Broader Awareness and Management of ARFID
A Growing Acknowledgement of a Complicated Eating Disorder
Persistent Food selectivity known as ARFID is a severe eating condition, rather than a mere idiosyncrasy.
Mara, a middle-aged woman, grapples with avoidant-restrictive food intake disorder (ARFID), a complex eating disorder that makes nourishment a challenge. Fruits, vegetables, and cold cooked meats are among the food items that evoke trepidation for Mara, causing her considerable distress during meal times. Recognizing a similar eating pattern on social media, Mara was able to identify her condition and sought help for her struggle.
"Strawberries are off-limits," Mara often finds herself explaining the constraints in her dietary habits. "Before a company's Christmas dinner, I would already feel anxious with sweaty palms," she shares, reflecting on three decades of food-related concerns that she initially believed were mere idiosyncrasies. It wasn't until she encountered an Instagram post about ARFID that she recognized the parallels and sought a diagnosis.
ARFID, as recognized in the United States since 2013 and recently included in the World Health Organization's International Classification of Diseases (ICD-11), is fundamentally distinct from picky eating habits. "There's a difference between things I don't like and things I can't eat," Mara clarifies. Her dislike for marzipan doesn't pose the same challenges as her inability to swallow cooked ham, analogous to individuals in the jungle camp who struggle with certain edible offal.
Eating as a Burden Instead of a Pleasure
"I'm relieved to finally know what I'm dealing with," Mara says, as she remains a person of normal weight after numerous consultations with doctors. She is considering visiting a psychotherapist or speech therapist, who specialize in addressing aversions to specific solid foods. Though both adults and children can develop ARFID, it often results in impaired physical and psychosocial functionality, impacting the eating habits of countless individuals.
According to Ricarda Schmidt of the Leipzig University Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, children or adults with ARFID may reject food due to sensory characteristics or their appearance. They may lack an appetite, feel anxious about eating, or develop aversions based on past traumatic experiences involving food, for example, severe choking incidents or allergies.
Typical Symptoms and Treatment in Germany
While ARFID is recognized in the US and the ICD-11, its diagnosis in Germany occurs under other eating disorders. Unbeknownst to many, the condition often manifests as anorexia in young patients, as healthcare professionals in Germany tend to focus on weight loss concerns rather than restrictive eating. "Children with ARFID don't restrict their food intake for the purpose of weight loss," explains Andrea Hartmann Firnkorn, the head of the working group on clinical psychology and psychotherapy of children and adolescents at the University of Konstanz.
In spite of limited data on the incidence of ARFID in Germany, psychologists are witnessing a significant increase in cases since the onset of the COVID-19 pandemic. The therapy for ARFID is not standardized and is typically individualized, consisting of psychoeducation for families, nutrition counseling, and support in expanding food options.
Causes and Potential Therapeutic Approaches
Little is known concerning the causes of ARFID, but a genetic predisposition might play a role in those with heightened sensitivity to odors, textures, or tastes. Early traumatic experiences involving food, such as severe choking episodes, allergic reactions, intubations, or swallowing difficulties, could also contribute to ARFID symptoms.
Research suggests family-based therapy, cognitive behavioral therapy, and, in certain cases, the addition of psychotropic drugs as potential approaches for treatment. More studies are needed to confirm these findings and assess long-term outcomes.
Implementing Practical Strategies and Support
Children with ARFID are known to display considerable stress and anxiety around meal times, making it essential for parents and caregivers to create a relaxed and accommodating environment during dining. Offering access to a variety of foods, including previously refused items, can help ease the transition and foster positive eating experiences.
Psychologists at the University of Konstanz offer support through online therapy sessions and self-learning modules, emphasizing the importance of having an outside perspective in addressing food-related issues that have often become contentious within families. The team at the university aims to provide families with tools to continue working on their child's eating habits beyond the therapy sessions, with a focus on making gradual, sustainable progress in expanding their diet.
- To manage and mitigate anxiety related to ARFID, Mara is contemplating vocational training in health-and-wellness or mental health fields, with the hope of finding solace in helping others facing similar challenges as she does.
- As part of her ongoing journey towards overcoming ARFID, Mara is researching community policies concerning vocational training programs in health-and-wellness and mental health to assess if they can assist her in making a career change that aligns with her personal experiences and passion for helping others.
