A new category of eating disorder, known as avoidant/restrictive food intake disorder (ARFID), emerged in May of 2013 in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
ARFID is found in children who self-impose significant restrictions on their own eating. It is associated with weight loss or lack of expected weight gain and often manifests with severe physiological and/or psychosocial distress. There are many types of eating problems that might arise from ARFID—difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite, or being afraid to eat after a frightening episode of choking or vomiting.
“ARFID is not just about picky eating—it’s a very challenging diagnostic category in the DSM-5. These kids have complexity, and this condition persists for long periods of time and requires treatment to address both the medical and psychosocial aspects of the condition. If left untreated, children and teens may be left with serious, long-term complications,” says coauthor Dr. Debra Katzman, a Staff Physician a Senior Associate Scientist at the Hospital for Sick Children (SickKids).
A. An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
We know that individuals with anorexia or bulimia struggle with distortions in how they see their bodies and that they have significant concerns about their weight. But this type of thinking does not occur in ARFID—children with ARFID typically don’t fear weight gain and don’t have a distorted body image.
As ARFID is still a relatively new diagnostic category, there is little data available on its development, disease course, or prognosis. We do know that symptoms typically present in infancy or childhood but they may also present or persist into adulthood; however, no research is available yet.
Many children develop different or strange patterns of eating at some point in their life—refusing to eat vegetables for a few months or wanting to eat only chicken nuggets for dinner— but for most individuals, those patterns eventually resolve on their own without intervention. For the small subset of individuals who have persistent or worsening problems with food intake, however, the introduction of ARFID in the DSM-V means there is a possibility of a more accurate diagnosis, which could ultimately result in better clinical outcomes.