitations are based on a food’s smell, texture, appearance, taste, or on a past experience with the food. If you suspect ARFID in yourself or a loved one, begin by noticing primary symptoms, work to understand the motivations behind the behavior, and rule out a normal phase of “picky eating." Of course, any disorder is best diagnosed by a medical professional. Seek professional guidance if you or someone you love is suffering from ARFID.

Method 1 - Noticing Primary Symptoms

1

→ Look for prolonged expressions of “picky eating.” On the surface, ARFID will look like regular “picky eating,” meaning that the individual will only eat select foods and refuse all others. If this behavior persists for more than four months, or appears to get worse, you may be dealing with more than just pickiness.

2

→ Notice if certain food groups are restricted altogether. Individuals with ARFID will often refuse entire food groups, such as vegetables, meat, or dairy. Notice if the individual has completely removed entire food groups from their diet.

3

→ Count the number of foods. An individual with ARFID usually accepts less than 20 foods. Begin keeping track of the number of different foods the individual will accept, and if that number comes to 20 or less, you may be dealing with ARFID.

Method 2 - Understanding Motivations

1

→ Determine the reasons for food avoidance. Individuals with ARFID with typically avoid foods based on sensory qualities, such as smell, taste, or texture. They may also avoid foods that are touching each other. Additionally, a previous bad experience with a certain food (such as choking or food poisoning) could be to blame. Try to uncover the motivations for the individual’s limited diet.

2

→ Realize that this avoidance is not based on weight. Unlike other eating disorders, ARFID involves fear or anxiety around certain foods, and is not motivated by the desire to lose weight. If food is being restricted to achieve a certain weight or body type, you may be dealing with anorexia or a related eating disorder.

→ Even though weight may not be a problem for adults with ARFID, children with ARFID are often underweight and have diminished bone mineral density.

3

→ Look for emotional responses. When a person with ARFID is presented with a new food, they will likely experience fear and anxiety. This fear and/or anxiety can be quite severe, and it is noticeably different from the normal response of someone who simply does not like a food. Visible signs of fear or anxiety can include:

→ Tensing of the shoulders or other muscles.

→ Fidgeting.

→ Sweating.

→ Crying.

→ Shaking in the hands.

→ Inability to look at the food.

→ A need to immediately leave the table.

Method 3 - Ruling Out Normal “Picky Eating”

1

→ Look at the age of onset. Occurrences of ARFID can begin anytime from birth to the age 4. If an adult is experiencing ARFID, it is likely to have started occurring during childhood.

→ Picky eating phases are common in children between 18 months and 3 years of age, but these phases will usually pass within a few months.

2

→ Recognize related disorders. ARFID is often occurs alongside other medical or emotional conditions. If the individual has been diagnosed with any of these other conditions, ARFID is a more likely diagnosis than simple “picky eating.” Consider the possibility of:

→ Obsessive-Compulsive Disorder (OCD)

→ Autism (including Asperger Syndrome and PDD-NOS)

→ Food trauma

→ Oral-motor delay

→ Swallowing disorders

→ Sensory Processing Disorder (SPD)

→ Gastrointestinal disorders

3

→ Notice the refusal food despite hunger. Most picky eaters will succumb under the weight of hunger. Individuals with ARFID, on the other hand, will not. The fear/anxiety of consuming a certain food will outweigh feelings of hunger in an ARFID individual.

TIPS

→ The eating behavior in ARFID is a persistent failure to meet one's nutritional needs. This includes children that have clinically significant weight loss, children who fail to achieve their expected weight gain, children with a nutritional deficiency, children who require enteral and oral feedings to provide adequate intake, and children with impaired psychosocial functioning.