ARFID Impacting Sensory

Written By Hannah Grandlund, OTS

What is ARFID?

ARFID is an acronym for Avoidant/Restrictive Food Intake Disorder (Eddy, 2024). It’s an eating disorder that was added to the Diagnostic and Statistical Manual of Mental Disorders also known as DSM-5, in 2013 (Seetharaman & Fields, 2020). ARFID negatively impacts eating or feeding patterns that result in limited nutritional intake due to a lack of interest in eating, being hypersensitive when exposed to foods ( e.g. tastes, texture, or smell), and/or having the fear of choking, vomiting, or having an allergic reaction after intaking food (Eating Disorders Families Australia, 2024a; Eddy, 2024; Seetharaman & Fields, 2020). 0.5-5% of children and adults are diagnosed with ARFID and develops within infancy/early childhood and can continue into adulthood (Eddy, 2024). This type of eating disorder has similar aspects to anorexia nervosa or bulimia nervosa; however, individuals with ARFID are not concerned with body image as it pertains to more sensory challenges (Eating Disorders Families Australia, 2024a). 

DMS-5

To be diagnosed with ARFID the following must occur:

  • Eating or feeding disturbances shown by the continuous failure to meet nutritional needs including:

    • Weight loss

    • Malnutrition

    • Relies on enteral feeding (e.g. feeding tube) or oral supplements for nutrition 

    • Facing challenges with psychosocial functioning 

      (Eddy, 2024)

Comorbidities & Prevalence

Studies have shown that children with psychiatric disorders can increase the risk of developing ARFID. The most common comorbidity found in individuals with ARFID is anxiety disorders which range from 36-72% of the population (Kambanis et. al., 2019). The most common anxiety disorder reported is generalized anxiety disorder (Kambanis et. al., 2019). Mood disorders follow next-in-line ranging from 17-33% (Kambanis et. al.,2019). In addition, the prevalence of ARFID has been shown in children who have neurodevelopmental disorders. Co-occurring rates between individuals with Attention Deficit/Hyperactivity Disorder (ADHD) and ARFID range from 4% to 26% and for individuals with Autism Spectrum Disorder (ASD) and ARFID range from 3% to 13%  (Kambanis et. al.,2019).  

Impacting Daily Activities 

Individuals who are impacted by ARFID often experience limited participation in their daily activities such as self-care habits and routines, leisure participation (specifically when eating or interacting with others), and preparing meals (Lock & Pépin, 2019 p. 160). 

Sensory Difficulties

Sensory challenges presented by ARFID negatively impacts participation in daily activities, habits, routines, and roles. Those with ARFID can experience sensory seeking (hyposensitive) or sensory avoiding (hypersensitive) behaviors that can impact their ability to interact with food in social settings (Eating Disorders Families Australia, 2024b). Below you will find the most common sensory impacts of those with ARFID experience: 

  • Tactile (Touch): Food textures that are slimy, mushy or crunchy can be unbearable.

  • Olfactory (Smell): The smell of food is crucial as it defines the overall taste experience. Strong or unfamiliar odors can cause a trigger of avoiding or increase the feeling of being overwhelmed.

  • Gustatory (Taste): Some individuals are hypersensitive to bitter, spicy, sour which can make it intolerable and only limit to mild or familiar tastes.

  • Interoception (temperature modulation): Some individuals prefer hot or cold food items. Room temperature can also be challenging from some individuals and can impact meal planning/prepping.

Ways to Support ARFID

Parents/Care Takers

  • Encourage your child to try new foods by introducing a small amount along with their safe food and gradually increase the amount of new foods over time.

  • Develop a meal/snack schedule. This can help your child know the outline of their meal times and what food(s) will be made to reduce worry and predictability.

  • Be a role model, you are there to support and promote a positive attitude.

  • Do your best to stay regulated throughout the engagement with food. This may include engaging in brief periods, playing calming music during the interaction, or using low lighting. Positive and encouraging language can support your child vs. inhibit their interactions with food.

    (Be Body Positive, 2024; Dorfzaun, 2024; Carmmarata, 2023) 

Individuals with ARFID

There are different ways to help cope with your eating disorder. Here are some mindfulness activities you can participate in.

  • Mindful breathing:

    • Square breathing or infinity breathing are helpful tools to trace your breathes.

    • Breathing colors: Start by picturing a color in your head. As you breath in, picture the color entering in your body and as you breathe out, picture it slowly leaving your body.

    • Below are handouts of the square/infinity breathing and the color breathing definition of each color. These can be used at any time and in any setting.

      (Ai Pono Hawaii Staff Writer, 2021; Gillis & Moawad,2023)

Self-care writing:

  • 5 Senses: Focus on the environment you are in and identify 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. There is a visual handout below you can use.

  • Positive affirmation notes: Write down your own personalized affirmations that resemble you and your journey. Place them them in visible areas of your home and practice saying them out loud to help increase your self-esteem and confidence. Here are some examples of positive affirmations:

    • I am worthy of love.

    • I have the power to create the life I deserve.

    • I will be kind to myself today.

    • Small progress is still progress.

    • I deserve happiness.

    • I am strong and courageous.

    • I am becoming the best version of myself.

      (Paul, 2024; Sanford Behavioral Health, 2024)

References

Ai Pono Hawaii Staff Writer. (2021). 4 mindfulness exercises for eating disorder recovery. Ai Pono Hawaii Eating Disorder Treatment Center. https://www.aipono.com/blog/4-mindfulness-exercises-for-eating-disorder-recovery

Be Body Positive. (2024). Creating supportive mealtimes for young people with arfid. Be Body Positive. (2024, March 21). https://bebodypositive.org.uk/resource/creating-supportive-mealtimes/

Cammarata, C. M. (Ed.). (2023). Avoidant/restrictive food intake disorder (arfid). KidsHealth. https://kidshealth.org/en/parents/arfid.html

Dorfzaun, S. (2024). Arfid: A bigger problem than picky eating. Columbia Doctors. https://www.columbiadoctors.org/news/arfid-bigger-problem-picky-eating#:~:text=Introduce%20new%20foods%20slowly%3A%20Introducing,the%20new%20food%20over%20time.

Eating Disorders Families of Australia. (2024a). Arfid avoidant restrictive food intake disorder. edfa. https://edfa.org.au/eating-disorders__trashed/arfid-avoidant-restrictive-food-intake-disorder/

Eating Disorders Families Australia (2024b). Sensory issues associated with arfid. edfa. https://edfa.org.au/education/sensory-issues-associated-with-arfid/

Eddy, K. (2024). Avoidant restrictive food intake disorder (arfid). National Eating Disorders Association. https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/#top

Dinker, L. (2023). 11 things we now know about arfid. University of Gothenburg. https://www.gu.se/en/gnc/11-things-we-now-know-about-arfid

Gillis, K., & Moawad, H. (2023). Color breathing for relaxation. Choosing Therapy. https://www.choosingtherapy.com/color-breathing/

Kambanis, P. E., Kuhnle, M. C., Wons, O. B., Jo, J. H., Keshishian, A. C., Hauser, K., Becker, K. R., Franko, D. L., Misra, M., Micali, N., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2019). Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. The International Journal of Eating Disorders, 53(2), 256–265. https://doi.org/10.1002/eat.23191

Lock, L. C. , & Pépin, G. (2019). Anxiety, obsessive-compulsive, and related disorders. In C. Brown, V. C. Hayes & J. P. Muñzo (Eds.), Occupational therapy in mental health: A vision for participation (2nd ed., pp. 154-168). F.A. Davis Company.

Paul, S. (2024). 20 affirmations for eating disorder recovery. Get Support. https://naturalfoodtherapy.co.uk/affirmations-eating-disorder-recovery/

Sanford Behavioral Health. (2024). 8 positive affirmations for eating disorder recovery. Sanford Behavioral Health. https://sanfordbehavioralhealth.com/rehab-blog/8-positive-affirmations-for-eating-disorder-recovery/

Seetharaman, S., & Fields, E. L. (2020). Avoidant and restrictive food intake disorder. Pediatrics in Review, 41(12), 613–622. https://doi.org/10.1542/pir.2019-0133


Hannah Grandlund, OTS
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