ARFID has only been in the DSM-5 since 2013, and despite the fact that it is in there as a legitimate eating disorder, there is little consensus about how to effectively treat it. Whether you’re seeking help for yourself or your child dealing with this issue, it’s important to know what your options are. This article discusses the choices you have for treatment, and how effective they have been found to be.
What Is ARFID?
Over time, this avoidance of most foods can continue, and it stays with some people through adulthood. It can initially seem like picky eating, but it is much more serious than that, and it can cause a deficiency in vital nutrients. To be diagnosed with ARFID, an aversion to food must be unrelated to food scarcity, cultural practices, or medical problems. Additionally, it must have led to a reliance on tube feeding or supplements, major nutrient deficiency, extreme weight loss, or challenges moving through life due to shame or anxiety about the illness.
ARFID Treatment
Because ARFID has only been in the DSM-5 for less than one decade, little research has been done about the treatment options for it and which offers the most effective outcomes. No randomized clinical trials have occurred yet. Instead, practitioners who treat people with ARFID must instead rely on their own experience with other patients and the field of eating disorders. It’s worth noting that ARFID is unlikely to go away on its own without intervention, so treatment is required. Even though no clinical trials have been done for ARFID treatment, there are still treatments available. The goals of treating ARFID are:
To achieve and maintain a healthy weight and healthy eating patternsTo increase the variety of foods eatenTo learn ways to eat without fear of pain, choking, or vomiting
The three main categories of treatment include therapy, prescription medication, and medical intervention. Let’s look closely at each of those options below.
Therapy
Because ARFID leads to physical problems, such as nutrient deficiency, it’s important that therapy be part of a multifaceted approach that also includes remedies that can lead to increased eating. That said, therapy can play a pivotal role in helping people get over myriad life challenges, so its impact may still be quite strong. Patients with ARFID may try one form of therapy at a time or multiple. Different modalities can lead to different breakthroughs and results, so it might be worth trying more than one at a time. Here are a few of the most common types of therapy used to treat ARFID: CBT Cognitive-behavioral therapy is a frequent recommendation for people dealing with any eating disorder, so it makes perfect sense it could be of use for ARFID. It has the strongest evidence backing of any eating disorder therapy modality. There is a newer form of CBT therapy, known as CBT-AR, that is proving quite promising for the treatment of ARFID. The first research conducted on it resulted in a level of success with 70% of patients. CBT-AR was designed specifically for ARFID, and it is being used for patients aged ten and up. Rehabilitative Therapy Both occupational therapy and speech therapy, which fall under the umbrella of rehabilitative therapy, are in use for ARFID treatment:
Occupational therapy involves sensory, motor, and developmental skills needed for everyday life, and eating is a key component of our daily activities. An occupational therapist might focus on the sensory issues around food, the tactile problems a person has with it, or the behaviors that are preventing the ARFID patient from being able to eat a wider variety of food. Speech therapy is a viable treatment for ARFID because speech therapists work with issues around swallowing, which is the main component of eating. Because some ARFID patients fear vomiting when they eat, and some have difficulty swallowing food, working directly with swallowing can be a helpful approach for them.
Family-Based Treatment Family-based treatment (FBT) is used for eating disorders, and it involves treating the problem as a separate entity while encouraging a family to come together to work with the issue. It is used primarily for treating children and adolescents, not adults. Initial research into FBT for ARFID, which was very small and only involved six patients, showed that in addition to medical intervention and prescription treatment, patients were able to meet their goal weight.
Prescription Medication
There is no medication currently in existence that is made or marketed specifically to treat ARFID. However, there are prescription medications on the market already that may help ARFID patients:
Appetite stimulants AntihistaminesAnxiety medicationsAntipsychotics
Appetite stimulants can help a person with ARFID eat more food because they are hungrier. An antihistamine called Cyproheptadine has been shown to have a positive impact on infants and small children with ARFID. And an appetite stimulant in the form of a depression medication called Mirtazapine has helped children in single case reports, though no studies have been conducted on it. Medications that relieve anxiety can also be helpful for ARFID patients, because they may experience significant anxiety around eating. A low dose of an antipsychotic also used to treat anxiety around food, and that promotes weight gain, called Olanzapine, is promising in initial research for both children and adolescents.
Medical Intervention
Treatment of ARFID on the medical side may involve an entire team of people, and that is recommended for the best possible outcome. Dietitians can discern what nutrients an ARFID patient is lacking, and a gastroenterologist can determine the potential damage to one’s digestive system that restricted eating has caused.
ARFID in the Long Term
ARFID is considered a treatable condition. That means that it’s entirely possible to overcome the aversion to food. Initial research shows stronger success rates for treating ARFID than for treating anorexia. Treatment for ARFID may take some time, and it often involves a whole-body approach that factors in cognitive work, sensory or tactile treatment, medication, and working with doctors. While there is no given success rate for getting past ARFID, the research being done shows significant promise that someone with ARFID can move on to live a full and healthy life in which they eat a variety of nourishing foods.
A Word From Verywell
ARFID may present similarly to picky eating, but it’s very different. Because of that, always be kind to people who have this condition. Don’t tease or make light of someone’s aversion to foods, as this is a real disorder and not just an issue of preference or pickiness. If you have ARFID, please know that help is available to you.
