The American Psychiatric Association publishes the Diagnostic and statistical manual of mental disorders as a guidebook that details all of the diagnostic criteria for various mental disorders, including eating disorders. In the 5th edition, avoidant/restrictive food intake disorder (ARFID) was added, replacing and changing a previous diagnosis entitled ‘feeding disorder of infancy or early childhood.’
In order to meet criteria for a diagnosis of ARFID, someone must meet the following diagnostic criteria:
- An eating or feeding disturbance so pervasive that the person is unable to meet appropriate nutritional needs, resulting in one (or more) of the following: significant weight loss, nutritional deficiency, dependency on nutritional supplements, or interference in social functioning.
- This problem with eating is not explained by a lack of food being available.
- This is different from both anorexia nervosa and bulimia nervosa in that the problems with eating are in no way related to what the person believes about his/her size, weight, and/or shape.
- This disturbance is not caused by a medical condition or another mental disorder.
The eating issues seen with a diagnosis of ARFID are often associated with being uninterested in eating, may be related to the sensory characteristics of the food, or concern about the consequences of eating. Some specific examples of this would be a refusal to eat anything other than liquids or soft foods, an intense fear of choking, or limiting intake to only a specific brand/type of food.
The previous diagnosis of ‘feeding disorder of infancy or early childhood’ indicated that these issues developed prior to age 6. While this is often the case, ARFID is also seen in late childhood, adolescence, and may persist into adulthood.
Unfortunately, there has been little research done on the development, course, and treatment of these issues. However, it is hypothesized that some cases may develop as a result of specific experiences surrounding food and eating – an experience with choking, for example. Children, who have had to rely on nutritional supplements as a result of a medical condition, may also struggle with a return to normalized eating.
There is currently no research data that would support the idea that people suffering from ARFID will develop another eating disorder such as anorexia nervosa or bulimia nervosa sometime in the future. However, higher rates of feeding problems are seen in children whose mother suffers from an eating disorder. ARFID is associated with anxiety disorders, the autism spectrum, obsessive-compulsive disorder and attention-deficit/hyperactivity disorder.
It is important to remember that many children go through phases of picky eating or a refusal to eat certain foods. Even as adults, everyone has developed preferences and dislikes for certain things. These issues are normal and not considered a disorder. Only if the problem is so pervasive that it results in significant weight loss, nutritional deficiencies, or significant relational problems should a diagnosis of ARFID be given.
If you believe that your child, adolescent (or yourself) may be struggling with this issue, it is important to seek help. Look for professionals with experience in feeding and/or eating disorders. They can create a personalized treatment plan for you.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Kenney, L. & Walsh, B.T. (2013). Avoidant/restrictive food intake disorder (ARFID): Defining ARFID. Eating Disorders Review, 24(3).