Avoidant Restrictive Food Intake Disorder (ARFID) is recently classified under one of the eating disorders, where this disorder fails to meet the desired nutritional requirements of the body. As time goes, this disorder can lead to malnutrition and energy deficiencies. ARFID is significantly distinct from anorexia nervosa as there is no connection between the distress about their body image and the disorder. But same as the anorexia nervosa these patients will reduce their calorie intake where they become fail to reach their daily energy requirements. This disorder is most commonly seen within the younger population and children.
Main types of ARFID
There are three main types of the above disorder where it has been classified according to the reason for the food restriction.
- The first type is that they have no interest and they do not have any desire to take foods. And they feel full even with a little amount of food.
- The next type avoids foods as they do not like to sense the food. They do not like the taste, smell, temperature, appearance, and texture of the food.
- The third type is that they have the fear that they get sick, allergies, nausea, and vomiting after the food intake.
Avoidant Restrictive Food Intake Disorder symptoms
The symptoms can be classified as behavioral, psychological, and physical symptoms. Where the patients will have the combination of all the behavioral, psychological, and physical changes together.
What are the behavioral and psychological changes within the ARFID patients?
- They always try to hide that they are skinny and that they have lost weight. So they try to wear several layers of clothes before facing society.
- They try to stay warm and they will lose the ability to tolerate cold climates.
- They feel very full during mealtime and when it gets close to mealtime. When the family gets ready for the meal, they try to avoid it and they get isolated within the family.
- Constipation and abdominal pain are very frequently reported.
- They will consume only a few selected foods where the intake is not enough.
- They always live with fear when they see foods, so they never try to taste the foods as they have the fear of getting nausea and vomiting.
- They will not have any issues regarding their body image and weight gain. So the food restriction is not related to their body image.
What are the physical changes observed within ARFID patients?
- As the physical changes build with time as a result of the inadequate food intake, these symptoms are similar to that of anorexia nervosa.
- Gastrointestinal symptoms such as acid reflux, gastritis, and abdominal cramps.
- Experiencing menstrual irregularities as the body does not receive enough nutrition for the functioning of their body systems. They need hormonal pills to maintain their regular menstruation.
- They become unable to focus and concentrate on certain things.
- Laboratory investigational studies show variations in their results. Low hemoglobin, low thyroxin, changes in electrolyte levels are some of the abnormal laboratory results.
- Bradycardia, As the body, does not receive enough nutrition the blood volume and the organ functions get weaken.
- They get easily fatigued and they are lethargic as they do not have energy stores within the body to use during the activities.
- Cold intolerance and reporting coldness even in normal climates
- Dry skin, brittle nails, and broken and dry hair. As the required nutrition is not supplied the nails, skin, and hair become unhealthy.
- Low immunity and prone to infections easily, Do not have enough ability to fight against the infections.
What is the course that leads to the development of Avoidant Restrictive Food Intake Disorder (ARFID)
There is no one reason for the development of ARFID. The combination of several psychological, biological and environmental factors can be the Couse for the development of such disorders.
Environmental triggers and bad experiences with food can trigger the occurrence of this condition among children with a family history of ARFID.
Children with developmental disorders and autism are more prone to experience ARFID.
Risk factors associated with Avoidant Restrictive Food Intake Disorder (ARFID)
- Anxiety disorders
- Malnutrition and weight loss
- Gastrointestinal diseases
- Developmental disorders
Complications of Avoidant Restrictive Food Intake Disorder (ARFID)
As time goes ARFID can develop various health problems.
- Nutritional deficiency –patients who suffer from ARFID will never get the required quantity of all the micro and macronutrients. As a result, the energy stored starts depleting day by day. So these patients will not have stored energy to use in an emergency. Malnutrition can make changes in the physiological process in the body. The electrolytes, the hormonal level will get altered calling for various chronic diseases.
- Weight loss – Restriction of food intake will imbalance the calorie wastage and the intake. The consumption of a very low number of calories than the expenditure results in weight loss and wastage of muscles.
- Developmental issues – This disorder is very common among the young generation. If this disorder affects the Youngers on the adolescence age, it can affect the growth spurt. So this undernutrition can result in short and underdeveloped physical characteristics.
Diagnosis of Avoidant Restrictive Food Intake Disorder (ARFID)
Diagnosis of the condition can be done as mentioned in the DSM -5 criteria.
Examination of the patient.
Physical examination and health history can be used in the diagnosis of the condition. The pattern and the frequency of food intake can be used in the diagnosis of the condition. Collect data regarding the unpleasant experiences related to the food intake.
Observation of the physical changes such as weight loss, dry skin, brittle nails, pallor eyes, loss of skin turgidity, etc.
Management of Avoidant Restrictive Food Intake Disorder (ARFID)
Growth and development are very important among children and adolescents. If they restrict their growth and development during this period they can end up with serious physical and psychological issues. During the assessment, it is very important to make their family involved in this. So the health care provider can obtain necessary information regarding their neonatal, infant growth, and wellbeing.
According to recent research studies, the therapies based on their family background can greatly help the patients to improve their condition.
What is the gold standard therapy for the treatment of ARFID?
Family-based therapy is considered the gold standard as the outcome is very successful after this therapy. Empowering the family members regarding the importance of the nutritional status is important. Family can involve in the recovery very effectively. The Family can pay more attention to the nutritional status of the patient. They can involve in helping the patient to improve their desire towards food intake.
The treatments are decided according to the health history. During the diagnosis, the actual reason behind the issue is examined and the treatments are decided according to the underline reason.
If the patient is having no appetite for food intake, appetite stimulants can help in this situation. So they improve their appetite and increase their food intake.
If the reason behind the disease progression is depression or anxiety, Treatments can be focused to treat depression and anxiety. Antipsychotic pharmacological treatments can alleviate anxiety as well as they can improve the appetite of the consumers. Olanzapine belongs to the atypical antipsychotic medications, where can be used to release anxiety and to improve appetite.
Combination therapy is preferred during the treatment regime. Nutritional supplements are also considered to rebuild the depleted nutritional stores within the body. Until the patient gets recovered the nutritional supplements can help in maintaining the daily nutritional requirements.
Available medical treatment opportunities for the treatment of ARFID
Depending on the patient’s physical condition the treatments can range from outpatient treatments to hospital admission. As this is a new condition that emerged recently there is not enough evidence that can use within the healthcare sector. The combination of a physician, nurses, dieticians, gastro entomologists can decide the final treatment option. The goal of the treatment regime is to rebuild the body weight, restore menstrual functions, and recover from the eating disorder.
When the patient’s physical fitness is very poor and if the patient is presenting with bradycardia and poor homeostasis, hospitalization is important to maintain their condition. If the BMI of the patient is 75% lower than the desired BMI to their age, this is considered a critical situation, where immediate treatments are necessary.
Nutritional supplements can be delivered orally or using tube feeding methods if the patient is not strong enough to swallow tablets.
If the patient is medically stable, cognitive behavioral therapy can be used as a treatment option. This treatment method can be implemented individually or as a whole including the family of the patient. Counseling can be done to discuss the bad experiences on food intake and to reduce the bad senses.
Coping and support
Other than the patient, their family and loved ones are under stress. Because they do not improve in their physical and psychological wellbeing. Parents become worried as their children are undernourished. Maybe they have struggled for years to improve their child’s nutritional level. So they may be under stress. So it is important to assess their condition and anxiety other than the child’s condition.
Coping with such a condition may be a challenge. However, the parents must decide to meet the nutritional requirements of their child. Educating the closed family members regarding the eating disorder and the treatment options may help them to understand the situation. Observing the progression of the patient will help in moving forward positively. Teach your child the importance of nutrition so they can start slowly to increase their food intake. As parents, you can discuss the reason for avoiding foods so you can help them to cope with difficult situations. Reporting and documenting the weight gain, increase food intake will help to motivate the child towards recovery.
If the child is refusing to accept several food categories try to introduce them slowly in small quantities. It will take more than 10 exposures to get familiar with the food. So it is important to keep calm while dealing with such situations. Introduce new food combinations and categories. If the child can tolerate the newly introduced foods, never try to give the same thing frequently. It is very helpful if you can prepare them in a rotation.
The next very important thing is taking care of yourself. You are the one who looks after the patent. So you needed to stay healthy before all. So maintain healthy body weight, engage in daily exercises, and try stress coping strategies, so you will become strong and confident enough to look after the patient.
Home remedies to support ARFID
Other than the medical treatment methods several home remedies can help in improving the appetite and preventing bad symptoms related to the gastrointestinal tract.
How do you improve your appetite?
- Administering small meals more frequently does not make them feel full. So small nutritious diets can help them to enhance their appetite.
- Make the mealtime a fun activity with the family members. So they do not feel to avoid the mealtime.
- Include fish containing omega 3 fatty acids, foods containing vitamin B1 and zinc. These ingredients can stimulate the appetite of the consumer.
- Introduce a less fiber diet as fiber makes you full easier.
- Engage in few activities may help in restoring the digestive function, where it helps the foods to move easily within the intestine making the patient feel hungry again.
- Never try to distract the patient while having their meal.
How to avoid Avoidant Restrictive Food Intake Disorder
Identification of the condition early as possible will help to prevent nutritional deficiencies and other physical growth restrictions within children. So notice your family doctor if your child is not taking enough nutritional foods that are needed. Immediate treatments and family coping methods can help them in the prevention of the disease progression. Restoring the appetite and the nutritional level is important in this situation. Nutritional supplements also help greatly in preventing complications and bad outcomes. Certain home remedies can help them to recover easily and to maintain their psychological wellbeing.