Avoidant restrictive food intake disorder (ARFID) is an eating disorder where a person limits the amount and/or type of foods that they eat. Unlike other eating disorders such as anorexia nervosa, a person with ARFID does not limit their diet because they want to change how their body looks or how much they weigh.
A person with ARFID may limit their diet for several other reasons, including that they have a lack of interest in eating, a fear of aversive consequences (like choking or vomiting), or sensory sensitivity.
Unlike normal “picky eating” in children, ARFID generally does not go away on its own as a person gets older. It is a mental health condition that requires treatment.
ARFID can seriously affect a person’s physical and mental health. The eating disorder can lead to medical complications such as weight loss and delays in growth and development. People with ARFID may also experience the consequences of malnutrition such as a slow heart rate, loss of menstruation, and electrolyte imbalances.
There is no standard treatment for ARFID because it is a relatively new diagnosis. Although there is extensive literature on the treatment of pediatric feeding disorders, there are no randomized controlled trials evaluating the efficacy of ARFID treatment in adolescents and adults.
Clinicians who have patients with ARFID rely on their clinical experience and judgment, as well as the limited research that is available.
No randomized controlled trials—the most rigorous form of research—have been done to look at the efficacy of any ARFID treatment for children, adolescents, or adults.
Here is an overview of some of the options available for treating ARFID.
Prescription medication is not usually a first-line treatment for ARFID. There are currently no randomized controlled trials that support the use of any prescription medication for treating ARFID, and no drugs have been approved by the Food and Drug Administration (FDA) to treat the disorder.
However, based on their experience and review of the research that is available, clinicians might decide to prescribe a medication off-label for a patient with ARFID.
Medications that are sometimes prescribed off-label for ARFID include:
- Cyproheptadine: This is an antihistamine that can stimulate appetite. It can be helpful for infants and young children with ARFID who have lost interest in food and are underweight.
- Mirtazapine: This antidepressant, also known as Remeron, is sometimes used to stimulate appetite and has a tendency to lead to weight gain. It may help reduce mealtime fear, but evidence to support its use for ARFID is limited to case reports.
- Lorazepam: This benzodiazepine, more commonly known as Ativan, is sometimes prescribed to reduce anxiety related to eating.
- Olanzapine: This is an atypical antipsychotic also known as Zyprexa. It is sometimes used to decrease anxiety and cognitive rigidity affecting a person’s food beliefs, and it can promote weight gain.
Clinicians also need to consider the other medications a person is taking before they decide to prescribe an off-label treatment. Many people with ARFID have another (co-occurring) mental health condition.
One example of a co-occurring condition that a person with ARFID may have is attention deficit hyperactivity disorder (ADHD). Stimulant medications that are used to treat ADHD have been found in both research and clinical practice to suppress appetite and exacerbate ARFID. If a person has both ARFID and ADHD, their doctor will need to adjust their medications accordingly.
Although ARFID is considered a mental health condition, like other eating disorders, it can also have profound physical consequences. Medical treatment for ARFID is needed to prevent long-term health consequences of weight loss and malnutrition.
A multidisciplinary team of medical and mental health professionals is recommended for treating ARFID. A tailored approach to building a team to support someone with ARFID is necessary, but may include:
- Medical doctors
- Mental health clinicians
- Occupational therapists
- Speech-language pathologists
People with severe ARFID may need to be hospitalized or attend residential programs or partial hospitalization programs. The treatment setting will depend on the severity of a person’s food restriction, their level of malnutrition, and their weight loss. Refeeding with a feeding tube (enteral nutrition) is sometimes part of a person’s medical treatment.
In a partial hospitalization program, a person receives medical treatment at a hospital during the day, but can return home with their parents, family, or caregivers at night.
A 2017 study found that ARFID can successfully be treated in a partial hospitalization program that is designed for eating disorders in general. Compared to patients with other eating disorders in the same partial hospitalization program, patients with ARFID had similar improvements in weight and psychological wellness, but over a shorter period of time.
In some cases, the diet restriction and refusal to eat in patients with ARFID is severe. A study from 2015 compared the outcomes of patients with ARFID and patients with anorexia nervosa who were hospitalized for nutrient insufficiency.
The study’s findings showed that ARFID patients generally required longer hospital stays than patients with anorexia (eight days compared to five days), and were more likely to need a feeding tube.
Once a person’s immediate physical needs are met and they are medically stable, therapy is often the next step in ARFID treatment. There are many types of therapy that can be used, and each is offered by different clinicians.
The best treatment will be individually designed in consultation with a medical professional and based on the person’s values and needs. In many cases, a person with ARFID is engaged in several types of therapy at the same time.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is a type of psychotherapy that is used to treat a wide variety of mental health conditions including eating disorders. In CBT, a trained therapist helps a person learn to identify their distorted thinking patterns, change their thoughts, and ultimately change their behavior.
There is a lot of evidence in support of the effectiveness of CBT for treating eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder.
However, high-quality evidence on CBT as a treatment for ARFID is lacking. Only a few case reports have suggested that CBT might be helpful for some people with the condition.
CBT-AR is a new, specialized form of CBT that is being developed by the Eating Disorders Clinical and Research Program team at Massachusetts General Hospital. It is currently in clinical trials.
The initial research on CBT-AR, published in 2020, found that 70% of participants who completed a round of CBT-AR no longer qualified for the diagnostic criteria of ARFID.
CBT-AR has only been studied in people with ARFID who were 10 years of age and older, medically stable, and not using a feeding tube.
With a philosophy of “volume before variety,” the program includes 20 to 30 sessions. With this method, patients are encouraged to eat large amounts of their preferred foods, with the goal of weight restoration, before introducing new foods.
Family Based Therapy (FBT)
Family based therapy (FBT) is a type of behavioral therapy that is commonly used to treat eating disorders in children and adolescents. In FBT, blame is removed from the patient and the family, and the eating disorder is viewed as an external force. Everyone in the patient’s family is treated as a unit that is dealing with the patient’s eating disorder together.
A small study of six participants with ARFID found that after treatment with medical monitoring, medication, and FBT, all participants met their goal weight. However, more research—particularly randomized controlled trials—is needed to determine the true effectiveness of FBT for children with ARFID.
Occupational therapists take a holistic approach to restoring health, well-being, and functioning through assessment and techniques designed to develop or recover meaningful activities or occupations.
Occupational therapists complete a full assessment of a person’s sensory, motor, developmental, environmental, cultural, and behavioral factors that could be impairing eating.
Eating is considered an activity of daily living, and treatment of ARFID is within the occupational therapy scope of practice.
Kids with ARFID and co-occurring sensory processing disorder, autism spectrum disorder (ASD), or ADHD might work with an occupational therapist in an outpatient therapy setting. Patients with eating disorders may also receive occupational therapy in residential treatment or inpatient settings.
Interventions are individualized to the person with ARFID, but can include tactile play to promote oral acceptance, food chaining techniques, social stories about self-feeding and eating, operant conditioning, and sensory diets.
A speech therapist (speech-language pathologist) is another kind of rehabilitation professional that can be part of an ARFID treatment team. Speech therapists treat issues relating to speech, hearing, and swallowing.
In the context of ARFID, a speech therapist can help people who have a food aversion that leads to swallowing difficulty (dysphagia).
Speech therapists work with people of all ages, using a variety of interventions. For example, they can help a person become more comfortable swallowing different textures through techniques like pre-chaining, food chaining, and feeding programs that target different consistencies.
A Word From Get Meds Info
There is no standard treatment for ARFID, and high-quality research is limited on the effectiveness of the options that are available. There are no specific medications for ARFID, but clinicians might prescribe some off-label, like antidepressants or drugs that help stimulate appetite, to help people with the condition.
The first step a clinician will take to help a person with ARFID is to assess their health. If they are malnourished or severely underweight, a person with ARFID may need to be hospitalized or attend a residential eating disorder treatment program. A feeding tube may also be necessary to help them gain weight and correct malnourishment.
Once a person with ARFID is medically stable, a multidisciplinary team of medical and mental health professionals continue to help them manage the condition and avoid serious health consequences.