ARFID: How to Deal With the Mental and Physical Health Risks

Struggling with ARFID (Avoidant/Restrictive Food Intake Disorder) is no joke. I’ve been working with teens and adults for years in San Diego who have ARFID. My heart goes out to them. Whether you live in sunny San Diego or elsewhere in California, Texas, Florida, and other states or countries, having ARFID means that others misunderstand you, and medical providers frequently misdiagnose you. It’s so isolating. You may have a hard time keeping on weight. You feel uncomfortable going to restaurants and eating in front of other people. Friends and family often say to you “just eat” or ask, “Why can’t you get over it? It’s just food.” They don’t understand that food isn’t “just food” to you. It’s so much more.

What Is ARFID?

ARFID is a relatively new eating disorder diagnosis. It first appeared in 2015, when the DSM-V came out. It means that children and adults with ARFID have either avoidant or restrictive tendencies.

Avoidant means that there are types of foods, or even overarching categories of foods, that individuals do not eat. Restrictive means that there is a limited amount of food a person eats.

ARFID has existed for a long time; it’s just that the scientific and eating disorder professional community didn’t recognize it as a mental disorder until 2015. Like all eating disorders, ARFID is a brain disorder. That means that in folks with ARFID, there are areas of the brain that are not functioning as efficiently or effectively when compared to the brains of people without ARFID. So it isn’t someone’s fault if they have ARFID.

Society has long stigmatized people with ARFID as being “picky” or “difficult” when it comes to eating and food. It’s a very isolating disorder because individuals with ARFID feel very misunderstood. Also, these folks may struggle eating in front of other people.

ARFID, at its core, has to do with a lot of anxiety. The more anxious a person is, the more ARFID symptoms they have. On the other hand, the more ARFID symptoms are present, the more anxiety an individual experiences. Context makes a huge difference; for example, eating with a person someone doesn’t know could make it harder to eat. New or unusual meal settings is also a trigger.

How Many Types of ARFID Are There?

It depends on who you ask. It can range from three to five subtypes. In the scientific literature, there are three: (a) sensory, (b) fear of adverse consequences, and (c) lack of interest. You can qualify for more than one subtype.

Sensory means that an individual is hyperaware of the following sensations when interacting with food and eating: How a food looks, what it smells like, how it tastes, the texture of the food, the food temperature, and how it feels when you’re swallowing it. I tell parents and family members that for people with ARFID, it’s like putting a bowl of boiling motor oil in front of them and asking them to eat it.

Fear of adverse consequences is when a person has a phobia of choking, vomiting, or other adverse physical or mental effects when they eat a particular food.

Lack of interest often co-exists with one of the other subtypes. It means an overall indifference toward food. Such folks often find eating annoying and inconvenient.

Other mental health professionals or eating disorder treatment centers have separated out Adult ARFID as a separate subtype. ARFID Plus is another category that I have seen in my clients. It is when someone demonstrates ARFID traits and has body image concerns as well, which is more common to anorexia, bulimia, and other eating disorders.

What Are the Mental Health Risks of ARFID?

Mental health risks of ARFID range from anxiety, depression, isolation, loneliness, and obsessive-compulsive behaviors. Anxiety is especially prominent.

It’s very difficult to struggle with food. It affects all aspects of life. Just think about it: You eat at least three times per day, if not more. Significant life events and celebrations like weddings, holidays, and birthdays center around food. Imagine that either you can’t participate in such events, or these situations trigger tremendous anxiety. Then afterward you feel depressed and lonely, as few people understand what you’re experiencing.

Dr. Panicha McGuire, LMFT, uses the following metaphor to explain ARFID to the parents of her neurodivergent child and teen clients (ARFID is present more in neurodivergent folks when compared to neurotypical individuals): Imagine that the world is mostly made up of people with brains that are PC computers. All of the programs, the hardware, and the systems are configured for PC, or neurotypical, brains. Now imagine that you have an Apple computer, or neurodivergent, brain. The entire world functions for PCs, not Apple computers. That means that if you want to use your Apple brain, you have to use adapters and special modifications to make it work.

It’s difficult to feel different. Whether you’re neurodivergent with ARFID or neurotypical with ARFID, it’s really lonely and isolating when you can’t be a part of a huge part of the world. You feel misunderstood, and you may internalize a sense that something is wrong with you.

What Are the Physical Health Risks of ARFID?

Physical health risks of ARFID include undernourishment, low weight, and gastrointestinal issues. First, undernourishment can be present regardless of body size. It’s important to meet with an eating disorder dietitian so that you’ll be able to learn how to maximize the nutrients you’re getting from the limited types of food that you eat. Over time, both the eating disorder dietitian and the eating disorder therapist will help you slowly add foods to your diet.

Second, low weight is a risk, especially for children and teens. Low weight results in the inability to eat, or in feelings of disinterest in food and eating. Some minors may have to be hospitalized, or they may enter into residential, intensive outpatient, or partial hospitalization programs. If you or your child are medically stable enough to have an outpatient team, it is vital for a medical professional and an eating disorder dietitian to be a part of it.

Third, gastrointestinal issues can occur because the digestive system is deprived of enough food for it to work consistently and effectively. Problems such as acid reflux, heartburn, or GERD can occur, as well as constipation, bloating, and cramps. Gastroparesis may also occur. Gastroparesis is when the stomach emptying process is delayed. Symptoms include feeling full very early, or feeling excessively full, feeling nauseous and bloated.

How Can I Get Help for ARFID?

One great place to start is my new ARFID and Selective Eating Course! It’s a self-paced, online eating disorder course that helps parents of kids with picky eating, as well as providers, plus adults who struggle with ARFID.

The level of care you or your teen needs for ARFID in San Diego, Dallas, Denver, etc., depends upon medical stability. Heart rate and other medical indicators are factors. Your primary care physician or pediatrician can determine it. It’s especially helpful if you consult a medical provider who is an eating disorder specialist, such as the Gaudiani Clinic.

Find ARFID Help in San Diego, Houston, and throughout California and Texas

An eating disorder therapist who specializes in ARFID is a must. I work with teens and adults in person and virtually in San Diego, as well as virtually throughout California and Texas. I partner with several eating disorder dietitians in the San Diego area, as well as dietitians in who can work anywhere in California or Texas. I have a network of medical professionals, such as eating disorder physicians and pediatricians, with whom I work.

Check out my services and schedule a free, initial, 15-minute phone consultation. I’d be happy to talk with you about options of care for you and your child.