ARFID, or Avoidant/Restrictive Food Intake Disorder, is a relatively new diagnosis that was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Unlike other eating disorders such as Anorexia Nervosa or Bulimia Nervosa, ARFID does not involve body image concerns or a desire to lose weight. Instead, ARFID is characterized by a persistent lack of interest in food or an avoidance of certain types of food, resulting in a limited and inadequate diet that can lead to malnutrition and other health problems. According to the National Eating Disorders Association (NEDA), in ARFID, “the body is denied the essential nutrients it needs to function normally,” and this can result in serious medical consequences as the body is forced to slow down its processes to conserve energy.
Research suggests there may be a link between ARFID and certain chronic health conditions. For example, individuals with MCAS (Mast Cell Activation Syndrome) may experience a range of symptoms such as abdominal pain, nausea, and vomiting after eating certain foods due to the activation of mast cells in the gut. Similarly, individuals with SIBO (Small Intestinal Bacterial Overgrowth) may experience bloating, gas, and other gastrointestinal symptoms after eating certain foods, leading to food avoidance or restriction.
Likewise, we see this as well with Celiac disease, an autoimmune disorder that affects the small intestine. Celiac disease is triggered by the consumption of gluten, a protein found in wheat, barley, and rye, and can lead to a range of gastrointestinal symptoms such as bloating, abdominal pain, and diarrhea.
Due to these symptoms individuals may begin to avoid certain foods and develop a restricted eating pattern in order to avoid triggering symptoms. In addition, individuals with these diseases may experience malabsorption of nutrients, leading to deficiencies in vitamins and minerals leading to a cascade of health and mental health struggles.
Individuals with chronic illnesses such as diabetes and PCOS may struggle with symptoms of ARFID by not getting appropriate guidance on nutritional support. This can lead to restricting certain types of food or adhering to a specific diet plan in order to manage their condition. This can lead to feelings of deprivation or frustration around food, making it difficult to maintain a balanced meal plan.
Oftentimes when we see these individuals with chronic health issues first, and we don’t label them with our “traditional” eating disorder diagnosis. We view them through the lens of how an underlying medical condition can drive food avoidance or restriction.
What If We Viewed Our Other Eating Disorder Diagnosis The Same?
What if we viewed other eating disorders issues through the lens of ARFID? What if there is an underlying condition of anxiety, depression, trauma, or chronic health condition creating a dysregulated nervous system that leads to difficulties with digestion? Could we find that more often than not, the development of the eating disorder is subsequent to the underlying health issue?
Instead, we often view it as “a choice to want to eat in restrictive ways to have a sense of control.” But what if it wasn’t about a sense of control for a drive for thinness, but a sense of control to try and find safety and comfort in their body that is negatively dysregulated inside?
Oftentimes we see clients with anxiety or trauma struggling with what some call “restrictive eating,” and label this as Anorexia Nervosa. But what if we looked at it more as having a “lack of appetite,” because their belly is often all twisted up in a knot because of an anxious thought or memory. What if we viewed this more as ARFID, Aversion, Avoidant or Restrictive types? What if these people are constantly stuck in their sympathetic nervous system and they don’t have an appetite or can’t digest their food and that’s why they are restricting their eating?
What if we helped them regulate their bodies first? What would happen to the disordered eating thoughts and behaviors?
Many times we see clients with digestive issues being stuck constantly in their sympathetic or parasympathetic nervous systems. If we are in the freeze or shut down state, our system also shuts down and stops digesting food as well. What if we were to view Bulimia for some instead as an inability to digest food? What if we can view this from the lens that the person is so wound up and constantly in their sympathetic or shut down state that they can’t digest their food? So, their nervous system is doing what their body does when it is preparing for a threat. It evacuates food from the digestive track and urine from our bladder so that they can run, fight or freeze effectively. If someone has diarrhea as a symptom of this, we view it through the body’s reaction and diagnose it as IBS. But if someone vomits we typically view it from the mental health side “that they decided to vomit,” and call it purging.
But, What If We Viewed It Differently?
Restrictive eating, over eating, or other compulsive food related struggles can provide a sense of control and comfort during times of stress or anxiety to the nervous system, but over time, this can lead to malnutrition and other health problems. What if instead we educate those struggling on why their body is not digesting their food due to the trauma, anxiety, or chronic health condition? What if we were to teach them how this is keeping them in a dysregulated nervous system that sets them up for lack of appetite, nausea, or trouble digesting their food?
What if we took away the shame, and instead gave them tools to regulate their body? Would the thoughts start to adjust over time as well and become less fearful of the foods over time? This is what we often see at HRWC! When our clients feel empowered and understand their bodies’ reactions more, they are much better suited to do “traditional talk therapies” like CBT, DBT, or EMDR because they are able to access their frontal lobes which is imperative for these types of therapeutic approaches.
If we address the anxiety, depression, trauma, and chronic health issues; we often see that the need for control and finding comfort through food over time decreases significantly! If the body is no longer stuck in their dysregulated nervous system, one doesn’t need to seek comfort through compensatory behaviors.
ARFID Is Not Just A Diagnosis For Children
It is important to recognize that ARFID can affect individuals of any age and with a variety of chronic health or mental health conditions. Oftentimes we speak of this diagnosis paired with children with sensory food issues. This is true for these children, as they struggle with an underlying condition that is creating the food aversion or sensory issue.
But if we take a closer look at traditional eating disorders, we may start to find other underlying factors that are contributing towards the disordered eating behaviors besides just body image and a desire for external control.
It is important for healthcare professionals to understand the complexity of ARFID and how it can impact individuals with various chronic health conditions. Addressing the underlying health condition is a critical component of treatment, as well as providing nutritional support and addressing any emotional or mental health concerns that may be contributing to the disordered eating behaviors. Collaborating with a multidisciplinary team that includes a registered dietitian, mental health professional, and medical professionals is instrumental in developing an individualized treatment plan that meets the unique needs of each person.
With proper support and treatment, individuals with ARFID can improve their relationship with food and achieve better overall health outcomes!
(Source: National Eating Disorders Association. (n.d.). ARFID: Symptoms and Warning Signs. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/arfid/symptoms-warning-signs)
