On the National Counselor Examination (NCE), the Counselor Preparation Comprehensive Examination (CPCE), or another counseling exam, you may come across questions related to diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). This will help you understand Avoidant/Restrictive Food Intake Disorder (ARFID).
Avoidant/Restrictive Food Intake Disorder (ARFID) is a diagnosis in the category of feeding and eating disorders in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR).
In past DSMs, ARFID was called Feeding Disorder of Infancy or Early Childhood. However, the name was updated to Avoidant/Restrictive Food Intake Disorder and now includes adolescents and adults as well.
ARFID is a diagnosis that, as the name suggests, centers around an avoidance or restriction of food. This might be because of a negative experience with food, such as choking, or because of sensory components of food that the person finds unpleasant or intolerable.
Typically, if the person with ARFID is responding to the texture or other sensory aspects of eating, this is more likely to develop in infancy or within the first decade of life. It can then persist into adulthood. If ARFID stems from a negative experience with food (like difficulty swallowing, vomiting, etc.), this can develop at any point in life.
For people with ARFID, they may be classified as a “picky eater”. But, it is important to be aware that this is more than picky eating. For people with ARFID, they can experience food avoidance and restriction to the point that they need supplemental nutrients, such as a feeding tube. People with ARFID will often experience weight loss or may not maintain weight gain consistent with what would be expected for their age in the case of children or adolescents.
The person with ARFID is going to have a disturbance in their feeding or eating that is characterised by a lack of interest in food, aversion to food because of the sensory aspects of it, or worry about the consequences of eating.
They must present with at least one of the following:
1. Significant weight loss or not gaining weight as would be expected for their age.
2. Nutritional deficiencies that would be considered significant.
3. Having to rely on an external source of nutrition, such as a feeding tube.
4. A disturbance in their social functioning because of their eating symptoms.
Keep in mind, the person must experience this when they have access to food. If they do not have access to adequate nutrition for some other reason, ARFID would not be an appropriate diagnosis. Also, if the person meets criteria for Anorexia Nervosa, Bulimia Nervosa, or another eating disorder, ARFID should not be diagnosed. This means that if the person should not be avoiding or restricting due to concern about their body weight or shape for an ARFID. Finally, these symptoms should not be able to be better explained by another medical or mental health condition.
While you review the risk factors for ARFID, keep in mind that these are not the causes of ARFID. Instead, they are things that may increase the likelihood of a person having or developing ARFID.
Risk Factor 1: The first risk factor is the person having an anxiety disorder, Obsessive-Compulsive Disorder (OCD), Attention-Deficit/Hyperactive Disorder (ADHD), or Autism Spectrum Disorder (ASD).
Risk Factor 2: Second, for those with a more anxious family, they are at an increased risk for ARFID.
Risk Factor 3: A third risk factor is having a mother with an eating disorder.
Risk Factor 4: Finally, certain medical problems, specifically those that might interfere with eating, may increase risk. This might include reflux or vomiting.
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