What Can Be Done for ARFID Treatment?

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Anyone who has looked into treatment for avoidant/restrictive food intake disorder (ARFID)—a disorder in which someone avoids food)—may experience frustration due to the lack of clear and defined modalities used to treat this illness.

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?

ARFID

ARFID is an acronym for Avoidant Restrictive Food Intake Disorder. It can present as young as one year old, when children are first eating solid food, and it expresses as a refusal to eat most new foods.

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.

ARFID Is Not About Body Size

ARFID is different than eating disorders like anorexia or bulimia. For people with those disorders, a focus on one's body, and its size, is present. Conversely, ARFID is all about food avoidance, and not a focus on body size.

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 patterns
  • To increase the variety of foods eaten
  • To 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.

It can also be of use for ARFID patients who have issues with food textures, as the fear of those textures can contribute to difficulty swallowing 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
  • Antihistamines
  • Anxiety medications
  • Antipsychotics

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.

An analysis noted that "these cases illustrate that judicious [i.e., sensible] use of low-dose olanzapine, when used as an adjunct to other treatment modalities, may facilitate eating, weight gain, and the reduction of anxious, depressive, and cognitive symptoms in ARFID patients."

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.

Additionally, nutritionists can be employed, and sometimes a feeding tube is a necessary step to move a person into a state where they are getting much-needed nutrients quickly. This can still be done while working on the overall issue with additional modalities such as therapy and medication.

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.

14 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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