Avoidant/Restrictive Food Intake Disorder (ARFID) Treatment at McCallum Place

What is ARFID?

ARFID is an acronym that stands for avoidant/restrictive food intake disorder. ARFID is a type of eating disorder that involves a cycle of avoiding and restricting foods due to three maintaining mechanisms: sensory sensitivity, fear of aversive consequences, and lack of interest in eating. One of the primary differences between ARFID and other eating disorders is that those who have ARFID are not motivated by concerns about body shape, size, or weight.

Why do some picky eaters develop ARFID and some do not?

Individuals can hold sensory sensitivity from birth due to biological reasons, such as a greater concentration of taste buds than others. When paired with personality traits that lead to higher emotional reactivity (e.g., vulnerability to high anxiety), a person can experience a dislike of foods because of a perceived threat to safety rather than as a result of displeasure or taste preference. Some individuals can also experience adverse events, such as choking or vomiting, which adds yet another layer to avoiding certain types of foods. Others may have a general disinterest in foods due to dysregulated hunger and fullness cues or low appetite since birth. These factors can play a role in how picky eating may develop into a serious, life-threatening condition such as ARFID.

For some, these factors may not result in problematic engagement with foods. For example, if the person is able to consistently reengage with the feared foods without the adverse events occurring, or if they build up a tolerance to the emotional discomfort some foods elicit, they are likely to develop adaptive eating patterns over time. However, if the person has developed the habituation of avoidance and/or the restriction of foods to the point where their life, or the lives of their caretakers, has become unmanageable, it is time to seek professional help.

When is it time to seek professional treatment for ARFID?

When you or your loved one has or is developing a deficiency in nutrition due to the avoidance or restriction of foods, it is time to seek treatment. Nutrition deficiency can include the overreliance on supplements such as Boost and Ensure. These deficiencies lead to malnutrition due to a limited variety of foods and/or volume of foods and can eventually cause serious medical and psychological impairments.

For parents and loved ones, watching someone experience the symptoms of ARFID can be challenging and can often feel defeating. The cycles of a loved one’s avoidant behaviors cannot be solved by force or by desperate bribes (e.g., “I’ll buy you a stuffed animal if you eat three pieces of broccoli.”). Although positive and negative reinforcement can be constructive to curb some behaviors, more action is necessary to help someone who has ARFID.

What can treatment for ARFID look like?

At McCallum Place, we understand that the treatments for ARFID at the residential (RTC) and partial hospitalization program (PHP) levels of care are underdeveloped, resulting in an underserved population. Other eating disorders like anorexia nervosa often dominate the populations and treatment approaches in facilities that offer these levels of care. People who have ARFID are frequently discharged from these facilities with incomplete treatments that fail to target their specific needs, or they are discharged early due to ineffective care.

Because of the need for effective ARFID treatment, McCallum Place is developing a pilot program that utilizes the principles of cognitive behavioral therapy for ARFID (CBT-AR) and family-based treatment (FBT) as clinically indicated. These treatments employ manualized systems of titrated exposures that can interrupt the cycle of anticipated negative food-related experiences, avoidance of foods, and the subsequent reinforcement of food restriction. By focusing treatment on a single or multiple maintaining mechanisms for ARFID while simultaneously replenishing nutritional deficiencies within a contained environment, people who have ARFID can be discharged from higher levels of care with medical stability, behavioral regulation, and psychological comprehension of how to continue to challenge their food avoidance.

Who is involved with ARFID treatment?

Although the person who is struggling with ARFID is central to treatment, they are not always the only one involved. For children ages 10-17 and for adults dependent on caregivers for meeting nutritional needs, family involvement is core to treatment. Caregivers are asked to participate in weekly therapy sessions and learn how to offer titrated food exposures at home. Additionally, they are provided with education opportunities outside of session time. The generalizability of treatment relies on the caregivers’ ability to define their roles within the healing process and learn more about their loved one’s ARFID symptoms.

Regardless of family involvement, working with an outpatient (OP) team is critical to transitioning successfully to lower levels of care. The treatment team at McCallum Place can collaborate with a person’s OP team established upon admission as well as work with referral resources to set up OP teams as needed. Resources such as Acadia Healthcare’s free Treatment Placement Specialists (TPS) services as well as internal networks are available throughout the treatment process.

How do I seek ARFID treatment at McCallum Place?

The first step to seeking treatment for ARFID at McCallum Place in St. Louis, Missouri, is to contact our admissions team for a free, confidential pre-admission screening by calling (866) 291-5276. The admissions team helps determine whether you or your loved one has an eating disorder and assesses medical and psychiatric risks. From there, the team works with medical clinicians from our facility to offer recommendations for the level of care you or your loved one needs. You can find out more about this process under the “Admissions” tab on our website. Upon admission to our facility, the treatment team further assesses your needs and customizes your ARFID treatment accordingly.

Author: Eva Sedjo, M.A., LPC, ATR, Art Therapist, McCallum Place

Editor: Callie Bishop, M.D., McCallum Place