ARFID in Teens: Eating Disorder Symptoms and Treatment Options
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ARFID and disordered eating in teens
Eating disorders are often misunderstood. Each one of us has our own unique relationship to food, just as we have a unique relationship with each person we encounter in life.
It can be confusing to know what “normal” eating is versus what counts as disordered eating.
In this piece, we discuss an eating disorder called avoidant/restrictive food intake disorder (ARFID).
If you are familiar with ARFID, you may have heard that it is related to “picky eating” -- but the truth is that ARFID is much more complex than that.
Teens with ARFID become malnourished because they avoid eating specific foods, restrict the amount of food they eat or avoid eating altogether.
ARFID symptoms in teens
If you are concerned that you or someone you care for might have ARFID, here are some of the signs to watch for.
- Lack of interest in food
- Avoidance of certain foods due to concern about their taste, texture, smell, temperature, or color
- Refusing to try new foods
- Requirement that that food be prepared a specific way
- Choosing not to eat when preferred foods are unavailable, even when hungry
- Avoiding meals or delaying them as long as possible
- Frequent lack of hunger
- Forgetting to eat
- Going for long periods without eating
- Fear of eating due to concern about possible allergic reactions, choking or vomiting
Since taste buds change every few years, parents and caregivers may notice food preferences and habits change in their child or teen every few years.
We asked Ovidio Bermudez, MD, FAAP, CEDS, senior medical director of child and adolescent services and chief clinical education officer at Eating Recovery Center (ERC), about the early signs of ARFID. He explains,
“If a young person develops a pattern of ‘I don't like something and I'll never have it again,’ and then they say, ‘I don't like the next thing, and I'll never have it again,’ that is a sign that they are developing atypically.
In this case, you may want to reach out to your health care provider for guidance.”
How to spot the signs of ARFID
We spoke to clinical psychologist Michelle Jones, PhD, clinical manager at ERC, on a recent ARFID episode of the Mental Note podcast.
Dr. Jones has studied ARFID since it first became a diagnosis over a decade ago. She shares,
“Signs of ARFID can show up as early as infancy or in the early toddler years. Some individuals may not show symptoms until middle childhood, adolescence or later."
Curious to learn more about ARFID? We discuss the different types of ARFID and associated symptoms in more detail below.
Types of ARFID
There are three main types of ARFID:
- Sensory sensitivity
- Lack of interest in food
- Fear of aversive consequences
Type 1: Sensory sensitivity
Teens who have strong sensory sensitivity may limit what they are eating based on the sensory properties of food. This could include avoiding foods based on:
- Taste
- Texture
- Temperature
- Smell
- Color
Restricting food due to sensory issues means that ARFID can overlap with autism spectrum disorder, since teens with autism often have strong sensory sensitivity.
Type 2: Lack of interest in food
Sometimes young people with ARFID seem to have a complete lack of interest in eating, and they don’t seem to enjoy food the way many people do.
They may not look forward to eating and they may not feel hunger the same way other people feel it. Since food isn’t enjoyable, they don’t eat as much; eating becomes something they want to avoid.
This type of ARFID can often overlap with attention-deficit/hyperactivity disorder (ADHD). Explains Dr. Jones,
"People who have ADHD tend to be less aware of hunger signals.
A person with ADHD and ARFID may feel that eating takes a lot of work, organization and coordination. It ends up feeling like a chore.
Eating is something that is more easily forgotten, avoided or procrastinated on.”
Type 3: Fear of aversive consequences
Individuals who have experienced a trauma or perceived trauma related to eating may restrict their food intake as a way of avoiding another traumatic experience.
Teens with this type of ARFID may restrict the foods they eat due to fear of having one of the following reactions while eating:
- Vomiting
- Choking
- Allergic reaction
- GI symptoms
- Pain
In order to prevent what they fear from happening, a person with this type of ARFID will avoid eating certain types of food (food aversion) or avoid eating altogether.
This type of ARFID often overlaps with mental health conditions like anxiety disorders and obsessive-compulsive disorder. For these individuals, exposure therapy may be helpful.
ARFID diagnosis in teens
ARFID is most commonly diagnosed in childhood and early adolescence. The research is mixed, but as many as 5% of young people –- or more -- could have ARFID.
While the true prevalence of ARFID remains to be studied, preliminary research[1] indicates that males may be more likely to present with ARFID than other eating disorders.
Unlike most other eating disorders, all genders face an equal risk for developing ARFID.
Dr. Jones shares insight regarding ARFID signs to watch for, and when to seek help.
“With ARFID, teens are not meeting appropriate nutritional needs, due to sensory sensitivity, a lack of interest in eating, or because they fear aversive consequences.
If a caregiver notices the signs listed above and unexpected weight loss, failure to gain weight, malnutrition or other physical and mental health problems, it’s advisable to seek help."
ARFID is a relatively new eating disorder, having been added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) -- a manual that helps providers make mental health diagnoses -- in 2013.
Because of its relative newness and due to surrounding myths, teens with ARFID symptoms (and their caregivers) may feel powerless or isolated at times.
We want you to know that you are not alone and there are many passionate healthcare providers who are here to help you.
ARFID vs. anorexia nervosa
Many people associate eating disorders with concerns about weight and body image. While that’s true in some cases, ARFID is an eating disorder with unique diagnostic criteria.
While ARFID symptoms, like food restriction and avoidance, may sound like symptoms of anorexia nervosa, the two diagnoses are quite different.
Notably, people with ARFID are not motivated by weight loss or thinness - which is what drives anorexia nervosa. However, due to their restrictive eating habits, people with ARFID suffer from malnutrition and may be at very low body weights, which can produce some of the same physical characteristics as anorexia nervosa.
As a result, there is a chance that ARFID might be misdiagnosed as anorexia nervosa -- or diagnosed later than would be ideal.
Dr. Jones explains the difference between ARFID and anorexia nervosa:
“If we think about anorexia nervosa, there is a disturbance in body image or overvaluation of body shape and weight.
With ARFID, there is an absence of that.
Or -- the body distortions are not driving the restrictive eating habits.”
Does your loved one have ARFID?
Take this ARFID quiz to find out.
ARFID treatment for teens
The most important step toward starting treatment for a teen with ARFID is having an accurate diagnosis -- and there is not a “one size fits all” treatment approach.
Dr. Bermudez offers his recommendation on how to ensure an accurate diagnosis,
“You want to be an informed consumer and ensure the diagnosis is verified by clinicians with experience, usually multidisciplinary.
If your pediatrician suspects a case of, say, restrictive ARFID, they should make a referral to a therapist and dietitian with the clinical expertise to get a consensus. Then, your child’s doctor can make a recommendation of where to find help.”
Depending on the diagnosis, and following a comprehensive assessment, treatment may include some or all of the following:
- A multidisciplinary team to coordinate and provide treatment
- Medical and psychiatric stabilization
- Nutritional rehabilitation and weight restoration
- Individual and group therapy
- Family therapy, education and support
- Collaboration with referring providers
What does ARFID treatment look like?
Here at ERC, the treatment approach at ERC is unique for each individual.
ARFID treatment addresses and includes the following:
- The patient's developmental history
- Internal and external motivators as well as goals and values
- Areas in the patient’s life that are negatively impacted by ARFID symptoms (e.g., physical health, social functioning, psychological well-being)
- Family dynamics and family involvement
A unique component of ARFID treatment at ERC is continuous education of patients and caregivers alike on diagnosis, interventions, treatment expectations and treatment goals.
Dr. Jones shares some insight into how the providers at ERC work with teens.
“We are not forcing anyone with an ARFID diagnosis into our expectations of recovery.
This is really about their life and their functioning and how can we help them function in a way that is going to better their life and not cause adverse experiences.
For teens, we might identify foods they can take to school for lunch, because they won't eat anything in the school cafeteria.
If they don’t eat lunch, they're going all day at school without eating anything at all.
And that's not good for their health or their growth or their development or socialization or anything like that.
We may even have them set alarms on their phone every day at certain times to remind them to eat.”
If you or your teen is struggling with any of the symptoms described below -- or have questions about an ARFID diagnosis or treatment options -- we’re here to help.
What are the goals of ARFID treatment?
Eating disorder treatment for ARFID works to fill the teen’s nutritional gaps.
At ERC, registered dietitians work individually with each teen to increase the variety of foods they will eat and help them eat on a routine schedule. The goal is to help them function better with a focus on their physical and emotional health.
As an example, fast food, prepackaged foods, convenience foods and frozen foods can all be normative for teens with the lack of interest subtype of ARFID.
These are young people that probably will not stick to an organic, cooked-from-scratch meal plan on a long-term basis.
Shares Dr. Jones,
“Once the teen is eating more regularly in a routine, their body starts to feel better, their brain starts to function better and recovery starts to kick in.”
Read our interview with Dr. Jones for a full discussion on our ARFID podcast and learn about our nutrition program for ARFID.
Get help for ARFID today
Eating Recovery Center is the nation's only health care system dedicated to the treatment of ARFID at all levels of care, including:
- Inpatient ARFID treatment
- Residential ARFID treatment
- Partial hospitalization ARFID treatment
- Intensive outpatient ARFID treatment
- Virtual ARFID treatment
If you believe you or your loved one may have ARFID, we’re here to support you on your recovery journey. Give us a call at 866-622-5914 or send us a quick note. We’d be happy to discuss the symptoms you are observing and explore your treatment options.
Learn more about ARFID and find support in our free virtual educational series “Supporting Loved Ones with ARFID” taking place in September and October 2024.
Related Reading
Sources
Norris, M.L., Spettigue, W.J., & Katzman, D.K. (2016). Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment,12, 213-218. doi: 10.2147/NDT.S82538.
