Selective eating disorder

Being picky with food may indicate an eating disorder

Pawel Malczewski
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Do you avoid whole groups of foods such as vegetables?
Do you only eat a very limited variety of foods?

In 2013, a new eating disorder was named by scientists and a medical team: “Avoidant/Restrictive Food Intake Disorder” (ARFID) and published in the latest edition of “Diagnostic and Statistical Manual of Mental Disorders”. (1)American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here. (2)American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here. (3)Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.

Food avoidance disorder in infants and children had only been recognized as “Feeding Disorder of Infancy and Early Childhood”. Being an adult meant that individuals with similar disorders were placed into a non-specific disorder group called “Eating disorder not otherwise specified (EDNOS)”.

The disorder name, now changed, captures not only children but also anybody with clinically significant eating problems. It allows for a more appropriate diagnosis of individuals.

Fussy eating disorder usually starts in childhood but since children usually grow out of it, it is not necessary to intervene.

It is now diagnosed as ARFID and therapy programs for adults are available.

Characteristics of ARFID: (4)American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here. (5)American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here. (6)Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.

  • May avoid foods of a specific texture, taste, smell, temperature or color;
  • May only pick specific brands of foods;
  • Usually there is no specific outward appearance associated with ARFID sufferers – most have weight within the normal range. However, it may also result in weight loss or growth impairment in children;
  • Certain foods may cause adverse reactions such as gagging or vomiting;
  • May avoid whole food groups such as vegetables or fruit;
  • Don’t necessarily have to worry about their weight as in anorexia nervosa;
  • In some cases, in both children and adults ARFID may impact social interactions during meals;
  • Favorite food in most adults with this disorder is French fries, also chicken fingers;
  • This disorder does not include scenarios where food is limited, there are certain cultural practices or the patient is diagnosed with anorexia nervosa or bulimia nervosa;
  • Disliking a specific food, such as spinach or Brussels sprouts, does not mean that one has ARFID.

Causes of ARFID: (7)American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here. (8)American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here. (9)Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.

  • For individuals who avoid foods due to their sensory food qualities (such as taste, color, texture and temperature) ,this disorder most likely started in early childhood and they never recovered from it;
  • Individuals who eat less but are not concerned about their body weight may have had an emotional disturbance related to eating. Meals or particular foods may then be associated with anxiety;
  • Individuals with difficulty with swallowing certain foods may have had a traumatic event related to eating such as choking on certain food. This could occur at any age, not necessarily during childhood.

Dangers of ARFID (10)American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here. (11)American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here. (12)Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.

  • Long term avoidance of certain foods may lead to deficiencies in certain nutrients which may result in the need for dietary supplementation or dependence on feeding tube;
  • These nutritional deficiencies may lead to serious health issues such as heart and bone problems;
  • May lead to weight loss and growth impairment in children;
  • Some scientists think that ARFID may develop into other eating disorders such as anorexia nervosa. However, no specific studies have been done;
  • In some cases, other disorders may be contributing to development of ARFID: anxiety disorders, obsessive-compulsive disorder (OCD), attention deficit disorders (ADD) and autism. If one of these disorders is present together with ARFID, that disorder should be treated first.

Treatment for ARFID (13)American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here. (14)American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here. (15)Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.

Since this is disorder was discovered relatively recently, an effective treatment hasn’t been globally adopted yet.
If the symptoms of ARFID don’t disappear during the teenage years or adulthood, cognitive/behavioral therapy may be a good option.
If individual has an underlying condition, such as depression, which results in ARFID treatment such as cognitive behavioral therapy may be effective.

References   [ + ]

1. American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here.
3. Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.
4. American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here.
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here.
6. Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.
7. American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here.
8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here.
9. Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.
10. American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here.
11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here.
12. Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.
13. American Psychiatric Association. 2013. Highlights of Changes from DSM-IV-TR to DSM-5 Available here.
14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. 2013. 5th Edition. Available here.
15. Kenney L, Walsh BT. Eating Disorders Review. Avoidant/Restrictive Food Intake Disorder (ARFID). Department of Psychiatry, College of Physicians and Surgeons. Columbia University and New York State Psychiatric Institute, New York. May/June 2013. Volume 24, Issue. Available here.

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