Published: November 12, 2014 Have you ever sat across the table from an 8 year old at the dinner table and heard, “Ugh, not this again! Parents often ask us when are kids just picky and when it is something more serious. In the eating disorder field, we’ve heard stories from patients and families about extreme restrictive and picky eating in childhood and beyond. The college student who only ate three foods (cereal, pizza, and pasta) and was worried that her friends were starting to notice. The pre-teen who ate a restricted diet of just orange things (Cheetos, orange soda, Cheez-Its) and gagged if she tried anything else. The 9-year-old boy who only ate peanut butter and jelly sandwiches and relied on drinking Ensure to make sure he didn’t fall off of his growth curve. In the past though, we didn’t have a specific diagnostic label to give these kids, teens, and adults. Often the kids and adults struggling with extreme picky eating didn’t have the other symptoms that we associate with eating disorders like body dissatisfaction, a desire to lose weight, or the binge eating episodes that are the hallmarks of disorders like anorexia or bulimia nervosa.

It was hard to tell: is this just a phase? Is it just a passing fad, or is it more serious? When should we intervene, and how should we help kids and adults who are struggling to eat a wide range of foods? With the Diagnostic and Statistical Manual 5th edition (DSM-5), we now have a systematic way to evaluate when picky eating is a serious problem. For the first time, DSM-5 includes Avoidant/Restrictive Food Intake Disorder (ARFID) as a diagnosis. To get the diagnosis, a child or adult must have a lack of interest in eating or food, worry about the negative consequences of eating (e.g., feeling uncomfortable or bloated), or avoid food because of sensory issues (e.g., how it looks, tastes, or feels). But the ARFID diagnosis also requires that picky eating interferes with an individual’s nutritional needs. For example, it could cause significant weight loss or lead to a child not growing and developing in the way that we would expect. It could also cause significant nutritional deficiencies like anemia and a dependence on nutritional supplements such as vitamins and liquid meals.

In addition, it also could cause problems in one’s social life, such as not being able to go out to dinner with friends or requiring others to go to extremes to cater to likes and dislikes. Dollhouse Kitchen FlooringIt’s important to distinguish ARFID from other eating disorders. Rims And Tires MercedesIf someone is struggling with anorexia nervosa or bulimia nervosa or struggling with body image issues, they can’t get an ARFID diagnosis. Camera Digital FlexAlso, you have to ensure that there isn’t another medical condition that might be a better explanation for picky eating. Now that we have an official diagnosis for the condition that we see in our clinics, it will be interesting to see how research on ARFID progresses. We have a lot to learn about how and when ARFID develops, how ARFID is related to other eating disorders, and which kids and adults are at risk for struggling with extremely picky eating.

Recent research found that children with ARFID were typically younger than those with anorexia or bulimia when they came for treatment (13 years old vs. 16 years old). They were more likely to be male (29% vs. 15% vs. 6% for anorexia and bulimia), and to have a comorbid medical condition such as gastrointestinal symptoms (19.4%); a history of vomiting/choking on food (13.2%); or food allergies (4.1%). In addition, although treatment approaches for children and adults with ARFID have already started, many clinicians will need training on the best ways to detect and treat ARFID. Across the highway from us at Duke University, our colleague Dr. Nancy Zucker has developed an exposure treatment for children with ARFID, (see this ABC News story about her work) and she’ll also be conducting a workshop on treating ARFID at the Academy for Eating Disorders International Conference on Eating Disorders this year in Boston. Although ARFID is kind of unwieldy to say and in truth the behaviors associated with the diagnosis aren’t “new”, having ARFID in the DSM-5 means that children and adults who deal with negative nutritional and social consequences of limiting their food intake can now find treatment options.

photo credit: r.nial.bradshaw via Creative CommonsPEAS would love to hear from you!  Please sign our guestbook (no spamming, we promise!) Please Sign Our GuestbookARFID – Avoidant / Restrictive Food Intake Disorder Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by highly selective eating habits and/or disturbed feeding patterns, including some cases of extreme “picky eating,” often resulting in severe nutritional, energy loss and an adverse impact on daily life. ARFID is most common in children and adolescents, with symptoms often persisting into adulthood. Potential Warning Signs of ARFID Avoidance of particular foods (texture, color, taste, smell, food groups, etc.) A fear of eating, often based on past negative experiences Trouble digesting specific types of foods Consuming extremely small portions Frequent vomiting or gagging after exposure to certain foods Weight loss or failure to gain weight

Inability/avoidance of eating in group settings The individual needs to present with a disturbed eating or feeding experience which is associated with one or more of the following: Nutritional deficiency as a result of inadequate intake of food Weight loss in adults or failure to gain weight in children Decline in psychological function Dependency on supplements in order to maintain nutritional health The disturbed eating is not due to an explainable external factor such as food being unavailable or in short supply. The person does not have the symptom of a distorted body image. The feeding disturbance or food restriction is not a result of some other physical or mental illness. For example, a person may lose weight due to the flu or food poisoning, but this would not be an example of an eating or feeding disorder, therefore a diagnosis of ARFID would not be relevant. Walden offers ARFID-specific treatment for male and female patients, which includes Cognitive Behavioral Therapy (CBT), Family-Based Treatment (FBT), Dialectical Behavioral Therapy (DBT), family-based education, nutrition counseling, meal coaching and more.