Eating Disorders Awareness Week: What is ARFID?
News from BACP

According to eating disorder charity Beat, there are approximately 1.25 million people in the UK living with an eating disorder – and around 5%¹ have ARFID. As part of National Eating Disorders Awareness Week (26 February – 3 March 2024), we asked several members to shine a light on one of the largely unknown and misdiagnosed eating disorders, ARFID (avoidant restrictive food intake disorder).

What is ARFID?

As one of the lesser-known eating disorders, ARFID is categorised by the avoidance and restriction of foods or whole food groups.

“Many people often go undiagnosed with ARFID due to it being a lesser-known eating disorder, and many of my patients have been called 'picky eaters' throughout their lives,” says eating disorder specialist, Ruth Micallef. “But ARFID can cause distress, fear, and anxiety around food, as well as vitamin deficiencies, malnutrition, a disinterest in food, and even choking on food.”

Three types of ARFID

Accredited therapist and BACP member Susie Pinchin says that ARFID can be categorised into three types: avoidant, aversive, and restrictive. Although these reasons can overlap in an individual - they “don't need to have just one type”, says Susie.

“Some people with ARFID will avoid foods related to sensory functions such as colours, smells, or how the food feels and its texture. For example, they may find it difficult to eat anything green so, of course, this can rule out many vegetables. Smells can also be an issue due to an association they put with that food, and an example of texture avoidance could be the softness of some fruits.

“Others will avoid certain foods because they associate them with an unpleasant reaction such as being sick or choking - a fear has been built up with that association or thought.

“And some people just have very little interest in food or a very small appetite so food and eating are low on their priorities - they may just forget to eat or just not feel like it, this is categorised as restriction.”

 Why does ARFID develop?

Senior accredited member Dee Johnson says that AFRID can develop at any age and at any weight – and it is not always obvious why.

Ruth adds that there are many reasons why ARFID might develop, but two of the most common are as a coping mechanism for trauma and sensory overstimulation - which is why ARFID is often aligned with autism.

Susie agrees and says ARFID may also develop because the individual is dealing with anxiety, medical conditions or neurodiversity - but she shares that “sometimes this isn’t the case”. 

“It can often start in children and young people when they are 'picky eaters' and this develops into AFRID,” explains Susie. “Some picky eaters become healthy eaters with no issues.” Unlike anorexia nervosa, it doesn’t develop as a concern about body shape or in order to lose weight.

The difference between picky eating and ARFID

Although often mistaken for picky eating, there are some important differences to be aware of.

“The main difference between ARFID and picky eating is that someone experiencing ARFID will find their life impacted by their eating disorder,” says Ruth.

“They may find it embarrassing or stressful to eat out in public, have an extremely limited number of 'safe' foods they can eat, and experience both psychological and physical side effects from their eating disorder.”

Accredited therapist and member Daniel Mills Da-Bell says that ARFID can look very different in each individual, and it can be ‘tricky to spot’ because of the many varying reasons or factors leading to it.

“You may notice somebody's emotional and psychological wellbeing or presence deteriorating, and perhaps their physical health,” says Dan. “Although weight loss isn't a key diagnosable feature, you may notice weight loss alongside anxiety, poor emotional wellbeing, low mood, and being socially distant - these things in combination might alert you to a problem.”

Misdiagnosis

Ruth claims that due to the stigma, misunderstanding, and often, poor media representation of a broader range of autism, women and girls continue to go sorely under-diagnosed with autism. And this has a knock-on effect of women and girls being underdiagnosed with ARFID.

“I support a staggering number of my own female identifying patients and clients (with ARFID) through a successful autism diagnosis,” says Ruth.

Dee adds that as ARFID is also a very isolating condition which affects self-confidence, relationships, and social interactions - as well as exacerbating anxieties and mood imbalances – ARFID can sometimes be mistaken for another issue.

How to seek help for ARFID

Ruth says that if you suspect that you may have ARFID, it’s important you reach out to a loved one, your GP, or a registered professional who specialises in eating disorders. And if you suspect a loved one may be suffering from ARFID, she encourages people to reach out to them with compassion.

“ARFID is a very serious eating disorder which can have significant consequences if left unsupported,” says Ruth.

How therapy can help

“Sadly, treatment for ARFID is still not in the NICE guidelines,” says Ruth. “Still, a combination of therapy from a registered professional and dietic support can help you successfully begin your recovery journey. In some cases, support from speech and language therapy and a diagnosis and support for autism can also be hugely beneficial.

Daniel adds that therapy can help in a number of ways, but it's important to find a therapist or service specialising in eating disorders.

“Therapy can help different symptoms such as anxiety or low mood, as well as really help to shift and change behaviours before looking for further support for the underlying causes or any other emotional difficulties experienced,” he explains.

To find a registered therapist to support you with an eating disorder, visit our therapists directory.

[1] Hay, 2017