Discussion: Parent Guide

WHAT IS arfid?

Avoidant/Restrictive Food Intake Disorder (ARFID) is suspected if the patient has significant weight loss, low energy and experiences impaired sensory manifestations such as repelling the smell of food, texture or size.  Adults with ARFID, may have had negative food related symptoms since childhood to adolescents which becomes even more restrictive with age (Norris et al., 2016). Some of these childhood behaviors generates restrictive eating habits, increase anxiety about food, facilitate food allergies and other patients may experience GI symptoms.

Avoidant Restrictive Food Intake Disorder (ARFID)

Diagnosis.

According to the DSM-5 criteria for diagnosing ARFID, the individual should have eating or feeding disturbance resulting to inadequate nutritional intake or weight loss, deterioration psychological and physical health (American Psychiatric Association, 2013). These presentations must not be associated with the absence of food or cultural practices. The eating avoidance should occur separately from other diagnosis of bulimia or anorexia nervosa and additional past medical conditions associated with the individual should be evaluated. Persistent failure to gain weight or increase nutritional intake marks a significant interference in growth and functioning which is clinically assessed in ARFID (American Psychiatric Association, 2013).

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Lock, J., & La Via, M. (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 412-425.

Norris, M., Spettigue, W., & Katzman, D. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric disease and treatment, 12, 213–218.

Ornstein, R., Essayli, J., Nicely, T. A., Masciulli, E., & Lane, L. (2017). Treatment of Avoidant/Restrictive Food Intake Disorder in a Cohort of Young Patients in a Partial Hospitalization Program for Eating Disorders. International Journal of Disorders, 50(9), 1067–1074.

Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake Disorder (ARFID). Current Problems in Pediatric and Adolescent Health Care, 47(4), 95–103

Signs & Symptoms

The disorder is characterized by avoidance or restriction of food resulting in one or more of the following: weight loss or failure to gain expected weight during a period of growth, nutrient deficiencies, dependence on oral or enteral nutritional supplements, and significant impairment in psychosocial functioning (Ornstein, et,al, 2017). The client can also have the following; weight loss, constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy, eating food of certain textures, lack of appetite, fear of weight gain, abdominal pain, menstrual irregularities, difficulties concentrating, dizziness, insomnia, dry skin and bradycardia (Zimmerman & Fisher, 2017).

Symptoms Broken Down by Type

ARFID- Limited Intake : low overall appetite, lack of interest in eating, take small bites, takes a long time to finish meals, energy deficient, weight loss, stunted grow, and medical issues as a result of their poor growth.

ARFID-Limited Variety : typically have a long standing issue with food, or picky eating, sensory or textile issues with food, aversions to specific food items, or food items on a plate cannot touch

ARFID- Aversive : typically have a prolonged history of food avoidance and that typically evolves into anxiety (Norris et al., 2017).

Pathophysiology

Psychiatric comorbidities, including anxiety disorders, autism spectrum disorder, learning disorder and attention deficit hyperactivity disorder (ADHD) are common among individuals with ARFID.

* Nutritional excesses, such as elevated mercury levels due to repeated consumption of high-mercury foods like tuna.

* Fear of aversive consequences presentation initially begin with restricting intake

* Belief that certain foods will cause pain or discomfort

Treatment

· Laboratory Screening – should be done to ensure medically stable and assess areas that need to be addressed

· Outpatient Interventions – Individual therapy and Family therapy are both important for everyone to learn how to cope.

· Inpatient Interventions – psychiatric admission may be needed if disordered eating continues and malnutrition and further issues progress.

Medication Interventions – there are not any medications to specifically address disordered eating however, when we pinpoint the triggers or causes of disordered eating we can prescribe medications to help manage these things (Lock & La Via, 2015).