ARFID and Fear of Eating

Kathryn Adel April 9, 2024 Health, IBS Irritable Bowel Syndrome

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder recently recognized in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is an eating disorder, just like anorexia or bulimia. However, it differs from the latter in that people with ARFID do not have body dysmorphia or a fear of gaining weight.

There are three presentations of this eating disorder:

• Lack of interest in food: People may often forget to eat, don’t enjoy eating, and are also full quickly
• Sensory avoidance: People may have hypersensitivities to the tastes, textures, appearance, temperature, or smells of food
• Fear of adverse consequences: People may be afraid to eat certain foods, often because they have had a negative experience with them in the past, such as choking, an allergic reaction, or digestive symptoms

Each of these presentations is self-sustaining:

• Eating little food leads to a decrease in appetite
• When you eat a limited variety of foods, you can get tired of eating the same foods over and over, making you want to eat even less
• When you are afraid to eat certain foods, the more you avoid them, the more scary they become, since you are no longer exposed to positive experiences with food

ARFID is defined in the DSM-5 as the persistent failure to meet sufficient nutritional or energy requirements, related to at least one of the following:

• Weight loss or inadequate growth
• Nutritional deficiencies
• Reliance on enteral nutrition or nutritional supplements (e.g., protein shakes) to ensure adequate intake
• Disruption of psychosocial functioning, such as an inability to eat with others

Eating very little can make you feel full quickly, even if you don’t get enough nutrients. It can also cause you to feel overfilled when consuming an adequate amount of food, as the capacity of the stomach decreases with chronic dietary restriction. Finally, going too long without eating or not having a regular meal and snack schedule can dampen hunger signals and make you think that you’re not hungry.

In the long term, inadequate food intake can lead to serious health consequences, including a decreased heart rate, weight and muscle mass loss, nutritional deficiencies, osteoporosis, an absence of menstruation, anxiety, irritability, depression, difficulty concentrating, and social isolation.

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Author

Kathryn Adel

Kathryn holds a Bachelor Degree in Nutrition as well as a Bachelor and a Master Degree in Kinesiology, all from Laval University. She is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ) and of the American Academy of Nutrition and Dietetics. She holds the Monash University's certification for the FODMAP diet and IBS, and has considerable clinical experience in that area. She is also an accomplished athlete, having ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health.