ARFID: Picky Eating or an Eating Disorder?
In the latest edition of the DSM-V-TR, the big book of mental health diagnoses that we use in the US, is a relatively new eating disorder diagnosis. Avoidant-Restrictive Food Intake Disorder (ARFID), is an eating disorder that is characterized by a very strict, rigid, and limited interest in very few foods items. In ARFID, someone's variety of eating is so limited, it causes them mental pain.
Here is a very common food selection for someone with ARFID:
- Scrambled eggs with butter
- White bread
- Peanut butter
- Pasta
- Chicken fingers
- Bananas
That's it. No beans, no tomato sauce, no turkey, no burgers, no celery: if it isn't on that list, you aren't eating it. Pretty limited, right?
So how is this not just a case of "picky eating"? When did picky eating become a mental health problem? Aren't we therapists taking this idea a little too far?
Well, frankly, that is an understandable question, and sometimes, therapists can define problems so broadly that anyone could be diagnosable (which is not the right way to do therapy). However, with ARFID, the term "picky eating" is really not enough to describe what is going on.
For someone suffering with ARFID, even the simple things in life become complicated. Imagine going on a job interview, and the interviewer invites you to talk over lunch. To most people, this would sound like a nice way to do an interview. If you have ARFID, however, that interview just became impossible, or at the very least, potentially awkward: how can you share a meal with someone if you can only eat 10% of what's served?
So that's our first big distinguishing factor that separates ARFID from "picky eating": dysfunction or difficulty in regular living. The second big factor is stress.
When someone with ARFID does eat something that is even a little bit off-the-beaten-trail, they feel extremely uncomfortable. What would normally an exciting opportunity to try something new becomes an ordeal or a challenge. Anxious thoughts around disliking the taste or texture of the food, or feeling sick, or confronting the unknown can hijack one's brain.
This is not a normal way to feel when confronted with a change, especially in a situation where there is no threat or danger. Eating is supposed to be a soothing experience: relieving hunger is satisfying and helps us fuel ourselves for whatever comes next. With ARFID, a healthy and interesting part of life becomes needlessly complicated and painful.
To summarize, ARFID is not just picky eating. It is a mental health problem that, while it does share some roots with with overly selective food preferences, is more than just that.
If you, or someone you love, are looking for help with ARFID, give us a call today for a free no-commitment phone consultation. Even if we aren't the right help for you, we can often point you in the right direction.
