Is my Child a Picky Eater or Is it Something Else?
Parents of young children are often concerned and frustrated by a child who seems to be willing to eat almost nothing. Often, these children eat a very limited range of foods, such as only eating “white foods” or sticking to foods that are more typical of very young children, such as macaroni and cheese, pizza, chicken nuggets, ice cream, and hamburgers, even when they get older. Although some pickiness is developmentally normal in childhood, it is important to distinguish this from an actual disorder, which could have much more serious and far-reaching effects for the person.
The long term effects of eating disorders are devastating. Without proper nutrition, the risk of cardiac events, growth abnormalities, and issues with bone density is higher than in healthy individuals.
Are you or do you know someone who is an extremely picky eater? Avoidant Restrictive Food Intake Disorder, known as ARFID (formerly known as Selective Eating) is a type of eating disorder that can negatively affect a person’s social life and physical well-being. If you or a loved one is suffering from ARFID, there are treatment options that can help you lead a more normal life.
To learn more about ARFID treatment and the condition itself, keep reading.
What is ARFID?
ARFID is a relatively new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. It stands for Avoidant Restrictive Food Intake Disorder but is sometimes referred to as “picky eaters” disorder.
This diagnosis is often given to individuals who experience difficulty with both eating and with food. However, generally, they don’t exhibit the classic symptoms of an eating disorder (i.e. anorexia nervosa, bulimia, etc.).
ARFID looks different in every individual. It could present as avoidance of certain colors or textures of food, it could be an avoidance of particular foods out of a fear of nausea or vomiting, or generally just a fear of certain classes of foods such as vegetables.
Many people with ARFID develop this condition due to a fear of choking or vomiting. In some instances the person had a traumatic incident that shaped this fear. It is always recommended though, that the individual be evaluated by a speech therapist who specializes in swallowing disorders to make sure there is not an actual medical issue related to being able to swallow.
While “picky eaters” disorders typically present in children and adolescents, it can affect people of any age or developmental level. An adult picky eater might eat as little as 10 or 20 foods. Untreated, this can last a lifetime and can become a major obstacle to health and socializing.
Is ARFID Serious?
People suffering from ARFID may experience a reduced quality of life as a result of their disorder. They often have problems with social situations and may avoid work, school, or family. This disorder can cause both weight loss and nutritional deficiencies. Once a child gets old enough to start socializing with friends out of the house, he may start to view his ARFID, or picky eating, as more of a problem because it is not possible for them to just go out to eat with friends. And for a teenager, there is nothing worse than missing out on a social event or being viewed as ‘different” from others. Often, teenagers will articulate that they find this problem with food to be embarrassing because they become known as the “picky eater.” These feelings can be helpful because the person feels some motivation to change the behavior and may even request treatment.
Parents of children with ARFID experience stress and anxiety because it is so difficult to find the foods that the child is willing to eat. Meals become tense and it interferes with the whole family’s ability to enjoy meals, celebrate holidays, go to restaurants, or visit other people who may serve food in their home. Parents with a child with ARFID have been known to go to extreme lengths to find the exact food the child is willing to eat just to ensure that their child does not starve. It is this fear, that the child will not get adequate nutrition, that ironically empowers the disorder and causes the parents to inadvertently engage in behaviors that wind up reinforcing the disorder. And in the end, the family feels as if their entire life revolves around making sure that their “picky eater” finds something to eat.
It is important to note that not all individuals with ARFID are underweight. Even if the individual is normal weight or overweight, it is still highly likely that they are malnourished due to the limited range of foods that they eat.
ARFID is also associated with other mental health conditions, such as anorexia nervosa, Autism Spectrum Disorder, Obsessive Compulsive Disorder, and Depression.
Signs and Symptoms of ARFID
Spotting the signs and symptoms of ARFID isn’t always easy. It can vary in its clinical presentation:
- Selective eating such as sensory food aversions (not liking the texture, smell, or taste of a certain food), very restricted range of foods, or fear of new foods
- Physical problems such gastrointestinal symptoms, abdominal pain, or physical symptoms beyond what would normally be expected if a medical diagnosis is present
- Phobia of severe allergic reaction
- Vomiting phobia (known as Emetophobia)
- Choking phobia
- Food avoidant emotional disorder which is a lack of interest in food, emotional problems that interfere with appetite and eating like anxiety, depression, trauma; with NO medical explanation or origin
These symptoms can be seen in any combination, while others may only have one of these symptoms.
Types of ARFID Treatment
There are different types of treatment for selective or picky eaters (ARFID). Depending on the symptoms and the goals of the patient, a doctor may recommend one or a combination of the following therapies. In general, the initial focus should be on weight restoration (if needed) and then adding an emphasis on increasing variety of foods later.
1. Exposure Therapy
In this type of therapy, a therapist will gradually expose a patient to fear-inducing foods through mental visualization, writing, and verbally talking about them. Working from the least to the most anxiety-causing, the patient can gradually become more comfortable with the foods they fear.
The therapist will also give the patient coping tools and organize life practice sessions. They’ll likely combine the treatment with cognitive behavioral therapy to address anxiety and negative thought processes around food.
2. Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) targets the negative thoughts and behaviors behind a disorder. It’s employed in everything from addiction recovery to eating disorder treatment. In ARFID treatment, these strategies are often combined with relaxation training so that the person learns to relax the body while also practicing new thoughts and behaviors.
In exposure therapy, treatment-interfering behaviors can affect the process of recovery. Using CBT, therapists work with a patient to discover what underlies their condition. They help the patient to understand how their fear operates and how it’s triggered by food and eating.
3. Dialectical Behavioral Therapy
Originally developed to treat borderline personality disorder, dialectical behavior therapy (DBT) empowers a patient to manage their emotions in a healthy way. Most importantly, it teaches patients how to manage their own distress so that they stop using self-destructive coping mechanisms. This can be very helpful to those with ARFID because re-introducing the foods they have not been eating can be quite overwhelming and distressing. In some cases, they will even gag or vomit when trying a new food, so it is important to develop strong, healthy coping skills as one tries to change the relationship with food.
4. Group Therapy
Group therapy can be an important component of therapy for people with this disorder. It facilitates a supportive space in which to share meals with others and treat sensory issues. As treatment progresses, this might mean eating in a public place or visiting the grocery store as a group.
Being among those who struggle with similar issues is invaluable. It gives the patient an opportunity to immerse themselves in social situations with familiar and understanding peers.
5. Family Based Treatment
There is increasing evidence that Family Based Treatment (FBT) may be the most effective form of treatment for ARFID and there are several sites around the country researching this form of treatment. In this type of treatment, the family is intimately involved in helping the child reach his or her goals related to increasing their food intake. FBT was initially developed for the treatment of Anorexia Nervosa but for ARFID is tailored to meet the needs of this specific population. In some cases, the FBT may be combined with other treatment protocols that help the person develop more coping skills.
Preparing for and Choosing ARFID Treatment
A large part of successfully treating ARFID is setting appropriate goals. When looking for ARFID treatment, have an idea of the changes you’d like to see. For example, decide whether social changes or a larger range of dietary options is your goal.
Choosing Your ARFID Treatment Program
In some cases, when the individual is either very malnourished or so compromised emotionally that h are not able to care for himself, residential treatment is considered as an option. In other cases, the family members are burnt out or overwhelmed to a point where they can no longer sustain their support. There are programs that treat ARFID at a residential level of care or as an intensive outpatient program.
At a residential program, patients receive 24-hour support and treatment and live at the facility. While attending the program, patients usually receive a combination of individual, family, nutritional, and group therapy.
Alternatively, patients may find an outpatient program which is attended a few days a week. This takes the form of group therapy sessions, usually with the option of individual sessions.
For some, a combination of a residential and then stepping down to an outpatient program gives the patient the best odds for a successful recovery.
Are You or a Loved One Suffering From an Eating Disorder?
Eating disorders are serious and complicated mental illnesses. While it may be tempting to write off ARFID as nothing more than picky eating, it can drastically affect your health or the health of your loved one. ARFID can lead to dramatic weight loss, nutritional deficiencies, social anxieties, and a decreased quality of life.
Take Our ARFID Assessment
Are you not sure if you or your children have ARFID? Take our free ARFID assessment:
ARFID treatment is available in both residential and outpatient programs. They can help a person regain control over their unhealthy relationship with food and live a more normal life. If you or a loved one is suffering from ARFID, contact us for help.
Get ARFID Treatment in Miami
I’m Dr. Amy Boyers, a Clinical Psychologist in Miami who specializes in eating disorder treatment (all types including anorexia treatment, bulimia treatment, and binge eating treatment) and other long term conditions, including addictions, bipolar disorder treatment, and OCD. I offer personalized and sophisticated eating disorder treatment services, individual and family psychotherapy, family member support and education, in-home meal support, cognitive behavioral therapy, anxiety treatment, depression treatment, and much more.
Have any questions about the eating disorder recovery process? I’d be happy to answer them. Simply reach out to me and I’ll be sure to answer anything you want to know.
I look forward to helping you obtain a brighter tomorrow.
Want to learn more about other eating disorders? Read our full guide to the different types of eating disorders.